Applications of the Healthy Eating Index for Surveillance, Epidemiology, and Intervention Research: Considerations and Caveats

• Published in: Journal of the Academy of Nutrition and Dietetics Vol. 118; no. 9; pp. 1603 - 1621
• Main Authors: Kirkpatrick, Sharon I., Reedy, Jill, Krebs-Smith, Susan M., Pannucci, TusaRebecca E., Subar, Amy F., Wilson, Magdalena M., Lerman, Jennifer L., Tooze, Janet A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2018
• Subjects: Biomedical Research - methods; computational methodology; Diet indexes; Diet quality; Diet, Healthy - methods; Dietary Guidelines; Dietary patterns; Dietetics - methods; eating habits; energy intake; Epidemiologic Methods; epidemiology; food intake; healthy diet; Healthy Eating Index; Humans; monitoring; Nutrition Disorders - epidemiology; nutritional adequacy; Population Surveillance - methods; statistical analysis; Statistical modeling; United States - epidemiology; United States; Healthy Eating Index; Dietary patterns; Statistical modeling; Diet quality; Diet indexes
• ISSN: 2212-2672; 2212-2680
• DOI: 10.1016/j.jand.2018.05.020

The Healthy Eating Index (HEI) is a measure of diet quality that can be used to examine alignment of dietary patterns with the Dietary Guidelines for Americans. The HEI is made up of multiple adequacy and moderation components, most of which are expressed relative to energy intake (ie, as densities) for the purpose of calculating scores. Due to these characteristics and the complexity of dietary intake data more broadly, calculating and using HEI scores can involve unique statistical considerations and, depending on the particular application, intensive computational methods. The objective of this article is to review potential applications of the HEI, including those relevant to surveillance, epidemiology, and intervention research, and to summarize available guidance for appropriate analysis and interpretation. Steps in calculating HEI scores are reviewed and statistical methods described. Consideration of salient issues in the calculation and interpretation of scores can help researchers avoid common pitfalls and reviewers ensure that articles reporting on the use of the HEI include sufficient details such that the work is comprehensible and replicable, with the overall goal of contributing to knowledge on dietary patterns and health among Americans.