Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Communication
  • Published:

Healthy Eating Index and obesity

Abstract

Background: There is a continuing need to examine the relationship between diet quality and health in the population. The Healthy Eating Index (HEI) has been developed as a composite measure of diet quality by the US Department of Agriculture.

Objectives: The first objective was to use the HEI to assess the diet quality of a representative sample of the US population and population groups. The second objective was to examine the association between HEI and obesity.

Design: Cross-sectional analysis of data from 10 930 adults who participated in the Third National Health and Nutrition Examination Survey. Sociodemographic, physical activity, dietary, and health data were used in the analysis. Diet quality was assessed with the HEI score, ranging from 0 to 100, based on 10 dietary criteria. A low HEI score indicates poor diet.

Results: A majority of survey participants had a low HEI score. The percentage of individuals classified as having a poor diet varied by age, gender, race/ethnicity, income, and education. A low HEI score was associated with overweight and obesity. There was a graded increase in the odds ratio of obesity across the HEI category after adjusting for age, gender, race/ethnicity, physical activity, smoking, alcohol use, income, and education.

Conclusions: An index of diet quality, such as HEI, may provide a comprehensive assessment of diet in the population. Since the HEI is based on the US Dietary Guidelines, the use of these guidelines as a way to improve health should be emphasized. However, the overall effectiveness of these guidelines in disease prevention needs to be studied further.

Sponsorship: None.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  • Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin P-H, Karanja N, Simons-Morton D, McCullough M, Swain J, Steele P, Evans MA, Miller ER & Harsha DW (1997): The DASH Collaborative Research Group. A clinical trial of the effects of dietary pattern on blood pressure. N. Engl. J. Med. 336, 1117–1124.

    Article  CAS  Google Scholar 

  • Bowman SA, Lino M, Gerrior SA & Basiotis PP (1998): The Healthy Eating Index: 1994–96. US Department of Agriculture, Center for Nutrition Policy and Promotion. CNPP-5.

  • Centers for Disease Control Prevention (CDC) & National Center for Health Statistic (NCHS) (1994): Plan and operation of the Third National Health and Nutrition Examination Survey, 1988–94. Vital and Health Statistics, Series 1, No. 32.

  • Centers for Disease Control Prevention (CDC) & National Center for Health Statistics (NCHS) (1997): National Health and Nutrition Examination Survey. NHANES III Data CD-ROM series 11, No. 1. http://www.cdc.gov/nchs/about/major/nhanes/nh3data.htm).

  • Flegal KM, Carroll MD, Ogden CL & Johnson CL (2002): Prevalence and trends in obesity among US adults, 1999–2000. JAMA 288, 1723–1727.

    Article  Google Scholar 

  • Fung TT, Willett WC, Stampfer MJ, Manson JE & Hu FB (2001a): Dietary patterns and the risk of coronary heart disease in women. Arch. Intern. Med. 161, 1857–1862.

    Article  CAS  Google Scholar 

  • Fung TT, Rimm EB, Spiegelman D, Rifai N, Tofler GH, Willett WC & Hu FB (2001b): Association between dietary patterns and plasma biomarkers of obesity and cardiovascular risk. Am. J. Clin. Nutr. 73, 61–67.

    Article  CAS  Google Scholar 

  • Haines PS, Siega-Riz AM & Popkin BM (1999): The Diet Quality Index revised: a measurement instrument for populations. J. Am. Diet Assoc. 99, 697–704.

    Article  CAS  Google Scholar 

  • Hann CS, Rock CL, King I & Drewnowski A (2001): Validation of Healthy Eating Index with use of plasma biomarkers in a clinical sample of women. Am. J. Clin. Nutr. 74, 479–486.

    Article  CAS  Google Scholar 

  • Hu FB, Rimm EB, Stampfer MJ, Ascherio A, Spiegelman D & Willett WC (2000): Prospective study of major dietary patterns and risk of coronary heart disease in men. Am. J. Clin. Nutr. 72, 912–921.

    Article  CAS  Google Scholar 

  • Kant AK, Schatzkin A & Ziegler RG (1995): Dietary diversity and subsequent cause-specific mortality in the NHANES I epidemiologic follow-up study. J. Am. Coll. Nutr. 14, 233–238.

    Article  CAS  Google Scholar 

  • Kennedy ET, Ohls J, Carlson S & Fleming K (1995): The Healthy Eating Index: design and applications. J. Am. Diet. Assoc. 95, 1103–1108.

    Article  CAS  Google Scholar 

  • Maskarine G, Novotny R & Tasaki K (2000): Dietary patterns are associated with body mass index in multiethnic women. J. Nutr. 130, 3068–3072.

    Article  Google Scholar 

  • McCullough ML, Feskanich D, Rimm EB, Giovannucci EL, Ascherio A, Variyam JN, Spiegelman D, Stampfer MJ & Willett WC (2000a): Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in men. Am. J. Clin. Nutr. 72, 1223–1231.

    Article  CAS  Google Scholar 

  • McCullough ML, Feskanich D, Stampfer MJ, Rosner BA, Hu FB, Hunter DJ, Variyam JN, Colditz GA & Willett WC (2000b): Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in women. Am. J. Clin. Nutr. 72, 1214–1222.

    Article  CAS  Google Scholar 

  • National Institutes of Health (NIH) (1998): Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—The evidence report. Obes. Res. 6 (Suppl 2), 51S–210S.

  • Newby PK, Muller D, Hallfrisch J, Qiao N, Andres R & Tucker KL (2003): Dietary patterns and changes in body mass index and waist circumference in adults. Am. J. Clin. Nutr. 77, 1417–1425.

    Article  CAS  Google Scholar 

  • Patterson RE, Haines PS & Popkin BM (1994): Diet quality index: capturing a multidimensional behavior. J. Am. Diet. Assoc. 94, 57–64.

    Article  CAS  Google Scholar 

  • Sichieri R (2002): Dietary patterns and their associations with obesity in the Brazilian city of Rio de Janeiro. Obes. Res. 10, 42–48.

    Article  Google Scholar 

  • Togo P, Osler M, Sorensen TI & Heitmann BL (2001): Food intake patterns and body mass index in observational studies. Int. J. Obes. Relat. Metab. Disord. 25, 1741–1751.

    Article  CAS  Google Scholar 

  • US Department of Agriculture (USDA) (1992): The Food Guide Pyramid. Hyattsville, MD: Human Nutrition Information Service Publication HG 252.

  • US Department of Health and Human Service (USDHHS) & US Department of Agriculture (USDA) (1995): Dietary Guidelines for Americans 4th ed. Washington, DC: US Government Printing Office.

  • US Department of Health and Human Services (USDHHS) (1998): 1998 poverty guidelines. Federal Register 63, 9235–9238.

Download references

Acknowledgements

We acknowledge the contributions of Ming Yin and Jean Orelien, who provided statistical consulting. None of us had any personal or financial affiliation with any organization involved in the study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to X Guo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Guo, X., Warden, B., Paeratakul, S. et al. Healthy Eating Index and obesity. Eur J Clin Nutr 58, 1580–1586 (2004). https://doi.org/10.1038/sj.ejcn.1601989

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1601989

Keywords

This article is cited by

Search

Quick links