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. 2023 Jan;123(1):117-143.
doi: 10.1016/j.jand.2022.08.114. Epub 2022 Aug 10.

Healthy Eating Index Diet Quality in Randomized Weight Loss Trials: A Systematic Review

Jessica Cheng  1 , Hai-Wei Liang  1 , Mary Lou Klem  2 , Tina Costacou  1 , Lora E Burke  3
Affiliations

Healthy Eating Index Diet Quality in Randomized Weight Loss Trials: A Systematic Review

Jessica Cheng et al. J Acad Nutr Diet. 2023 Jan.

Abstract

Background: Weight loss interventions focus on dietary and physical activity changes to induce weight loss. Both through weight loss and independent of it, diet quality is important for reducing chronic disease risk. However, whether and how diet quality changes over the course of a behavioral intervention is unclear.

Objective: To systematically review the evidence from randomized controlled trials on the effect of behavioral interventions on diet quality as defined by the Healthy Eating Index (HEI) among adults with overweight and obesity.

Methods: PubMed, Ebscohost CINAHL, Embase, OVID APA PsycInfo, Scopus, and Web of Science were searched through May 2021. Inclusion criteria comprised randomized controlled trial design, a primary or secondary aim of weight loss, a sample of US adults with overweight or obesity, measurement using the HEI-2005, 2010, or 2015, and assessment of the time by treatment effect. Interventions must have included behavioral components and lasted at least 3 months. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. The systematic review protocol was published on Open Science Framework.

Results: Of 3,707 citations retrieved, 18 studies met inclusion criteria. A wide array of behavioral interventions were assessed, including in-person and mobile health interventions as well as those prescribing intake of specific foods. Risk of bias in the included studies primarily arose from the measurement of the outcome variable. Sample sizes ranged from 34 to 413 participants. Nine studies used multiple dietary recalls, with few using the recommended method of Healthy Eating Index calculation. Changes in diet quality ranged from no improvement to a 20-point improvement. More often, improvement was in the 4- to 7-point range.

Conclusions: The evidence for the efficacy of behavioral weight loss interventions for improving diet quality among adults with overweight and obesity is limited. Modest improvements in HEI scores were observed in the reviewed studies.

Keywords: behavioral intervention; diet quality; healthy eating index; systematic review; weight loss.

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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.
Search strategies by database for a systematic review of the assessment of Healthy Eating Index diet quality change in behavioral weight loss trials.
Figure 2.
Figure 2.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram and filtering for a systematic review of the assessment of HEI diet quality change in behavioral weight loss trials.
Figure 3.
Figure 3.
Design and sample characteristics of studies included in the systematic review of the assessment of healthy eating index diet quality change in behavioral weight loss trials (n = 18)
Figure 3.
Figure 3.
Design and sample characteristics of studies included in the systematic review of the assessment of healthy eating index diet quality change in behavioral weight loss trials (n = 18)
Figure 3.
Figure 3.
Design and sample characteristics of studies included in the systematic review of the assessment of healthy eating index diet quality change in behavioral weight loss trials (n = 18)
Figure 3.
Figure 3.
Design and sample characteristics of studies included in the systematic review of the assessment of healthy eating index diet quality change in behavioral weight loss trials (n = 18)
Figure 4.
Figure 4.
Components of the intervention and control of studies included in the systematic review of the assessment of Healthy Eating Index diet quality change in behavioral weight loss trials (n = 18)
Figure 4.
Figure 4.
Components of the intervention and control of studies included in the systematic review of the assessment of Healthy Eating Index diet quality change in behavioral weight loss trials (n = 18)
Figure 4.
Figure 4.
Components of the intervention and control of studies included in the systematic review of the assessment of Healthy Eating Index diet quality change in behavioral weight loss trials (n = 18)
Figure 4.
Figure 4.
Components of the intervention and control of studies included in the systematic review of the assessment of Healthy Eating Index diet quality change in behavioral weight loss trials (n = 18)
Figure 4.
Figure 4.
Components of the intervention and control of studies included in the systematic review of the assessment of Healthy Eating Index diet quality change in behavioral weight loss trials (n = 18)
Figure 5.
Figure 5.
Study measurements and analysis of randomized controlled trials included in the systematic review of healthy eating index diet quality (n = 18)
Figure 5.
Figure 5.
Study measurements and analysis of randomized controlled trials included in the systematic review of healthy eating index diet quality (n = 18)
Figure 5.
Figure 5.
Study measurements and analysis of randomized controlled trials included in the systematic review of healthy eating index diet quality (n = 18)
Figure 5.
Figure 5.
Study measurements and analysis of randomized controlled trials included in the systematic review of healthy eating index diet quality (n = 18)
Figure 5.
Figure 5.
Study measurements and analysis of randomized controlled trials included in the systematic review of healthy eating index diet quality (n = 18)
Figure 5.
Figure 5.
Study measurements and analysis of randomized controlled trials included in the systematic review of healthy eating index diet quality (n = 18)
Figure 5.
Figure 5.
Study measurements and analysis of randomized controlled trials included in the systematic review of healthy eating index diet quality (n = 18)
Figure 6.
Figure 6.
Assessment of bias for studies included in the systematic review of the assessment of Healthy Eating Index diet quality change in weight loss trials using the Cochrane Risk of Bias 2 tool (n = 18).
See this image and copyright information in PMC

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