Validation of the Texas School Physical Activity and Nutrition (SPAN) Dietary Index Against the Healthy Eating Index Among Elementary-Aged Students

Abstract

Objective: Assess the accuracy of the Texas School Physical Activity and Nutrition (SPAN) survey's diet quality index against the 24 h recall-based Healthy Eating Index (HEI-2020). Methods: Fifty-one rising third and fourth graders (mean age 9.5 yrs., SD = 1.03 yrs.) from a summer program completed the SPAN survey and a 24 h dietary recall on the same day. The study compared SPAN HEI scores from survey food frequency items to HEI-2020 scores from recalls using Nutrition Data System for Research (NDS-R) software, evaluating correlations and agreement metrics. Results: SPAN HEI averaged 36.87 (SD = 3.78), while recall-derived HEI was 49.05 (SD = 11.92). The mean difference between indices was 12.18 (SD = 10.83), with an absolute difference of 13.51 (SD = 9.01). Bland-Altman analysis indicated limits of agreement from -9.05 to 33.40. Spearman correlation between SPAN HEI and recall HEI was r = 0.44 (p < 0.01), with an ICC of 0.45 (95% CI = 0.04, 0.68). Conclusions and Implications: After comparing HEI scores from both tools, SPAN HEI and HEI-2020 demonstrated a moderate correlation, indicating that SPAN HEI may serve as a practical and less burdensome alternative for large-scale dietary assessments. While further validation is needed, these findings suggest its potential utility in monitoring diet quality at the population level.

Keywords: Healthy Eating Index (HEI); Texas School Physical Activity and Nutrition (Texas SPAN); diet quality; validation.

Figure 1

Bland–Altman difference in agreement examining SPAN survey HEI and 24 h. recall HEI.