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Evaluation of the Healthy Eating Index‐2010 (HEI‐2010)

The Healthy Eating Index, a measure of diet quality, was recently updated to reflect the 2010 Dietary Guidelines for Americans. To assess the validity and reliability of the HEI‐2010, 24‐hour dietary recall data from individuals aged 2 years and older (n=8262) from the 2003–2004 National Health and Nutrition Examination Survey were used to estimate usual HEI‐2010 scores and to assess whether the HEI‐2010 measures diet quality independently of energy intake, distinguishes between groups with known differences in diet quality, and has more than one underlying dimension. In addition to these population‐level assessments, exemplary menus expected to have high diet quality were scored with the HEI‐2010. Low correlations were observed between total and component scores with energy intake (|r|<0.21), demonstrating that the HEI‐2010 uncouples diet quality from quantity. Diet quality was lower among smokers (mean total HEI‐2010 score=45.7) compared to nonsmokers (53.3) (P<0.01), and exemplary menus received scores at or near the maximum levels, indicating construct validity. Cronbach's alpha was 0.68, supporting the reliability of the total score as an indicator of overall diet quality. Nonetheless, principal components analysis indicated multiple underlying factors, highlighting the importance of the component scores. Overall, the HEI‐2010 is a valid and reliable measure of diet quality. Support: NCI/CNPP.