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America's Children: Key National Indicators of Well-Being, 2017

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 associated with obesity and obesity-related chronic diseases. The Dietary guidelines for Americans highlight the importance of enhancing overall healthy eating and physical activity patterns to help promote good health and prevent chronic disease.145 The Healthy Eating Index-2010 (HEI-2010) is a dietary assessment tool designed to measure alignment with the 2010 Dietary guidelines for Americans as implemented by the U.S. Department of Agriculture (USDA) Food Patterns.145, 146 The HEI-2010 total and component scores in this analysis are averages across all children ages 2–17 and reflect usual dietary intakes.147 Children and adolescents can improve the quality of their diets by replacing foods high in sodium, empty calories, and refined grains with more nutrient-dense foods such as fruits, vegetables, whole grains, and low-fat dairy and by increasing the variety of their protein food choices, so that they include seafood and plant proteins such as legumes, nuts, and seeds.

Indicator HEALTH6: Average diet quality scores using the Healthy Eating Index-2010 for children ages 2–17 by age groups, 2011–2012
Indicator HEALTH6: Average diet quality scores using the Healthy Eating Index-2010 for children ages 2–17 by age groups, 2011–2012

NOTE: The Healthy Eating Index-2010 (HEI-2010) has 12 components. Nine of the 12 components (shown on the left-hand side of the figure) represent adequacy components of a diet. The remaining components (the three components on the right-hand side of the figure) represent moderation components of a diet, components that should be consumed in moderation. The darker colored portion of a bar represents the average component score, while the lighter colored portion of a bar represents the difference between the average component score and the maximum achievable score. (In a case where the average component score is equivalent to the maximum achievable score—such as for the total fruit component for the ages 2–5 group—the bar is made up solely of the darker color.) An average intake that achieves the standard set for a component is assigned a maximum score. Scores for intakes between the minimum and maximum standards are scored proportionately. Scores for each of the 12 components are summed to a total maximum score of 100. For the adequacy components, higher scores reflect higher intakes of these dietary components. For the moderation components, higher scores reflect lower intakes of these less desirable dietary components. A higher total score indicates a higher quality diet. Starting with America's Children 2017, Diet Quality component scores will be reported as the actual scores instead of percentages of the maximum component scores. Detailed information on how the HEI scores were developed can be found at https://www.cnpp.usda.gov/sites/default/files/healthy_eating_index/HEI2010-UpdatePaper.pdf.

SOURCE: National Center for Health Statistics, National Health and Nutrition Examination Survey and U.S. Department of Agriculture, Center for Nutrition Policy and Promotion and the U.S. Department of Health and Human Services, Healthy Eating Index-2010.

  • The diets of children and adolescents did not align with the 2010 Dietary guidelines for Americans. The total average HEI scores were 60, 54, and 52 out of a maximum 100 points for children ages 2–5, 6–11, and 12–17, respectively.
  • The only age group to achieve the maximum score for total fruit, whole fruit, and dairy was the ages 2–5 group.
  • Total fruit, whole fruit, total protein foods, seafood and plant proteins, and dairy were closest to the HEI maximum component score, while total vegetables, greens and beans, whole grains, refined grains, sodium, and empty calories were farthest from the maximum HEI component score.

table icon HEALTH6 HTML Table

145 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 https://www.cnpp.usda.gov/dietary-guidelines-2010

146 Guenther, P. M., Casavale, K. O., Reedy, J., Kirkpatrick, S. I., Hiza, H. A. B., Kuczynski, K. J., Krebs-Smith, S. M. (2013). Update of the Healthy Eating Index: HEI-2010. Journal of the Academy of Nutrition and Dietetics, 113 (4), 569–580.

147 Freedman, L. S., Guenther, P. M., Krebs-Smith, S. M., & 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.