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America's Children: Key National Indicators of Well-Being, 2013

Diet Quality

A good quality diet is a major contributing factor to the health and well being of children and adolescents. Poor eating patterns in childhood are major contributors to childhood obesity (see HEALTH 7) and contribute to chronic diseases starting in childhood, such as type 2 diabetes,129 and those that emerge throughout the life cycle, such as cardiovascular disease.130 The Healthy Eating Index-2010 (HEI-2010) is a dietary assessment tool comprising 12 components designed to measure quality in terms of how well diets meet the recommendations of the 2010 Dietary Guidelines for Americans and the USDA Food Patterns.131, 132 The HEI-2010 component scores are averages across all children and reflect usual dietary intakes.133 Nine components of the HEI-2010 address dietary adequacy. The remaining three components assess refined grains, sodium, and empty calories, all of which should be consumed in moderation, that is, in limited quantities.

Indicator Health6: Average diet scores for children ages 2–17, expressed as a percentage of Federal diet quality standards, 2003–2004, 2005–2006, and 2007–2008
Average diet scores for children ages 2–17, expressed as a percentage of Federal diet quality standards, 2003–2004, 2005–2006, and 2007–2008

NOTE: HEI-2010 scores are expressed as percentages of recommended dietary intake levels. A score corresponding to 100 percent indicates that the recommendation was met or exceeded, on average. For the adequacy components, higher scores reflect higher intakes. For the moderation components, higher scores reflect lower intakes because lower intakes are more desirable. For all components, a higher percentage indicates a higher quality diet. "Empty calories" refers to calories from solid fats (i.e., sources of saturated fats and trans fats) and added sugars (i.e., sugars not naturally occurring). Total fruit includes 100 percent fruit juice.

SOURCE: National Center for Health Statistics, National Health and Nutrition Examination Survey, 2003–2004, 2005–2006, 2007–2008 and U.S. Department of Agriculture, Center for Nutrition Policy and Promotion Addendum to the MyPyramid Equivalents Database.

  • The total Healthy Eating Index-2010 score is a measure of overall diet quality. For children ages 2–17 years in 2003–2004, 2005–2006, and 2007–2008, the total scores were only between 47 and 50 percent, and the differences were not statistically significant. The diet quality of children and adolescents fell considerably short of recommendations.
  • The average scores for all the components of the HEI-2010 were below the standards. Dairy (milk and milk products) and total protein foods (meat, fish, poultry, eggs, etc.) were closest to the standards (between 83 and 86 percent and between 80 and 84 percent, respectively). Scores for greens and beans and whole grains were farthest from the standards (between 14 and 18 percent and between 16 and 18 percent, respectively). This meant that 2- to 17-year-olds consumed far less than the recommended level of dark green vegetables and beans and of whole grains. On average, the component scores were similar across the three time periods, except for total fruit and whole fruit, which were the highest in 2007–2008.
  • The diet quality scores of children and adolescents would be improved by increasing the intake of vegetables, especially dark greens and beans, replacing refined grains for whole grains, substituting seafood for some meat and poultry, and decreasing the intake of sodium (salt) and empty calories from solid fats and added sugars. 

table icon HEALTH6 HTML Table

130 Wilson, P.W., D'Agostino, R.B., Sullivan, L., Parise, H., and Kannel, W.B. (2002). Overweight and obesity as determinants of cardiovascular risk: The Framingham Experience. Arch Intern Med, 162, 1867–1872.

131 U.S. Department of Agriculture and U.S. Department of Health and Human Services. (2010). Dietary Guidelines for Americans. (7th ed.). Washington, DC: U.S. Government Printing Office. Available at

132 Guenther, P.M., Casavale, K.O., Reedy, J., Kirkpatrick, S.I., Hiza, H.A.B., Kuczynski, K.J., Kahle, L.L., and Krebs-Smith, S.M. (2013). Update of the Healthy Eating Index: HEI-2010. Journal of the Academy of Nutrition and Dietetics, Apr; 113(4): 569–80.

133 Freedman, L.S., Guenther, P.M., Krebs-Smith, S.M., and Kott, P.S. (2008). A population's mean Healthy Eating Index-2005 scores are best estimated by the score of the population ratio when one 24-hour recall is available. Journal of Nutrition, 138, 1725–1729.