Evaluation of the Healthy Eating Index-2005



      The Healthy Eating Index (HEI), a measure of diet quality as specified by federal dietary guidance, was revised to conform to the Dietary Guidelines for Americans 2005. The HEI has several components, the scores of which are totaled.


      The validity and reliability of the HEI-2005 were evaluated.


      Validity was assessed by answering four questions: Does the HEI-2005 1) give maximum scores to menus developed by experts; 2) distinguish between groups with known differences in diet quality—smokers and nonsmokers; 3) measure diet quality independently of energy intake, a proxy for diet quantity; and 4) have more than one underlying dimension? The relevant type of reliability, internal consistency, was also assessed.


      Twenty-four−hour recalls from 8,650 participants, aged 2 years and older, in the National Health and Nutrition Examination Survey, 2001-2002 were analyzed to answer questions 2 to 4. Results were weighted to consider sample design and nonresponse.

      Statistical analyses

      T tests determined differences in scores between smokers and nonsmokers. Pearson correlation coefficients determined the relationship between energy intake and scores. Principal components analysis determined the number of factors that comprise the HEI-2005. Cronbach's coefficient α tested internal consistency.


      HEI-2005 scores are at or very near the maximum levels for all sets of exemplary menus with one exception; the Harvard menus scored low on the milk component because these menus intentionally include only small amounts of milk products. Nine of 12 component scores were lower for smokers than nonsmokers. The correlations of component scores were virtually independent of energy intake (< ∣.22∣). Multiple factors underlie the HEI-2005. Coefficient α was .43. The α value for all tests was .01.


      The HEI-2005 is a valid measure of diet quality. Potential uses include population monitoring, evaluation of interventions, and research. The individual component scores provide essential information in addition to that provided by the total score.
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        • US Health and Human Services and US Department of Agriculture
        Dietary Guidelines for Americans 2005.
        6th ed. US Government Printing Office, Washington, DC2005
        • Kennedy E.T.
        • Ohls J.
        • Carlson S.
        • Fleming K.
        The Healthy Eating Index: Design and applications.
        J Am Diet Assoc. 1995; 95: 1103-1108
        • US Department of Agriculture, Center for Nutrition Policy and Promotion
        The Healthy Eating Index. Center for Nutrition Policy and Promotion Web site. CNPP-1.
        (Accessed January 28, 2008.)
        • Bowman S.A.
        • Lino M.
        • Gerrior S.A.
        • Basiotis P.P.
        The Healthy Eating Index: 1994-96. US Department of Agriculture, Center for Nutrition Policy and Promotion. CNPP-5; 1998. Center for Nutrition Policy and Promotion Web site.
        (Accessed January 28, 2008.)
        • Basiotis P.P.
        • Carlson A.
        • Gerrior S.A.
        • Juan W.Y.
        • Lino M.
        The Healthy Eating Index: 1999-2000. US Department of Agriculture, Center for Nutrition Policy and Promotion. CNPP-12; 2002. Center for Nutrition Policy and Promotion Web site.
        (Accessed January 28, 2008.)
        • US Department of Agriculture
        USDA Strategic Plan for FY 2005-2010; 2006.
        (Accessed January 25, 2008.)
        • Guenther P.M.
        • Reedy J.
        • Krebs-Smith S.M.
        Development of the Healthy Eating Index-2005.
        J Am Diet Assoc. 2008; 108: 1896-1901
        • Britten P.
        • Marcoe K.
        • Yamini S.
        • Davis C.
        Development of food intake patterns for the MyPyramid food guidance system.
        J Nutr Educ Behav. 2006; 38: S78-S92
        • National Center for Health Statistics
        NHANES 2001-2002 Public Data General Release File Documentation; 2004.
        (Accessed January 25, 2008.)
        • US Department of Agriculture, Center for Nutrition Policy and Promotion
        Sample Menus for a 2000 Calorie Food Pattern; 2006.
        (Accessed January 28, 2008.)
        • National Heart Lung and Blood Institute
        Your Guide to Lowering Your Blood Pressure With DASH; 2006. NIH Publication No. 06-4082. National Heart Lung and Blood Institute Web site.
        (Accessed January 28, 2008.)
        • Willett W.C.
        Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating.
        Free Press, New York, NY2005
        • American Heart Association
        No-Fad Diet Sample Menu Plan: 1,200 calories; 2005.
        (Accessed January 28, 2008.)
        • American Heart Association
        No-Fad Diet Sample Menu Plan: 2,000 calories; 2005.
        (Accessed January 28, 2008.)
        • US Department of Agriculture, Center for Nutrition Policy and Promotion
        Healthy Eating Index 2001-2002 Data; 2004.
        (Accessed April 10, 2007.)
        • Larkin F.A.
        • Basiotis P.P.
        • Riddick H.A.
        • Sykes K.E.
        • Pao E.M.
        Dietary patterns of women smokers and non-smokers.
        J Am Diet Assoc. 1990; 90: 230-237
        • Subar A.F.
        • Harlan L.C.
        • Mattson M.E.
        Food and nutrient intake differences between smokers and non-smokers in the US.
        Am J Public Health. 1990; 80: 1323-1329
        • Palaniappan U.
        • Jacobs Starkey L.
        • O'Loughlin J.
        • Gray-Donald K.
        Fruit and vegetable consumption is lower and saturated fat intake is higher among Canadians reporting smoking.
        J Nutr. 2001; 131: 1952-1958
        • Dallongeville J.
        • Marecaux N.
        • Fruchart J.C.
        • Amouyel P.
        Cigarette smoking is associated with unhealthy patterns of nutrient intake: A meta-analysis.
        J Nutr. 1998; 128: 1450-1457
        • Jolliffe I.T.
        Principal Component Analysis.
        2nd ed. Springer, New York, NY2002
        • Britten P.
        • Marcoe K.M.
        • Juan W.Y.
        • Guenther P.M.
        • Carlson A.
        Trends in consumer food choices within the milk group.
        Nutr Insight. 2007; : 35
        • Guthrie H.A.
        • Scheer J.C.
        Validity of a dietary score for assessing nutrient adequacy.
        J Am Diet Assoc. 1981; 78: 240-245
        • Sorenson A.W.
        • Wyse B.W.
        • Wittwer A.J.
        • Hansen R.G.
        An Index of Nutritional Quality for a balanced diet: New help for an old problem.
        J Am Diet Assoc. 1976; 68: 236-242
        • Patterson R.E.
        • Haines P.S.
        • Popkin B.M.
        Diet quality index: Capturing a multidimensional behavior.
        J Am Diet Assoc. 1994; 94: 57-64
        • Haines P.S.
        • Siega-Riz A.M.
        • Popkin B.M.
        The Diet Quality Index revised: A measurement instrument for populations.
        J Am Diet Assoc. 1999; 99: 697-704
        • Bodnar L.M.
        • Siega-Riz A.M.
        A Diet Quality Index for Pregnancy detects variation in diet and differences by sociodemographic factors.
        Public Health Nutr. 2002; 5: 801-809
        • Feskanich D.
        • Rockett H.R.H.
        • Colditz G.A.
        Modifying the Healthy Eating Index to assess diet quality in children and adolescents.
        J Am Diet Assoc. 2004; 104: 1375-1383
        • Kranz S.
        • Hartman T.
        • Siega-Riz A.M.
        • Herring A.H.
        A diet quality index for American preschoolers based on current dietary intake recommendations and an indicator of energy balance.
        J Am Diet Assoc. 2006; 106: 1594-1604
        • Kim S.
        • Hainse P.S.
        • Siega-Riz A.M.
        • Popkin B.M.
        The Diet Quality Index-International (DQI-I) provides an effective tool for cross-national comparison of diet quality as illustrated by China and the United States.
        J Nutr. 2003; 133: 3476-3484
        • McCullough M.L.
        • Feskanich D.
        • Stampfer M.J.
        • Giovannucci E.L.
        • Rimm E.B.
        • Hu F.B.
        • Spiegelman D.
        • Hunter D.J.
        • Colditz G.A.
        • Willett W.C.
        Diet quality and major chronic disease risk in men and women: Moving toward improved dietary guidance.
        Am J Clin Nutr. 2002; 76: 1261-1271
        • Trichopoulou A.
        • Costacou T.
        • Bamia C.
        • Trichopoulos D.
        Adherence to a Mediterranean diet and survival in a Greek population.
        N Engl J Med. 2003; 348: 2599-2608
        • Fogli-Cawley J.J.
        • Dwyer J.T.
        • Saltzman E.
        • McCullough M.L.
        • Troy L.M.
        • Jacques P.F.
        The 2005 Dietary Guidelines for Americans Adherence Index: Development and application.
        J Nutr. 2006; 136: 2908-2915
        • Reedy J.
        • Mitrou P.N.
        • Krebs-Smith S.M.
        • Wirfält E.
        • Flood A.
        • Kipnis V.
        • Leitzmann M.
        • Mouw T.
        • Hollenbeck A.
        • Schatzkin A.
        • Subar A.
        Index-based dietary patterns and risk of colorectal cancer: The NIH-AARP Diet and Health Study.
        Am J Epidemiol. 2008; 168: 38-48


      P. M. Guenther is a nutritionist at the Center for Nutrition Policy and Promotion, US Department of Agriculture, Alexandria, VA


      J. Reedy is a nutritionist and S. M. Krebs-Smith is Chief in the Risk Factor Monitoring and Methods Branch and B. B. Reeve is a psychometrician in the Outcomes Research Branch of the Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD