The healthy eating index, 1999-2000: charting dietary patterns of Americans
Written by Davinder Bisht on 10:44 PMHealthful eating is essential for human development and well-being. In the United States today, some dietary patterns are associated with 4 of the 10 leading causes of death (coronary heart disease, certain types of cancer, stroke, and type 2 diabetes) (U.S. Department of Health and Human Services [DHHS], 2000). A healthful diet, however, can reduce major risk factors for chronic diseases such as obesity, high blood pressure, and high blood cholesterol (USDA & DHHS, 2000). Studies have shown an increase in mortality associated with overweight (1) and obesity resulting from poor eating habits (DHHS, 2001). Thus, major improvements in the health of the American public can be made by improving people's dietary patterns.
To assess Americans' dietary status and to 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), (Kennedy, Ohls, Carlson, & Fleming, 1995). Relatively new, the HEI had been computed twice, with 1989-90 and with 1994-96 data (USDA, 1995; Bowman, Lino, Gerrior, & Basiotis, 1998), and is a summary measure of the overall quality of people's diets (broadly defined in terms of adequacy, moderation, and variety).
This article presents the HEI for 1999-2000 (Basiotis, Carlson, Gerrior, Juan, & Lino, 2002), which for the first time uses data from the National Health and Nutrition Examination Survey (see box); 1999-2000 is the most recent period for which nationally representative data are available to compute the HEI. The 1999-2000 HEI is calculated for the general population and selected subgroups and is compared with the HEI of earlier years to examine possible trends in the diets of Americans.
Components and Scoring of the Healthy Eating Index
The HEI, representing various aspects of a healthful diet, provides an overall picture of the type and quantity of foods that people eat, their compliance with specific dietary recommendations, and the variety in their diets. The total HEI score is the sum of 10 dietary components:
* Components 1-5 measure the degree to which a person's diet conforms to serving recommendations for the five major food groups of the Food Guide Pyramid: 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 examines variety in a person's diet.
With each component of the HEI having a maximum score of 10 and a minimum score of 0, the highest possible overall HEI score is 100. Recommendations of the Dietary Guidelines for Americans (USDA, 2000), the Food Guide Pyramid (USDA, 1996; Dietary Guidelines Advisory Committee, 2000), the Committee on Diet and Health of the National Research Council (National Research Council, 1989a, 1989b), as well as consultations with nutrition researchers, were the bases used by CNPP to score intake levels. (See table 1 for details on the scoring system.) CNPP assigned a score of l0 when food consumption met the Food Guide Pyramid recommendations; when fat (total and saturated), cholesterol, and sodium intake met the recommendations; or when a person consumed at least half a serving each of 8 or more different foods in a day (variety). A score of 0 was assigned when a person did not consume any item from a Pyramid food group; when intake was greater than the recommendations for fat, cholesterol, and sodium; or when a person consumed at least half a serving of 3 or fewer different foods in a day. All other consumption and intake levels were scored proportionately. With this scoring system, the higher the component scores, the closer consumption or intakes are to the recommended ranges or amounts.
An HEI score over 80 implies that a person has a good diet; a score between 51 and 80, a diet that needs improvement; and a score less that 51, a poor diet. (2) (For more details on how the HEI is computed, see The Healthy Eating Index: 1999-2000 at www.cnpp.usda.gov.)
Healthy Eating Index Overall and Component Scores
During 1999-2000, the mean HEI score for the U.S. population was 63.8; that is, the score indicates that the American diet needs improvement. Ninety percent of Americans had a diet that was poor or needed improvement. Only 10 percent of Americans had a good diet--one that mostly met recommendations of the Dietary Guidelines for Americans, the Food Guide Pyramid, and other recommendations for healthful eating.
During 1999-2000, the highest mean HEI component scores for the U.S. population were for cholesterol and variety, both averaging 7.7 on a scale of 10 (fig. 2a). With an average score of 6.9, total fat accounted for the next highest component score. People had the two lowest mean scores for the fruits and milk components of the HEI, averaging 3.8 and 5.9, respectively. Average scores for the other HEI components were between 6 and 6.7.
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