Healthy Eating Index Component Research Articles

A Population’s Mean Healthy Eating Index-2005 Scores Are Best Estimated by the Score of the Population Ratio when One 24-Hour Recall Is Available1,

The USDA Healthy Eating Index-2005 (HEI-2005) is a tool to quantify and evaluate the quality of diet consumed by the U.S. population. It comprises 12 components, expressed as ratios of a food group or nutrient to energy intake. The components are scored on a scale from 0 to M, where M is 5, 10, or 20. Ideally, the HEI-2005 is calculated on the basis of the usual dietary intake of an individual. Intake data, collected via a 24-h recall, are often available for only 1 d for each individual. In this article, we examine how best to estimate a population’s mean usual HEI-2005 component and total scores when 1 d of dietary information is available for a sample of individuals from the population. Three methods are considered: the mean of individual scores, the score of the mean of individual ratios, and the score of the ratio of total food group or nutrient intake to total energy intake, which we call the population ratio. We investigate via computer simulation which method is the least biased. The simulations are based on statistical modeling of the distributions of intakes reported by 738 women participating in the Eating at America’s Table Study. The results show that overall, the score of the population ratio is the preferred method. We therefore recommend that the quality of the U.S. population’s diet be assessed and monitored using this method.

Diet quality among a community sample of Latinas reporting drug and alcohol use; The Latino Women’s Study

Background: Substance use is known to negatively impact health through direct toxicity of drugs on metabolism, substance using lifestyle and poor dietary intake. Hispanic women (Latinas) have not been the focus of substance use research because their rates of use tend to be lower compared to Latinos. Yet, Latinas enter substance use treatment with more severe medical conditions than their male counterparts. Objective: To determine whether diet quality of Latinas who use substances is different from those who do not. Method: 320 Latinas were recruited from Miami, FL. After signed informed consent, a 24 hour dietary recall, the Drug Use Frequency Questionnaire and the Health and Daily Living Form were administered. We calculated the Healthy Eating Index (HEI), a measure of diet quality based on conformance to Federal dietary guidelines. Substance users (n=153) were defined as those reporting illicit drug use, non-prescribed use of sedatives, and/or >5 alcoholic beverages on one occasion at least once a month in the past year. Results: ANOVA indicated substance using Latinas had lower mean HEI scores than non using (n=167) (60.4±12 vs. 64.5±12 p=.002). Similarly, substance users had lower HEI component scores with respect to fruit consumption (5.0±4 vs. 3.2±3.7 p<.05) and variety of diet (8.9±2.3 vs. 8.2±2.8 p=.03). Conclusions: Diet quality among substance using Latinas is compromised and needs improvement. This group should receive nutrition counseling to meet dietary guidelines. Funded by NIDA grant #1F31 DA020205-01A1

Dietary Quality and Associated Factors among Adults Living in the State of São Paulo, Brazil

This study sought to analyze dietary quality and associated factors among adults living in regions of the State of São Paulo, Brazil. It was a cross-sectional population-based study of a sample of 3,454 adults ages 20 years and over who were included in the Household Health Survey. Dietary intake was measured by means of the 24-hour recall method, and dietary quality was assessed by means of the Healthy Eating Index (HEI), adapted to local realities. Probabilistic samples were obtained via multistage cluster samples from four regions in the State of São Paulo. Linear regression analyses were performed to evaluate the relationships between the HEI and the demographic, socioeconomic, and lifestyle variables. Among the individuals assessed, 5% had a good diet, 74% a diet that needed some degree of improvement, and 21% a poor diet. The means for HEI components were lowest for vegetables, fruits, and dairy products. The highest HEI scores were obtained by individuals who were nonsmokers, practiced physical activity, were retired, lived in houses or apartments, and had adequate living conditions surrounding them. In the multiple regression analysis, the variables of numbers of consumer durable goods, schooling of the head of the family, energy intake, and age had a positive association with the HEI. However, the association was inverse for the variables of smoking and body mass index. Higher dietary quality is associated with higher income, higher schooling level, better nutritional status, and being a nonsmoker. Knowledge of these factors is important for implementing programs for preventive nutrition or intervention.

The Relationship between Self-Rated Health Status and the Overall Quality of Dietary Intake of US Adolescents

The objective of this study was to compare the quality of overall dietary intake of US adolescents by self-rated health status. Using 2 nonconsecutive days of dietary recall data and responses to a single question describing self-rated health status from the Continuing Survey of Food Intakes by Individuals 1994-1996, linear regression analysis was used to detect differences in Healthy Eating Index (HEI) scores by self-rated health status for 1,504 adolescents, ages 11 to 18 years. After adjusting for factors related to both overall dietary quality and self-rated health status, overall HEI scores did not differ by self-reported health status. However, two individual HEI component scores were found to be significantly related to adolescent self-rated health status: the vegetables score ( P=0.01) was higher among those with positive self-rated health status, and the total fat score ( P=0.01) was higher among those with negative self-rated health status. Self-perception of health status is not related to the overall quality of the adolescent diet; therefore, food and nutrition professionals should focus on understanding motivators other than health status when exploring adolescent dietary behaviors.

Dietary Patterns of Young, Low-Income US Children

Objective The purpose of this study was to identify dietary patterns of young, low-income US children, describe differences in diet quality between identified patterns, and make targeted food recommendations to improve diet quality. Design Dietary patterns were assessed using dietary variables from the Pyramid Servings Database within the Continuing Survey of Food Intakes by Individuals 1994-1996, 1998. Healthy Eating Index (HEI) scores were used to validate identified dietary patterns. Subjects/Setting Two subsamples of low-income children, aged 2 to 3 years (n=1,242) and 4 to 8 years (n=1,506), were selected from the Continuing Survey of Food Intakes by Individuals data. Statistical Analysis Cluster analysis was performed to determine unique dietary patterns within the two subsamples. Linear regression analyses were used to compare energy intake, discretionary fat, added sugars, and HEI scores across cluster groups. Descriptive statistics were computed for each cluster. Results Cluster analysis identified six and seven distinct dietary patterns for the younger and older children, respectively. Four patterns were similar for both age groups. For the 2- to 3-year-old children, energy intake, overall HEI scores, and nine of the 10 HEI component scores differed among the four most prevalent dietary patterns. Among the older children, energy intake and six of the HEI component scores differed between the four most prevalent clusters but not overall HEI. Conclusions Neither age group had a cluster of children who followed a balanced/moderate diet pattern consistent with Food Guide Pyramid recommendations. Children consuming almost every pattern identified could benefit by reducing added sugars and discretionary fat and increasing low-fat, low-sugar options from the vegetables, fruits, meat, and milk groups.

Modifying the healthy eating index to assess diet quality in children and adolescents

Objective The Healthy Eating Index (HEI) is a scoring system used by the US government to assess adherence to the Dietary Guidelines for Americans. We examined the ability of the HEI to monitor diet quality among youth. Design We modified and simplified the HEI for use by older children and adolescents. The new Youth Healthy Eating Index (YHEI) focuses on food quality and assesses both healthful and unhealthful foods and eating behaviors. Both HEI and YHEI scores were calculated from a food frequency questionnaire that was mailed to participants in the Growing Up Today Study in 1996. Subjects/setting Girls (n=8,807) and boys (n=7,645) 9 to 14 years of age who are children of participants in the Nurses Health Study II cohort and who reside across the United States. Statistical analysis Mean HEI and YHEI scores were calculated by sex and age, and associations with age, body mass index, activity, inactivity, energy intake, and several nutrients were assessed with Pearson correlations. Linear regression was used to examine the contributions of the individual HEI and YHEI components toward the total scores. Results The HEI score was highly correlated with total energy intake ( r=0.67), indicating a strong association with quantity of food consumption. In contrast, the YHEI was not strongly correlated with energy intake ( r=0.12) but was inversely associated with time spent in inactive pursuits ( r=–0.27). The HEI component for variety in food selection accounted for 60% of the variation in the total score and several HEI components were highly correlated with each other, particularly those for total and saturated fat ( r=0.78). Conclusions To successfully monitor diet in a population of children and adolescents, the HEI may benefit from modifications that focus on food quality and include assessments of unhealthful foods. Further research is needed to determine the dietary elements that are most related to health in diverse populations of youth.