The Healthy Eating Index (HEI) is a measure for assessing whether a set of foods aligns with the Dietary Guidelines for Americans (DGA). An updated HEI is released to correspond to each new edition of the DGA, and this article introduces the latest version, which reflects the 2015-2020 DGA. The HEI-2015 components are the same as in the HEI-2010, except Saturated Fat and Added Sugars replace Empty Calories, with the result being 13 components. The 2015-2020 DGA include explicit recommendations to limit intakes of both Added Sugars and Saturated Fats to <10% of energy. HEI-2015 does not account for excessive energy from alcohol within a separate component, but continues to account for all energy from alcohol within total energy (the denominator for most components). All other components remain the same as for HEI-2010, except for a change in the allocation of legumes. Previous versions of the HEI accounted for legumes in either the two vegetable or the two protein foods components, whereas HEI-2015 counts legumes toward all four components. Weighting approaches are similar to those of previous versions, and scoring standards were maintained, refined, or developed to increase consistency across components; better ensure face validity; follow precedent; cover a range of intakes; and, when applicable, ensure the DGA level corresponds to a score >7 out of 10. HEI-2015 component scores can be examined collectively using radar graphs to reveal a pattern of diet quality and summed to represent overall diet quality.

The results demonstrated evidence supportive of construct validity, reliability, and criterion validity. The HEI-2015 can be used to examine diet quality relative to the 2015-2020 Dietary Guidelines for Americans.

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.

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Objectives. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) aims to safeguard the health of low-income, nutritionally at-risk pregnant and postpartum women and children less than 5 years old. This systematic review evaluates whether participation in WIC is associated with nutrition and health outcomes for women, infants, and children, and whether the associations vary by duration of participation or across subgroups. Because of major revisions to the WIC food package in 2009, we prioritized studies published since 2009 and included studies comparing outcomes before and after the 2009 food package change. Data sources. Using electronic publication databases, we conducted a literature search from January 2009 to September 2021 and a targeted search for selected outcomes from January 2000 to September 2021. Review methods. Paired team members independently screened search results, serially abstracted data, assessed risk of bias, and graded strength of evidence (SOE) using standard methods for observational studies. Results. We included 82 quantitative observational studies and 16 qualitative studies, with 49 studies comparing outcomes of WIC participants with WIC-eligible non-participants. WIC prenatal participation was associated with lower risk of three outcomes: preterm delivery (moderate SOE), low birth weight (moderate SOE), and infant mortality (moderate SOE). Prenatal WIC participation was associated with better maternal diet quality (low SOE), lower risk of inadequate gestational weight gain (low SOE), lower alcohol use in pregnancy (low SOE), and no difference in smoking (low SOE). Maternal WIC participation was associated with increased child preventive care and immunizations (each low SOE), and higher cognitive scores for children (low SOE). Child WIC participation was associated with better diet quality (moderate SOE), and greater intakes of 100 percent fruit juice, whole grain cereals, and age-appropriate milk (moderate SOE). Household WIC participation was associated with greater purchasing of healthy food groups (moderate SOE). Maternal WIC participation was not associated with breastfeeding initiation (moderate SOE). The evidence was insufficient for other outcomes related to maternal health and child growth. The evidence generally was insufficient on how WIC participation affects outcomes across subgroups. Conclusions. Maternal WIC participation was associated with improved birth outcomes, lower infant mortality, and better child cognitive development. WIC participation was associated with purchasing healthier foods and with improved diets for pregnant women and children. More research is needed on maternal health outcomes; food security; child growth, development, and academic achievement; and effectiveness of WIC in all segments of the eligible population.