Fruit and Vegetable Healthy Eating Index Component Scores of Distributed Food Bags Were Positively Associated with Client Diet Scores in a Sample of Rural, Midwestern Food Pantries

Published:October 21, 2020DOI:



      Food pantries have the potential to improve the quality of clients’ diets.


      This study evaluated the relationship between the quality of the mix of foods in pantry inventories and client food bags (separately), as assessed by the Healthy Eating Index-2010 (HEI-2010), with client diet quality and how these relationships varied by food security status.


      This cross-sectional, secondary analysis used baseline data from the Voices for Food intervention study (Clinical Trial Registry: NCT03566095). A demographic questionnaire, the US Household Food Security Survey Module, and up to three 24-hour dietary recalls on nonconsecutive days, including weekdays and weekends, were collected. Foods available in pantry inventories and distributed in client food bags were recorded at one time point during baseline data collection.

      Participants and setting

      A convenience sample of adult food pantry clients (N = 575) from 24 rural, food pantries in the US Midwest was recruited from August to November 2014.

      Main outcome measures

      Pantry inventories, client food bags, and client diets were scored using the HEI-2010. Main outcomes were client HEI-2010 scores.

      Statistical analyses performed

      Linear regression models estimated associations between HEI-2010 total and component scores for pantry inventories and client food bags (in separate models) and the corresponding scores for client dietary intake. The interaction of client food security status, and potential pantry- and client-level confounders, was considered.


      Client food bag HEI-2010 scores were positively associated with client diet scores for total vegetables, greens and beans, and total fruit components, whereas pantry inventory HEI-2010 scores were negatively associated with client diet scores for total fruit, total protein foods, and seafood and plant proteins components. Client food bag whole-grains scores were more strongly associated with very low food secure compared with food secure client diet scores (all P values < 0.05).


      The quality of client food bags, but not of pantry inventories, was positively associated with client diet quality in a rural sample in the US Midwest.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Anderson S.
        Core indicators of nutritional state for difficult-to-sample populations.
        J Nutr. 1990; 120: 1559-1600
        • Coleman-Jensen A.
        • Rabbitt M.P.
        • Gregory C.A.
        • Singh A.
        Household food security in the United States in 2018.
        (Accessed January 24, 2020. 2019)
        • Hanson K.L.
        • Connor L.M.
        Food insecurity and dietary quality in US adults and children: A systematic review.
        Am J Clin Nutr. 2014; 100: 684-692
        • Gundersen C.
        • Ziliak J.P.
        Food insecurity and health outcomes.
        Health Aff (Millwood). 2015; 34: 1830-1839
        • US Depts of Health and Human Services and Agriculture
        Dietary Guidelines for Americans 2015-2020.
        • Verpy H.
        • Smith C.
        • Reicks M.
        Attitudes and behaviors of food donors and perceived needs and wants of food shelf clients.
        J Nutr Educ Behav. 2003; 35: 6-15
      1. Johnson K, Rawlings-Blake S, Schneider H, Cochran T. Hunger and Homelessness Survery: A status report on hunger and homelessness in America's cities. 2013(December):1-120.

        • Martin K.S.
        • Wu R.
        • Wolff M.
        • Colantonio A.G.
        • Grady J.
        A novel food pantry program: Food security, self-sufficiency, and diet-quality outcomes.
        Am J Prev Med. 2013; 45: 569-575
        • Caspi C.E.
        • Canterbury M.
        • Carlson S.
        • et al.
        A behavioural economics approach to improving healthy food selection among food pantry clients.
        Public Health Nutr. 2019; 22: 2303-2313
        • Long C.R.
        • Narcisse M.R.
        • Rowland B.
        • et al.
        Written nutrition guidelines, client choice distribution, and adequate refrigerator storage are positively associated with increased offerings of Feeding America's detailed Foods to Encourage (F2E) in a large sample of Arkansas food pantries.
        J Acad Nutr Diet. 2020; 120: 792-803.e5
        • Coleman-Jensen A.
        • Rabbitt M.P.
        • Gregory C.
        • Singh A.
        Statistical supplement to household food security in the United States in 2018. Administrative Publication no. 081.
        • Kicinski L.R.
        Characteristics of short and long-term food pantry users.
        Michigan Sociol Rev. 2012; 26: 58-74
        • Kaiser M.L.
        • Cafer A.
        Understanding high incidence of severe obesity and very low food security in food pantry clients: Implications for social work.
        Soc Work Public Health. 2018; 33: 125-139
        • Kaiser M.L.
        • Cafer A.M.
        Exploring long-term food pantry use: Differences between persistent and prolonged typologies of use.
        J Hunger Environ Nutr. 2016; 12: 46-63
        • Spees C.K.
        • Clark J.E.
        • Hooker N.H.
        • Watowicz R.P.
        • Taylor C.A.
        Dietary intake contributions of food and beverages by source and food security status in US adults.
        J Nutr Educ Behav. 2017; 49: 667-673.e661
        • US Dept of Agriculture, Economic Research Service
        Definitions of food security.
        • Wright B.N.
        • Bailey R.L.
        • Craig B.A.
        • et al.
        Daily dietary intake patterns improve after visiting a food pantry among food-insecure rural Midwestern adults.
        Nutrients. 2018; 10: 583
        • Stluka S.
        • Moore L.
        • Eicher-Miller H.A.
        • et al.
        Voices for food: Methodologies for implementing a multi-state community-based intervention in rural, high poverty communities.
        BMC Public Health. 2018; 18: 1055
        • Efrati Philip D.
        • Baransi G.
        • Shahar D.R.
        • Troen A.M.
        Food-aid quality correlates positively with diet quality of food pantry users in the Leket Israel Food Bank Collaborative.
        Front Nutr. 2018; 5: 123
        • Martin K.S.
        • Colantonio A.G.
        • Picho K.
        • Boyle K.E.
        Self-efficacy is associated with increased food security in novel food pantry program.
        SSM Popul Health. 2016; 2: 62-67
        • Remley D.T.
        • Gallagher T.
        • McDowell J.
        • Kershaw M.
        • Lambea M.C.
        • Melgar-Quinonez H.
        Extension's role in developing "choice" food pantries in Southwest Ohio.
        J Extens. 2006; 44
        • Remley D.T.
        • Zubieta A.C.
        • Lambea M.C.
        • Melgar-Quinonez H.
        • Taylor C.
        Spanish- and English-speaking client perceptions of choice food pantries.
        J Hunger Environ Nutr. 2010; : 120-128
        • US Dept of Agriculture, Food and Nutrition Service
        Supplemental Nutrition Assistance Program (SNAP).
        • US Dept of Agriculture, Food and Nutrition Service
        Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
        Date accessed: January 24, 2020
        • Bickel G.
        • Nord M.
        • Price C.
        • Hamilton W.
        • Cook J.
        Guide to measuring household food security.
        • US Dept of Agriculture, Economic Research Service
        US Adult Food Security Survey Module: Three-stage design, with screeners. 2012.
        Date accessed: September 22, 2020
        • Subar A.F.
        • Kirkpatrick S.I.
        • Mittl B.
        • et al.
        The Automated Self-Administered 24-hour dietary recall (ASA24): A resource for researchers, clinicians, and educators from the National Cancer Institute.
        J Acad Nutr Diet. 2012; 112: 1134-1137
        • Kirkpatrick S.I.
        • Guenther P.M.
        • Douglass D.
        • et al.
        The provision of assistance does not substantially impact the accuracy of 24-hour dietary recalls completed using the Automated Self-Administered 24-H Dietary Assessment Tool among women with low incomes.
        J Nutr. 2019; 149: 114-122
        • National Cancer Institute
        Healthy Eating Index-2010.
        Date accessed: January 8, 2019
        • Krebs-Smith S.M.
        • Pannucci T.E.
        • Subar A.F.
        • et al.
        Update of the Healthy Eating Index: HEI-2015.
        J Acad Nutr Diet. 2018; 118: 1591-1602
        • Guenther P.M.
        • Kirkpatrick S.I.
        • Reedy J.
        • et al.
        The Healthy Eating Index-2010 is a valid and reliable measure of diet quality according to the 2010 Dietary Guidelines for Americans.
        J Nutr. 2014; 144: 399-407
        • Nanney M.S.
        • Grannon K.Y.
        • Cureton C.
        • et al.
        Application of the Healthy Eating Index-2010 to the hunger relief system.
        Public Health Nutr. 2016; 19: 2906-2914
        • US Dept of Agriculture, Agricultural Research Service
        What’s in the foods you eat search tool.
      2. FAO/INFOODS Density Database [database]. Version 2.0. FAO/INFOODS, Brussels, Belgium2012
        • US Dept of Agriculture, Agricultural Research Service
        Food Patterns Equivalents Database: Databases and SAS Data Sets. [database].
        • US Dept of Agriculture, Agricultural Research Service
        Food and Nutrient Database for Dietary Studies: FNDDS Documentation and Databases.
        • National Cancer Institute Division of Cancer Control & Population Sciences Epidemiology and Genomics Research Program
        Healthy Eating Index SAS Code.
        Date accessed: November 22, 2019
      3. SAS [computer program]. Version 9.4. Cary, NC: SAS Institute Inc; 2013.

        • US Department of Agriculture Center for Nutrition Policy and Promotion
        HEI-2010 total and component scores for children, adults, and older adults during 2011-2012.
        • Jetter K.M.
        • Cassady D.L.
        The availability and cost of healthier food alternatives.
        Am J Prev Med. 2006; 30: 38-44
        • National Cancer Institute Division of Cancer Control & Population Sciences
        Research uses of the HEI.
        Date accessed: September 1, 2018
        • Liu Y.
        • Desmond N.E.
        • Wright B.N.
        • et al.
        Nutritional contributions of food pantries and other sources to the diets of rural, midwestern food pantry users in the U.S.
        Br J Nutr. 2020; : 1-26


      B. N. Wright is a postdoctoral fellow, Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.


      C. M. Vasquez-Mejia is a graduate research assistant with the Department of Nutrition Science, Purdue University, West Lafayette, IN.


      P. M. Guenther is a research professor, Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT.


      L. McCormack is an associate professor, Health and Nutritional Sciences, South Dakota State University, Brookings.


      S. Stluka is an associate extension director, Montana State University, Bozeman.


      L. Franzen-Castle is an associate professor and extension nutrition specialist, Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln.


      B. Henne is an associate program leader, extension, Michigan State University, Eaton County Extension Office, Charlotte.


      D. Mehrle is a specialist, extension, University of Missouri, Columbia.


      D. Remley is an associate professor, extension, Ohio State University, Piketon.


      H. A. Eicher-Miller is an associate professor, Purdue University Department of Nutrition Science, West Lafayette, IN.