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Article Excerpt
The Healthy Eating Index (HEI) provides a numerical yardstick of diet quality based on the Food Guide Pyramid (U.S. Department of Agriculture [USDA], 1996) and the Dietary Guidelines for Americans (USDA & U.S. Department of Health and Human Services [DHHS], 1995). It was designed to evaluate diets according to a more contemporary understanding of healthful eating, one that recognizes the role of overconsumption and poor diet choice as contemporary public health problems (Kennedy, Ohls, Carlson, & Fleming, 1995).
Previous study of HEI scores among demographic groups reports that age may be associated with more careful choices of nutritious foods (Basiotis, Hirschman, & Kennedy, 1996; Gaston, Mardis, Gerrior, Sahyoun, & Anand, 2001). In fact, healthful eating as it is currently defined is highest among those in the oldest age categories (McDonald & Webster, 1998; Bowman, Lino, Gerrior, & Basiotis, 1998). This result is surprising given the potential impediments to a nutritious diet such as lower average nutrition knowledge and diet-health awareness (McDonald & Webster, 1998), reduced mobility, lower average educational attainment, financial resources (Administration on Aging, 2003), and even receptiveness (Bernheim, 1990) to new information among the elderly.
Further exploration of the HEI and its components is needed to understand better the relationship between advanced age and higher HEI scores. Gaston et al. (1999) note that mean scores among the elderly may be attributed to reduced consumption of food energy, which leads to better scores for components (e.g., fat, saturated fat, cholesterol, and sodium) that penalize for overconsumption. Compared with younger groups, the elderly also appear to consume more fruits. Identifying the independent effect of age on HEI components may provide insight into elderly nutrition and ultimately into the factors leading to variation in HEI scoring.
The HEI score comprises 10 components that represent different aspects of a healthful diet. The first five components measure adherence to the food groups of the Food Guide Pyramid: grains, vegetables, fruits, milk, and meat. Components 6 and 7 measure total fat and saturated fat consumption, respectively, as a percentage of total food energy intake. Components 8 and 9 measure total cholesterol and sodium intake, respectively, and component 10 examines the variety in a person's diet. Scores for each component range from to 10; thus, 100 is the highest HEI score attainable. According to the USDA Center for Nutrition Policy and Promotion (CNPP), an HEI score at or below 80 suggests that one's diet needs to improve, a score below 51 rates a diet as poor, and a score above 80 is considered a good diet (USDA, 1995).
This study compares average scores and CNPP ratings of diet quality for the total HEI as well as for component scores among age groups. A multivariate analysis is also performed on the total HEI and each component to estimate the independent effect of age upon scores.
Methods
HEI mean scores for each of the 10 components were compared among five age groups: less than 35, 35-49, 50-64, 65-79, and 80 and above. Those age 65 and above were considered elderly in this analysis. To conduct the comparison, we used CNPP's categorical scoring system for overall diet quality to determine the proportion of diets designated "poor," "needs improvement," or "good." Each person's HEI component was also graded according to guidelines as outlined by Variyam, Blaylock, Smallwood, and Basiotis (1998). For the first five components (grains, vegetables, fruits, milk, meat), a score of 10 was awarded if the respondent met the recommended servings for that component....
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