The Healthy Eating Index and Youth Healthy Eating Index Are Unique, Nonredundant Measures of Diet Quality among Low-Income, African American Adolescents

Abstract

Chronic disease is related to poor diet quality. The Healthy Eating Index (HEI) was developed to assess diet quality. The Youth HEI (YHEI) is an adaptation of the HEI for use with children and adolescents. The objectives were to compare HEI and YHEI scores among adolescents at risk for chronic disease and to compare associations between the scores and health indicators. This cross-sectional study included 2 low-income, urban African American adolescent samples (Challenge, n = 196; Three Generation, n = 121). HEI and YHEI scores were calculated from a FFQ and compared with BMI, body composition, and micronutrient, energy, and dietary intakes. YHEI scores were lower than HEI scores across both adolescent samples (Challenge, 48.94 +/- 9.31 vs. 62.83 +/- 11.75; Three Generation, 47.08 +/- 9.65 vs. 59.93 +/- 11.27; P < 0.001). Females (64.47 +/- 11.70) had higher HEI scores than males (61.15 +/- 11.61) (P < 0.05), but there was no gender difference in YHEI scores. HEI and YHEI scores were associated with higher micronutrient and total energy intakes (r = 0.19-0.76; P < 0.05). Higher percent body/abdominal fat was associated with lower HEI scores (r = -0.17 to -0.19; P < 0.05) but not with YHEI scores. BMI was not associated with either HEI or YHEI scores. In conclusion, many adolescents were consuming diets that placed them at risk for developing chronic disease. Although both the HEI and YHEI are useful in assessing diet quality, the HEI is inversely associated with body composition, a predictor of chronic disease, and accounts for gender differences in the Dietary Guidelines, whereas the YHEI discounts nutrient-poor, energy-dense foods.

Diet quality among Iranian adolescents needs improvement

“…The second point is that to calculate DDS we derived twenty-three subgroups from five main food groups; counting twenty-three food subgroups resulted in reaching more accurate DDS as it represented the diversity of food groups as well as the diversity within food groups. The mean HEI score in the present study is consistent with some earlier studies that were carried out with the same method to calculate HEI in this age group (34,35) . One study reported 51·5 (SD 9·07) points as the mean HEI score (36) .…”

Diet quality is associated with measures of body fat in adolescents from Otago, New Zealand

“…In their study, HEI was significantly associated with lower percentage body fat and abdominal fat as measured by DXA, but not with BMI, among 196 African American adolescents aged less than 16 years (20) . Therefore, our findings provide support for the conceptual premise that total body fatness, rather than body weight or central fatness, may have a stronger association with diet quality.…”

“…BMI, being simple and practical to measure (39) , has been used as the indicator of body composition in the majority of studies that examined diet quality and body composition among adolescents (15)(16)(17)(18)(19)(20)(21)(22)(23) . Four studies found significant associations between diet quality and BMI (16,18,19,22) ; however, only two of these found an inverse association between diet quality and BMI (18,22) .…”

Association of Dietary Variety and Diversity With Body Mass Index in US Preschool Children

“…In contrast, other measures of overall dietary quality have been shown in some studies to be negatively associated with BMI in children. 34,35 It is important to note that, although we saw some positive associations between variety and diversity with BMIz, the effect sizes were small and are not indicative of an increased risk of attaining an unhealthy BMIz. Furthermore, previous literature shows that greater dietary variety and diversity are associated with a decreased risk for nutritional inadequacy.…”