High cost of nutritious foods and eating out of home (OH) might be barriers to healthy and sustainable diets. We examined adherence to Dietary Approaches to Stop Hypertension (DASH), EAT–Lancet reference diet (EAT) and Mediterranean diet score (MDS) and the associations with dietary cost and eating OH. We evaluated cross-sectional data from single multiple-pass 24-h diet recalls from 289 young adults (18–24 years) in Tirana, Albania. Dietary cost (in Albanian Lek (ALL)) was estimated by matching food consumption data with retail prices from local fast-food chains, supermarkets, restaurants and food vendors. Poisson regression was fitted to models that included DASH, EAT and MDS as dependent variables to assess associations between healthy sustainable diet indicators and dietary cost and eating OH. Adjusted models were controlled for BMI, sex and total energy intake (kJ) using the residual method. Our findings indicate relatively poor adherence to healthy and sustainable dietary patterns among young men and women in Albania. Furthermore, better adherence to DASH, EAT or MDS was not associated with dietary cost (per 100 ALL; range incidence rate ratios (IRR): 0·97–1·00; all (un-)adjusted P > 0·05). Nonetheless, eating OH was related to lower adherence to DASH (IRR: 0·79; P = 0·003) and MDS (IRR: 0·69; P < 0·001). In conclusion, adherence to health and sustainable dietary patterns was poor and not differentiated by cost, but rather source of foods (i.e. OH or at home). Further research on the potential public and environmental health effects of these findings is warranted in Albania.

The EAT–Lancet Commission promulgated a universal reference diet. Subsequently, researchers constructed an EAT–Lancet diet score (0–14 points), with minimum intake values for various dietary components set at 0 g/d, and reported inverse associations with risks of major health outcomes in a high-income population. We assessed associations between EAT–Lancet diet scores, without or with lower bound values, and the mean probability of micronutrient adequacy (MPA) among nutrition-insecure women of reproductive age (WRA) from low- and middle-income countries (LMIC). We analysed single 24-h diet recall data (n 1950) from studies in rural DRC, Ecuador, Kenya, Sri Lanka and Vietnam. Associations between EAT–Lancet diet scores and MPA were assessed by fitting linear mixed-effects models. Mean EAT–Lancet diet scores were 8·8 (SD 1·3) and 1·9 (SD 1·1) without or with minimum intake values, respectively. Pooled MPA was 0·58 (SD 0·22) and energy intake was 10·5 (SD 4·6) MJ/d. A one-point increase in the EAT–Lancet diet score, without minimum intake values, was associated with a 2·6 (SD 0·7) percentage points decrease in MPA (P < 0·001). In contrast, the EAT–Lancet diet score, with minimum intake values, was associated with a 2·4 (SD 1·3) percentage points increase in MPA (P = 0·07). Further analysis indicated positive associations between EAT–Lancet diet scores and MPA adjusted for energy intake (P < 0·05). Our findings indicate that the EAT–Lancet diet score requires minimum intake values for nutrient-dense dietary components to avoid positively scoring non-consumption of food groups and subsequently predicting lower MPA of diets, when applied to rural WRA in LMIC.