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America's Children: Key National Indicators of Well-Being, 2021

Diet Quality

The Dietary Guidelines for Americans provide science-based advice on what to eat and drink to promote health, reduce the risk of chronic disease, and meet nutrient needs.132, 133 Poor eating patterns in childhood are associated with childhood obesity; the risk of chronic diseases starting in childhood, such as type 2 diabetes; 134, 135 and diseases that emerge throughout the life cycle, such as cardiovascular disease and cancer.132, 133, 134 The Healthy Eating Index–2015 (HEI-2015) is a dietary assessment tool comprising 13 components designed to measure quality in terms of how well dietary intake aligns with the 2015–2020 Dietary Guidelines for Americans.134 HEI scores among children show that from an early age, diets do not align with the Dietary Guidelines. Children and adolescents can improve the quality of their diets by making nutrient-dense food choices as part of a healthy dietary pattern described in the Dietary Guidelines for Americans. Nutrient-dense foods provide vitamins, minerals, and other health-promoting components and have no or little added sugars, saturated fat, and sodium. A healthy dietary pattern consists of nutrient-dense forms of foods and beverages across all food groups, in recommended amounts, and within calorie limits.

Indicator HEALTH6: Average diet quality scoresa using the Healthy Eating Index–2015 for children ages 2–17 by age group, 2017–2018
Indicator HEALTH6: Average diet quality scoresa using the Healthy Eating Index–2015 for children ages 2–17 by age group, 2017–2018

a Calculated using the population ratio method.

NOTE: The Healthy Eating Index–2015 (HEI-2015) is a measure of diet quality with 13 components used to assess how well a set of foods aligns with the key recommendations of the 2015–2020 Dietary Guidelines for Americans. Intakes equal to or better than the standards set for each component are assigned a maximum score. Maximum HEI-2015 component scores range from 5 to 10 points. Scores for intakes between the minimum and maximum standards are scored proportionately. Scores for each component are summed to create a total maximum HEI-2015 score of 100 points. Nine of the 13 components assess adequacy components. The remaining four components assess dietary components that should be consumed in moderation. For the adequacy components, higher scores reflect higher intakes. For the moderation components, higher scores reflect lower intakes because lower intakes are more desirable. A higher total score indicates a diet that aligns better with the Dietary Guidelines. HEI-2015 total and component scores reflect usual dietary intakes among children ages 2–17 in the United States, during 2017–2018. The light solid bars represent the maximum scores possible for each component. The dark shaded bars represent the actual scores obtained for each component.

SOURCE: U.S. Department of Agriculture, Center for Nutrition Policy and Promotion; U.S. Department of Health and Human Services, National Cancer Institute; and National Center for Health Statistics, National Health and Nutrition Examination Surveys.

  • During 2017–2018, the average Total HEI-2015 scores for ages 2–5, 6–11, and 12–17 were 61, 53, and 51, respectively, out of 100. Overall, the total diets of children and adolescents did not align with the Dietary Guidelines for Americans.
  • During 2017–2018, children ages 2–5 met the maximum HEI-2015 component scores for Total Fruit and Whole Fruit. Children ages 6–11 met the maximum HEI-2015 component score for Whole Fruit.
  • Component scores were furthest from the maximum for Greens and Beans, Whole Grains, Fatty Acids, Sodium, and Saturated Fats among children ages 2–17.

table icon HEALTH6 HTML Table

132 U.S. Department of Agriculture and U.S. Department of Health and Human Services. (2020). Dietary Guidelines for Americans, 2020–2025 (9th ed.). https://dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_ Americans-2020-2025.pdf

133 U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2015). 2015–2020 Dietary Guidelines for Americans (8th ed.) http://health.gov/dietaryguidelines/2015/guidelines

134 Centers for Disease Control and Prevention. (n.d.). Childhood obesity causes & consequences. http://www.cdc.gov/obesity/childhood/causes.html

135 Gordon-Larsen, P., The, N. S., & Adair, L. S. (2010). Longitudinal trends in obesity in the United States from adolescence to the third decade of life. Obesity, 18(9),1801–804.