Adherence to the combined Mediterranean-dietary approaches to stop hypertension diet is shaped by neighborhood socio-economics and food environments

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INTRODUCTION: Over the years, different diets have been recommended often with little consideration to how feasible they may be to follow given a person's circumstances and surroundings (e.g., the food environment). Therefore, we sought to determine how difficult it would be for people to maintain the Mediterranean and Dietary Approaches to Stop Hypertension (MED-DASH) versus default to the Typical American diet (TAD) in three different income-level neighborhoods in Los Angeles, California. METHODS: We developed geospatially explicit ABMs of three neighborhoods in Los Angeles that had varied socioeconomics and food environments with varying income levels - one lower-income (Boyle Heights), one middle-income (Inglewood), and one higher-income (Santa Monica). We tested how well the virtual residents (represented by computational agents) could adhere to the MED-DASH compared to defaulting to TAD. To summarize outcomes of average dietary adherence levels among agents within each neighborhood, we used means and 95 % confidence intervals (CIs) for each diet scenario. RESULTS: Adherence to the MED-DASH diet was on average only 57.43 % (95 % CI: 55.67 %-59.19 %) in the lower-income neighborhood, 62.39 % (95 % CI: 60.59-64.19 %) in the middle-income neighborhood, and 68.02 % (95 % CI: 66.21-69.82 %) in the higher-income neighborhood. Decreasing by 50 % the average price of foods that comprise the MED-DASH diet increased adherence by 17.24 %, 10.36 %, and 1.88 % in the neighborhoods, respectively. CONCLUSIONS: Dietary recommendations, especially precision nutrition approaches, should take into consideration the surrounding food environment and ways to make suggested diets more feasible.

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