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.

This paper aims to give an overview of out-of-home care in India. It looks at the history and culture of extra-familial care in the country, the urgent need for organised out-of-home care, and tries to understand the role of the state, including legislation and policies. The belief that individual families should solve their children's problems is deeply ingrained. There are different support systems that cater to the children's needs and right to healthy living in home and with family. While the government and community choose and decide for the children of the country, the government drags its feet in drafting policies which recognise that large number of children are growing up without families. More research is needed to look at the need and quality parameters for out-of-home care. Action from both government and non-government organisations (NGOs) will require a large number of institutions that, in turn, will require sufficient budgets and trained staff to ensure an environment of protection, support and appropriate development for an estimated 20 million children in need of good quality out-of-home care in India.