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Review
. 2018 Sep;118(9):1603-1621.
doi: 10.1016/j.jand.2018.05.020.

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

Sharon I Kirkpatrick, Jill Reedy, Susan M Krebs-Smith, TusaRebecca E Pannucci, Amy F Subar, Magdalena M Wilson, Jennifer L Lerman, Janet A Tooze
Review

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

Sharon I Kirkpatrick et al. J Acad Nutr Diet. 2018 Sep.

Abstract

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.

Keywords: Diet indexes; Diet quality; Dietary patterns; Healthy Eating Index; Statistical modeling.

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Conflict of interest statement

STATEMENT OF POTENTIAL CONFLICT OF INTEREST

No potential conflict of interest was reported by the authors.

Figures

Figure 1.
Figure 1.
Considerations in the application of the Healthy Eating Index (HEI) for surveillance, epidemiology, and intervention research. NOTE: Information from this figure is available at www.jandonline.org as part of a PowerPoint presentation.
Figure 1.
Figure 1.
Considerations in the application of the Healthy Eating Index (HEI) for surveillance, epidemiology, and intervention research. NOTE: Information from this figure is available at www.jandonline.org as part of a PowerPoint presentation.
Figure 2.
Figure 2.
Summary of methods for the calculation of Healthy Eating Index (HEI) scores.
Figure 2.
Figure 2.
Summary of methods for the calculation of Healthy Eating Index (HEI) scores.
Figure 2.
Figure 2.
Summary of methods for the calculation of Healthy Eating Index (HEI) scores.
Figure 2.
Figure 2.
Summary of methods for the calculation of Healthy Eating Index (HEI) scores.
Figure 2.
Figure 2.
Summary of methods for the calculation of Healthy Eating Index (HEI) scores.
Figure 3.
Figure 3.
Recommended methods to calculate Healthy Eating Index (HEI) scores depending on the main purpose of the study.
Figure 3.
Figure 3.
Recommended methods to calculate Healthy Eating Index (HEI) scores depending on the main purpose of the study.
See this image and copyright information in PMC

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