The Healthy Eating Index, 1994-96

Family Economics and Nutrition Review, Summer, 1998 by Shanthy A. Bowman, Mark Lino, Shirley A. Gerrior, Peter P. Basiotis

Some recent reports have indicated that in 4 of the 10 leading causes of death (cardiovascular disease, certain types of cancer, stroke, and diabetes) in the United States, diet and lack of physical activity are significant contributing factors (5,12). It has been well documented that a healthful diet reduces the risk of chronic diseases such as cardiovascular disease and certain forms of cancer (8,17). A study using a healthy diet indicator, based on the World Health Organization's dietary recommendations, found that mortality was lowest in people with the most healthful diets (6). Major improvements in the American public's health can, therefore, be made by improving the dietary patterns of people.

To assess the dietary status of Americans and monitor changes in these patterns, the U.S. Department of Agriculture's (USDA) Center for Nutrition Policy and Promotion (CNPP) developed the Healthy Eating Index (HEI) based on the work of Kennedy et al. (7) and first computed the Index using 1989 data. The HEI is a summary measure of people's overall diet quality (broadly defined in terms of adequacy, moderation, and variety). The Index consists of scores for consumption of the suggested number of servings of each of the five major Food Guide Pyramid food groups (15); intake of total fat, saturated fat, cholesterol, and sodium; and a measure of dietary variety (fig. 1). The HEI is the only index issued by the Federal Government, and computed on a regular basis, that gauges overall diet quality of the population. According to the American Dietetic Association, the Index is "The most accurate measurement to date on how Americans eat" (1).

[Figure 1 ILLUSTRATION OMITTED]

This article presents the HEI for 1994-96--the most recent years for which nationally representative data are available to compute the Index. The HEI is calculated for the general population and selected subgroups. CNPP also compares the 1996 HEI with the 1989 HEI to examine possible trends in the diets of Americans.

Components of the Healthy Eating Index

The Healthy Eating Index provides an overall picture of the types and quantity of foods people eat, their compliance with specific dietary recommendations, and the variety in their diets. The total Index score is the sum of 10 dietary components, weighted equally (table 1). The maximum overall HEI score is 100. The 10 components represent various aspects of a healthful diet.

* Components 1-5 measure the degree to which a person's diet conforms to the USDA Food Guide Pyramid serving recommendations for the five major food groups: Grains (bread, cereal, rice, and pasta), vegetables, fruits, milk (milk, yogurt, and cheese), and meat (meat, poultry, fish, dry beans, eggs, and nuts).

* Component 6 measures total fat consumption as a percentage of total food energy (calorie) intake.

* Component 7 measures saturated fat consumption as a percentage of total food energy intake.

* Component 8 measures total cholesterol intake.

* Component 9 measures total sodium intake.

* Component 10 measures the variety in a person's diet.

Table 1. Components of the Healthy Eating Index and scoring system

                           Score             Criteria for Maximum
                           Ranges(1)             Score of 10

Grain consumption          0 to 10            6 - 11 servings(2)
Vegetable consumption      0 to 10            3 - 5 servings(2)
Fruit consumption          0 to 10            2 - 4 servings(2)
Milk consumption           0 to 10            2 - 3 servings(2)
Meat consumption           0 to 10            2 - 3 servings(2)

Total fat intake           0 to 10      30% or less energy
                                        from fat
Saturated fat intake       0 to 10      Less than 10% energy from
                                        saturated fat
Cholesterol intake         0 to 10      300 mg or less
Sodium intake              0 to 10      2400 mg or less
Food variety               0 to 10      8 or more different
                                        items in a day

                           Criteria for Minimum
                            Score of 0

Grain consumption                 0 servings
Vegetable consumption             0 servings
Fruit consumption                 0 servings
Milk consumption                  0 servings
Meat consumption                  0 servings

Total fat intake           45% or more energy from fat
Saturated fat intake       15% or more energy from
                           saturated fat
Cholesterol intake         450 mg or more
Sodium intake              4800 mg or more
Food variety               3 or fewer different items in
                           a day

(1) People with consumption or intakes between the maximum and minimum ranges or amounts were assigned scores proportionately.

(2) Number of servings depends on Recommended Energy Allowance--see table 2. All amounts are on a per day basis.

USDA Food Guide Pyramid Food Group Components

The USDA Food Guide Pyramid translates recommendations from the Dietary Guidelines for Americans (16) into groups and amounts of foods people can eat to achieve a healthful diet. The recommended number of Food Guide Pyramid servings depends on a person's caloric requirement. In developing the Index, the researchers used serving recommendations from the Food Guide Pyramid for various age/ gender groups. Pyramid serving recommendations for 1600, 2200, and 2800 calories were used as the basis to interpolate serving recommendations for age/gender groups not described in the Pyramid (table 2).