Cost Associated with Adherence to the EAT-Lancet Score in Brazil

Food prices are a crucial factor in food choices, especially for more vulnerable populations. To estimate the association between diet cost and quality, as measured by the EAT-Lancet score, across demographic groups in Brazil.

Data from the 2017/18 Household Budget Survey were used to calculate the EAT-Lancet score, comprising 14 components. Scores ranged from 0 (low adherence) to 42 (high adherence), with emphasized components (e.g., vegetables, fruits, legumes) and limited components (e.g., red meat, sugar, eggs). Results were stratified by per capita income, geographic region, and area of residence and compared using linear regression adjusted for high and low costs. In addition, the association between the EAT-Lancet score (and its emphasized and limited components) and diet cost (continuous) was analyzed for the total population and for income tertiles.

The mean EAT-Lancet score was 18.65 points (range: 7 to 25) and the mean diet cost was BRL$0.65/100 kcal. Total scores showed no significant difference between low- and high-cost diets. However, limited intake was more pronounced in low-cost diets, while high-cost diets featured emphasized foods such as fruits, vegetables, and seafood. High-cost diets also included sugars and red meat, while unsaturated fats scored higher in low-cost diets. Each one-point increase in the EAT-Lancet score was associated with a BRL$0.38 reduction in cost, driven by lower costs in the Limited component, especially among the lowest-income strata (reductions of BRL$1.58 and BRL$1.55 in the lowest income and middle income tertiles, respectively). However, higher scores for emphasized foods increased costs (BRL$0.89) in the lowest tertile.

Higher EAT-Lancet scores were associated with reduced diet costs, likely influenced by the lower Limited component costs in low-income groups. Emphasized foods, however, tended to increase costs, particularly among the lowest-income group. These findings suggest that the role of diet composition plays a significant role in cost differences and underscore the challenges that low-income groups face in accessing affordable, healthy diets.