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  1. Huang, Yue MS
  2. Houser, Robert F. PhD
  3. Roberts, Susan B. PhD
  4. Lichtenstein, Alice H. DSc


One barrier to achieving healthier eating patterns is the perceived higher cost of healthier food. The objective of this cross-sectional study was to investigate the potential association between cost and the nutrition quality among entrees from casual dining restaurants.


Nutrition and price information were collected from 11 restaurants in Boston metropolitan area. A nutrition quality metric (Estimated Nutrition Score [ENS]) was developed based on the 2015-2020 Dietary Guidelines for Americans to allow comparisons between more healthy and less healthy entrees. Associations between entree price and ENS were assessed as continuous variables and dichotomized based on median ENS, availability of "small," "half," and "light" options, and with or without calories as a component of the score.


Of the 11 restaurant chains meeting the inclusion criteria, the association between ENS and price was significant for 6. Of those 6, more healthy options were less expensive at 4 restaurants, and more healthy options were more expensive at 2 restaurants. Eliminating small, half, and light options from the analyses resulted in a null association for 1 restaurant in the former category. Eliminating calories from the score resulted in loss of a significant association between price and ENS for all 6 restaurants, whereas for 2 additional restaurants, significant negative relationships were detected.


There was no consistent association between ENS and entree price in the sample assessed. Hence, within the category of restaurants evaluated, customers can often choose healthier entrees that are priced less than or equal to less healthy entrees.