Tradeoffs Between Convenience, Cost, and Healthy Eating Index for Diets Aligned to the Dietary Guidelines for Americans but Varying in Ultra-Processed Foods

Background: Ultra-processed foods (UPFs) comprise 65% of US household food purchases and are considered more convenient and economical than many minimally foods. Despite evidence linking UPF consumption with adverse health outcomes, the Dietary Guidelines for Americans (DGAs) have not addressed UPFs. While previous theoretical work demonstrated a menu containing >80% of energy from UPFs could be designed to align with the DGAs, direct comparisons with alternative menus having similar ingredients are essential to understanding real-world tradeoffs.Objective: To examine the convenience, cost, diet quality, and shelf-stability in theoretical diets aligned with DGAs but varying in UPF content.Methods: We created three 7-day, 2000-kcal menus using similar ingredients but varying in convenience and UPFs as classified by the Nova system by four PhD-level dietitians: UPF (91% energy from UPFs), minimally processed alternatives (MPF) (19% UPFs), and convenience-focused (CONV) menus (96% UPFs). The menus were analyzed according to their Healthy Eating Index (HEI)-2015, cost, shelf stability, and a novel meal inconvenience score. A weekly shopping simulation model estimated annual costs and waste for 4-person households.Results: The MPF menu achieved the highest HEI score (91/100) compared to UPF (86/100) and CONV (74/100). Annual costs were highest for MPF ($22,571), followed by UPF ($20,163) and CONV ($20,130), with food waste representing 17%, 16%, and 6% of expenditures, respectively. Inconvenience scores differed between UPF and CONV (p=0.006), and between MPF and CONV (p<0.001), but not between UPF and MPF (p=0.148). Shelf stability analysis showed the CONV menu offered the longest shelf life. Conclusions: While healthy eating patterns can be achieved with varying levels of UPFs, significant trade-offs exist between convenience, cost, diet quality, and shelf stability. Future work should consider these practical constraints when investigating healthy eating patterns.