The Healthy Eating Index-2010 Is a Valid and Reliable Measure of Diet Quality According to the 2010 Dietary Guidelines for Americans
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The Healthy Eating Index (HEI), a measure of diet quality, was updated to reflect the 2010 Dietary Guidelines for Americans and the accompanying USDA Food Patterns. To assess the validity and reliability of the HEI-2010, exemplary menus were scored and 2 24-h dietary recalls from individuals aged ≥2 y from the 2003-2004 NHANES were used to estimate multivariate usual intake distributions and assess whether the HEI-2010 1) has a distribution wide enough to detect meaningful differences in diet quality among individuals, 2) distinguishes between groups with known differences in diet quality by using t tests, 3) measures diet quality independently of energy intake by using Pearson correlation coefficients, 4) has >1 underlying dimension by using principal components analysis (PCA), and 5) is internally consistent by calculating Cronbach's coefficient α. HEI-2010 scores were at or near the maximum levels for the exemplary menus. The distribution of scores among the population was wide (5th percentile = 31.7; 95th percentile = 70.4). As predicted, men's diet quality (mean HEI-2010 total score = 49.8) was poorer than women's (52.7), younger adults' diet quality (45.4) was poorer than older adults' (56.1), and smokers' diet quality (45.7) was poorer than nonsmokers' (53.3) (P < 0.01). Low correlations with energy were observed for HEI-2010 total and component scores (|r| ≤ 0.21). Cronbach's coefficient α was 0.68, supporting the reliability of the HEI-2010 total score as an indicator of overall diet quality. Nonetheless, PCA indicated multiple underlying dimensions, highlighting the fact that the component scores are equally as important as the total. A comparable reevaluation of the HEI-2005 yielded similar results. This study supports the validity and the reliability of both versions of the HEI.
author list (cited authors)
Guenther, P. M., Kirkpatrick, S. I., Reedy, J., Krebs-Smith, S. M., Buckman, D. W., Dodd, K. W., Casavale, K. O., & Carroll, R. J.