Healthy Eating Index-2015 Scores Vary by Types of Food Outlets in the United States

Diet quality in the United States is improving over time but remains poor. Food outlets influence diet quality and represent the environments in which individuals make choices about food purchases and intake. The objective of this study was to use the Healthy Eating Index-2015 (HEI-2015) to evaluate the quality of foods consumed from the four major outlets where food is obtained—stores, full-service restaurants, quick-services restaurants, and schools—and to assess changes over time. This cross-sectional study used 24 h dietary recall data from eight cycles (2003–2004 to 2017–2018) of the National Health and Nutrition Examination Survey (NHANES). Linear trend estimation was used to test for changes in HEI scores over time, and balanced repeated replicate weighted linear regression was used to test for differences in total and component scores between types of food outlets. Overall, Americans are not consuming a mix of foods from any major category of food outlet that aligns with dietary guidelines. The total score for schools (65/100 points) and stores (62/100 points) was significantly higher than full-service (51/100 points) and quick-service (39/100 points) restaurants (p < 0.0001). HEI scores significantly improved over time for schools (p < 0.001), including an increase in whole grains from less than 1 point in 2003–2004 to 7 out of 10 points in 2017–2018. In 2017–2018, schools received the maximum score for total fruits, whole fruits, and dairy. Continued research on strategies for improving the quality of foods consumed from restaurants and stores is warranted.

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Is The Healthy Eating Index-2015 Associated With Rheumatoid Arthritis?

10.21203/rs.3.rs-1061469/v1 ◽

2021 ◽

Author(s):

Atiyeh Nayebi ◽

Davood Soleimani ◽

Shayan Mostafaei ◽

Negin Elahi ◽

Homayoun Elahi ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Healthy Eating ◽

Diet Quality ◽

Linear Trend ◽

Cross Sectional Study ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

P Value ◽

Cross Sectional

Abstract Objective: Healthy Eating Index-2015 (HEI-2015) is a multidimensional criterion of diet quality utilized to evaluate how well people’s dietary behaviors align with major recommendations of the 2015–2020 Dietary Guidelines for Americans. We aim to investigate the association between the diet quality and Rheumatoid arthritis (RA) activity.Design: Cross-sectional studySetting: This study was done on 184 patients with RA in rheumatology clinic in Kermanshah city, Iran, in 2020. RA was diagnosed according to the criteria of the 2010 American College of Rheumatology/ European League against Rheumatism. The overall quality diet was extracted from a validated 168-item food frequency questioner (FFQ) to calculate the HEI-2015 score. RA disease activity was assessed using Disease Activity Score 28 (DAS28) scores. One-way ANOVA and ANCOVA were done to find the associations.Participants: RA patientsResults: Individuals in the highest HEI-2015 quartile had a lower mean Erythrocyte Sedimentation Rate (ESR) than those in the lowest quartiles of the HEI scores (P-value: 0.014). A linear trend towards decreasing waist circumference in patients was observed with increasing quartiles of the HEI-2015 scores (P-value= 0.005). After controlling for all potential confounders, patients in the highest HEI-2015 quartile had the lowest DAS28 scores than those in the lowest quartile of the HEI-2015 scores (Q1= 3.65; 95% CI= 3.29 – 4.02 vs. Q4= 2.35; 95% CI= 1.94 - 2.67; P-value<0.001).Conclusion: Our results indicated that following a high diet quality might be one of the therapeutic strategies to control or reduce the disease activity in RA patients.

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Differences in Diet Quality between School Lunch Participants and Nonparticipants in the United States by Income and Race

Nutrients ◽

10.3390/nu12123891 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3891

Author(s):

Elizabeth C. Gearan ◽

Kelley Monzella ◽

Leah Jennings ◽

Mary Kay Fox

Keyword(s):

United States ◽

Diet Quality ◽

School Lunch ◽

The United States ◽

School Nutrition ◽

Healthy Eating Index ◽

Lower Income ◽

Cost Study ◽

Hispanic White

Prior research has shown that participation in the United States’ National School Lunch Program (NSLP) is associated with consuming higher-quality lunches and diets overall, but little is known about differences by income and race/ethnicity. This analysis used 24 h dietary recall data from the School Nutrition and Meal Cost Study to examine how NSLP participation affects the diet quality of students in different income and racial/ethnic subgroups. Diet quality at lunch and over 24 h was assessed using the Healthy Eating Index (HEI)-2010, where higher scores indicate higher-quality intakes. HEI-2010 scores for NSLP participants and nonparticipants in each subgroup were estimated, and two-tailed t-tests were conducted to determine whether participant–nonparticipant differences in scores within each subgroup were statistically significant. NSLP participants’ lunches received significantly higher total HEI-2010 scores than those of nonparticipants for lower-income, higher-income, non-Hispanic White, and non-Hispanic Black students, suggesting that participating in the NSLP helps most students consume healthier lunches. These significantly higher total scores for participants’ lunch intakes persisted over 24 h for higher-income students and non-Hispanic White students but not for lower-income students or students of other races/ethnicities. For NSLP participants in all subgroups, the nutritional quality of their 24 h intakes was much lower than at lunch, suggesting that the positive influence of the NSLP on their overall diet quality was negatively influenced by foods consumed the rest of the day (outside of lunch).

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Awareness and Use of Nutrition Information Predict Measured and Self-Rated Diet Quality of Older Adults in the United States (P18-046-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz039.p18-046-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Anna Vaudin ◽

Edwina Wambogo ◽

Alanna Moshfegh ◽

Nadine Sahyoun

Keyword(s):

United States ◽

Older Adults ◽

Socioeconomic Status ◽

Older Adult ◽

Diet Quality ◽

The United States ◽

Healthy Eating Index ◽

Nutrition Information ◽

Ratio Method

Abstract Objectives This study aimed to investigate: 1) the diet quality of older adults, using the Healthy Eating Index 2015 (HEI-2015) and self-rated diet quality, 2) characteristics associated with reported awareness and use of nutrition information, 3) factors associated with HEI-2015 score and self-rated diet quality, including the relationship with awareness and use of nutrition information. Methods A cross-sectional analysis of 24-hour recall and questionnaire data from the National Health and Nutrition Examination Survey 2009–2014, including 4493 subjects, aged 60 years and older. The population ratio method was used in SAS 9.4 to calculate mean HEI scores. Data was stratified by gender, then t-tests and ANOVA were used to compare means and chi-squares were used to compare proportions. Logistic and linear regression were used to test for associations with diet quality, controlling for potential covariates. Results The mean total HEI score for men was significantly lower than for women (63.7 ± 0.8 vs. 66.6 ± 0.8 respectively, P < 0.0001). Compared to men, more women reported nutrition awareness (53.7% vs. 41.1%, P < 0.0001), and use of nutrition information (19.3% vs. 9.2%, P < 0.0001). Nutrition awareness was also associated with race, age, education, socioeconomic status, and food security. In bivariate analyses, nutrition awareness and use of nutrition information were significantly associated with both HEI score and self-rated diet quality in both men and women. In multivariate analyses, nutrition awareness remained a significant predictor of HEI for women but not men, and remained a significant predictor of self-reported diet quality in men but not women. Conclusions Nutrition awareness and use of nutrition information are significantly related to diet quality in older adults, even when controlling for other factors. There are differences in these relationships for older adult men versus women. Gaps in awareness, indicating need for nutrition education, exist in men, non-whites, those participating in nutrition assistance programs, and those with lower education and socioeconomic status. Closing these gaps may lead to improved diet quality in segments of the older adult population. Funding Sources Agricultural Research Service, United States Department of Agriculture.

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Healthy Eating Index Protocol: Review, Update, and Development Process to Reflect Dietary Guidance Across the Lifespan

Current Developments in Nutrition ◽

10.1093/cdn/nzab038_059 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 447-447

Author(s):

Jill Reedy ◽

TusaRebecca Pannucci ◽

Kirsten Herrick ◽

Jennifer Lerman ◽

Marissa Shams-White ◽

...

Keyword(s):

Healthy Eating ◽

Diet Quality ◽

Dietary Patterns ◽

Development Process ◽

Life Stage ◽

The United States ◽

Nutrition Policy ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

Infants And Toddlers

Abstract Objectives The Healthy Eating Index (HEI) is a measure of diet quality, independent of quantity, that can be used to assess alignment with the Dietary Guidelines for Americans (DGAs), which are the basis of nutrition policy for the United States (US) government and the foundation of all federal nutrition guidance. The recently released 2020–2025 DGAs include recommendations for infants and toddlers for the first time, and necessitate a review, update, and development process of the HEI to reflect healthy eating across the lifespan. Methods Since 2005, researchers at the HHS National Cancer Institute (NCI) and the USDA Center for Nutrition Policy and Promotion have collaborated to revise the HEI based on updates to the DGAs, and the HEI-2015 is the most recent iteration. The process includes: 1) gathering information from dietary guidelines, experts, and federal stakeholders; 2) considering substantive changes and needs for new development; and 3) completing validation analyses. Results Updates to the HEI have aimed to maintain stability, reflecting the consistency of recommendations over time. A guiding principle is to only make changes to the HEI that have a strong rationale. With no significant changes in the USDA Dietary Patterns, few changes are anticipated for the HEI for 2 years and older; instead, the emphasis for the update process is focusing on considerations for an index for infants and toddlers under 2 years. Additionally, the Scientific Report of the 2020 Dietary Guidelines Advisory Committee identified the development of a scoring system (such as the HEI) for infants and toddlers as a research recommendation, because comparisons of diet quality using the HEI have thus far only been possible for Americans 2 years and older. The HEI review, update, and development process aims to consider analyses with distributions of HEI scores across the lifespan with nationally representative data and diverse cohorts. Conclusions The HEI is a valuable tool for research that can be used in nutrition interventions, epidemiology, and consumer nutrition education programs. The timely release of a new HEI will enable application across the lifespan and support additional methodological research to examine needs specific to each life stage and how to model optimal trajectories of healthy dietary patterns. Funding Sources None.

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Association between Ready-to-Eat Cereal Consumption and Nutrient Intake, Nutritional Adequacy, and Diet Quality in Adults in the National Health and Nutrition Examination Survey 2015–2016

Nutrients ◽

10.3390/nu11122952 ◽

2019 ◽

Vol 11 (12) ◽

pp. 2952

Author(s):

Yong Zhu ◽

Neha Jain ◽

Vipra Vanage ◽

Norton Holschuh ◽

Anne Hermetet Agler ◽

...

Keyword(s):

United States ◽

Dietary Intake ◽

National Health ◽

Diet Quality ◽

The United States ◽

Healthy Eating Index ◽

Nutrition Examination Survey ◽

Food Groups ◽

Dietary Recall ◽

Health And Nutrition

This study examined differences in dietary intake between ready-to-eat cereal eaters and non-eaters in adults from the United States. Participants (n = 5163) from the National Health and Nutrition Examination Survey 2015–2016 were included. One-day dietary recall was used to define ready-to-eat cereal consumption status and estimate dietary intake in eaters and non-eaters. Data from Food Patterns Equivalent Database 2015–2016 were used to compare intakes of food groups by consumption status. Diet quality was assessed by Healthy Eating Index 2015. Nineteen percent of US adults were ready-to-eat cereal eaters; they had a similar level of energy intake as non-eaters, but they had significantly higher intake of dietary fiber, and several vitamins and minerals, such as calcium, iron, magnesium, potassium, zinc, vitamin A, thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, and vitamin D. They were also more likely to meet nutrient recommendations. Compared to non-eaters, ready-to-eat cereal eaters had the same level of added sugar intake but they had significantly higher intake of whole grains, total fruits, and dairy products. The diet quality of ready-to-eat cereal eaters was significantly higher than that of non-eaters. The study supports that ready-to-eat cereal eaters have better dietary intake with a healthier dietary pattern than non-eaters in the United States.

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Diet Quality of Preschoolers in Greece Based on the Healthy Eating Index: The GENESIS Study

Journal of the American Dietetic Association ◽

10.1016/j.jada.2008.12.011 ◽

2009 ◽

Vol 109 (4) ◽

pp. 616-623 ◽

Cited By ~ 50

Author(s):

Yannis Manios ◽

Georgia Kourlaba ◽

Katerina Kondaki ◽

Evangelia Grammatikaki ◽

Manolis Birbilis ◽

...

Keyword(s):

Healthy Eating ◽

Diet Quality ◽

Healthy Eating Index

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Dietary intake and diet quality by weight category among a racially diverse sample of women in Birmingham, Alabama, USA

Journal of Nutritional Science ◽

10.1017/jns.2020.51 ◽

2020 ◽

Vol 9 ◽

Author(s):

Rebecca B. Little ◽

Renee Desmond ◽

Tiffany L. Carson

Keyword(s):

Diet Quality ◽

Weight Status ◽

Vegetable Intake ◽

The United States ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

Rank Test ◽

Deep South ◽

Weight Category ◽

Maximum Score

Abstract Diet is a modifiable contributor to health. The lack of adherence to recommended dietary guidelines may contribute to the disproportionate burden of obesity and other chronic conditions observed in the Deep South region of the United States. The objective of this cross-sectional study was to describe food group intake and diet quality by race and weight status of women in the Deep South. Study participants were eighty-nine healthy female volunteers (56 % black, 44 % white, mean age 39⋅7 ± 1⋅4 years) recruited from Birmingham, AL, USA. Body Mass Index (BMI) determined weight status (non-obese/obese). Healthy Eating Index-2010 (HEI-2010) calculated from dietary recalls assessed diet quality. Wilcoxon sum-rank test compared HEI-2010 scores by race and weight status. χ2 analysis compared the percentage of women who achieved maximum points for HEI-2010 index food components by subgroup. Caloric and macronutrient intake did not differ by race or weight status (mean kcal 1863⋅0 ± 62⋅0). Median Total HEI-2010 Score for the sample was 51⋅9 (IQR: 39⋅1–63⋅4). Although there was no statistical difference in diet quality by race, more whites achieved the maximum score for vegetable intake compared to blacks, while blacks reported higher total fruit intake. Non-obese women reported better diet quality (56⋅9 v. 46⋅1; P = 0⋅04) and eating more whole fruits, and more achieved the maximum score for protein from plant and seafood sources. In summary, differences in diet quality were observed by weight status, but not race among this sample. These results point to tailored dietary interventions for women in metropolitan areas of Alabama, USA.

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Nutritional intake and overall diet quality of female soccer players before the competition period

Revista de Nutrição ◽

10.1590/1678-98652016000400010 ◽

2016 ◽

Vol 29 (4) ◽

pp. 555-565 ◽

Cited By ~ 2

Author(s):

Daniel dos SANTOS ◽

Jacqueline Queiroz da SILVEIRA ◽

Thais Borges CESAR

Keyword(s):

Nutritional Status ◽

Dietary Intake ◽

Healthy Eating ◽

Diet Quality ◽

Protein Quality ◽

Healthy Eating Index ◽

Soccer Players ◽

Cross Sectional ◽

Professional Soccer

ABSTRACT Objective: To assess the dietary intake and overall diet quality of female soccer players before the competitive games. Methods: This descriptive and cross-sectional study included 21 women aged 20.8±4.5 years from a professional soccer team. Their nutritional status and dietary adequacy during the training period, before competition season, were assessed. Dietary intake was assessed by three 24-hour recalls, one food frequency questionnaire, and the Healthy Eating Index, an overall diet quality index based on food group intake. Results: The athletes have shown proper nutritional status, but a diet deficient in energy due largely to low carbohydrate intake. On the other hand, the intakes of protein, fatty acids, and sodium were above the recommended intakes, even for athletes. Diet quality assessment by the Healthy Eating Index - 2010 resulted in a mean score of 54.6 points of a maximum of 100, indicating a need of improving the overall diet quality. Conclusion: The study found that the dietary patterns of female football players were both quantitatively and qualitatively inappropriate. A nutritional intervention is indicated to improve diet quality, with the inclusion of various foods, such as whole grains, fruits, vegetables, dairy products, and better protein quality, along with a reduction in saturated fats, sodium, and added sugar.

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Role of alternate healthy eating index (AHEI) in communicating the quality of diet

FOOD SCIENCE RESEARCH JOURNAL ◽

10.15740/has/fsrj/11.2/96-102 ◽

2020 ◽

Vol 11 (2) ◽

pp. 96-102

Author(s):

Krishna Mohandas ◽

L. Prema

Keyword(s):

Healthy Eating ◽

Diet Quality ◽

Dietary Habits ◽

Mean Value ◽

Healthy Eating Index ◽

Overweight And Obesity ◽

Food Groups ◽

Good Tool ◽

The Difference

The food habits of global population has been evolving in such a way that makes unhealthy foods cheaper and widely available and healthy foods costly and less available. Being surrounded by such foods and living in an environment with lesser requirement for physical activity is the primary reason for the pandemic explosion in overweight and obesity. This study is an attempt to analyze the quality of diet with an aim to study the significance of Alternate Healthy Eating Index (AHEI) in predicting the quality of dietary intake. Methodology: The study was conducted in 66 respondents (44 females and 22 males) aged 18-65 years with BMI between 23 kg/m2 to 50 kg/m2. The respondent’s data were collected using a pretested standard questionnaire. The nutrient consumption was calculated from the 24 hour recall and the AHEI scores were derived from recall and food use frequency data. The data were analysed using SAS software. Results: The intake of Energy, protein, fat and carbohydrates were more than their requirement while intake of fibre was not meeting the requirement. The AHEI scores obtained ranged from 36 to 76 with a mean value of 55.6 ± 9.54. A positive linear association for AHEI with BMI (0.0362) and energy intake (0.13) was established through Pearson’s correlation while the association was negative with BMR (-0.14). Paired t test comparing AHEI against the difference between intake and requirement of macronutrients revealed that when the diet quality was good (as indicated by AHEI>51), the difference in intake exhibited a significant linear relationship with p values <0.001 while no relation was established when the diet quality was poor. Conclusion: AHEI encompasses all nutrients and food groups relevant to metabolic health and it can be used as a good tool to assess the quality of dietary habits of overweight and obese subjects.

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