Perspectives in Practice
Development of the Healthy Eating Index-2005
PATRICIA M. GUENTHER, PhD, RD; JILL REEDY, PhD, RD; SUSAN M. KREBS-SMITH, PhD, RD
The Healthy Eating Index (HEI) is a measure of diet
quality as specified by Federal dietary guidance, and
publication of the Dietary Guidelines for Americans 2005
necessitated its revision. An interagency working group
based the HEI-2005 on the food patterns found in My-
Pyramid. Diets that meet the least restrictive of the food-
group recommendations, expressed on a per 1,000 calorie
basis, receive maximum scores for the nine adequacy
components of the index: total fruit (5 points), whole fruit
(5 points), total vegetables (5 points), dark green and
orange vegetables and legumes (5 points), total grains (5
points), whole grains (5 points), milk (10 points), meat
and beans (10 points), and oils (10 points). Lesser
amounts are prorated linearly. Population probability
densities were examined when setting the standards for
minimum and maximum scores for the three moderation
components: saturated fat (10 points), sodium (10 points),
and calories from solid fats, alcoholic beverages (ie, beer,
wine, and distilled spirits), and added sugars (20 points).
Calories from solid fats, alcoholic beverages, and added
sugars is a proxy for the discretionary calorie allowance.
The 2005 Dietary Guideline for saturated fat and the
Adequate Intake and Tolerable Upper Intake Level for
sodium, expressed per 1,000 calories, were used when
setting the standards for those components. Intakes be-
tween the maximum and minimum standards are pro-
rated. The HEI-2005 is a measure of diet quality as
described by the key diet-related recommendations of the
2005 Dietary Guidelines. It has a variety of potential
uses, including monitoring the diet quality of the US
population and subpopulations, evaluation of interven-
tions, and research.
J Am Diet Assoc. 2008;108:1896-1901.
guidance (1). The Dietary Guidelines are revised every 5
years by the United States Departments of Agriculture
(USDA) and Health and Human Services.
In 1995, the USDA Center for Nutrition Policy and Pro-
motion released a Healthy Eating Index (HEI), which mea-
sured diet quality in terms of compliance with Federal di-
etary guidance (2,3). The original HEI (Table 1) and minor
updates to it are described in detail elsewhere (4-7).
Publication of the 2005 Dietary Guidelines necessi-
tated a revision of the HEI because of the increased
emphasis on important aspects of diet quality, such as
whole grains, various types of vegetables, specific types of
fat, and the introduction of the new concept of “discre-
tionary calories.” Therefore, the goal set for this revision
of the HEI was to develop a tool that measures diet
quality in terms of compliance with the key diet-related
recommendations of the 2005 Dietary Guidelines.
The purposes of this article are to describe the devel-
opment of the revised HEI, which is called the HEI-2005,
and its strengths, limitations, and potential applications.
An evaluation of the validity and reliability of the HEI-
2005 is presented in a companion article (8).
he Dietary Guidelines for Americans 2005 are the
basis of nutrition policy for the United States Gov-
ernment and the foundation of all Federal nutrition
An interagency working group reviewed the original HEI
and its uses and decided to base the revised index on the
food patterns found in USDA’s food guidance system,
MyPyramid. MyPyramid translates key recommendations
in the 2005 Dietary Guidelines into specific, quantified di-
etary recommendations (9). Dietary intake data from 8,650
respondents, who had provided complete and reliable data
from one 24-hour dietary recall, in the National Health and
Nutrition Examination Survey, 2001-2002 were used to de-
younger than the age of 2 years and breast-fed children
were excluded because the 2005 Dietary Guidelines were
not designed to meet their needs. Pregnant and lactating
women were excluded in accordance with practices for cal-
culating original HEI population scores (5-7).
Recommended amounts of foods to consume found in
the 12 MyPyramid food patterns and the Adequate In-
take (AI) and Tolerable Upper Intake Levels (UL) for
sodium were converted to densities, that is, amounts per
1,000 calories. The discretionary calorie allowances were
converted to calories from solid fats, alcoholic beverages,
and added sugars, and, along with saturated fat, were
expressed as percentages of total calories. Probability
densities for 1-day intakes of sodium per 1,000 calories,
percentage of calories from saturated fat, and percentage
P. M. Guenther is a nutritionist at the Center for Nutri-
tion Policy and Promotion, US Department of Agricul-
ture, Alexandria, VA. J. Reedy is a nutritionist and
S. M. Krebs-Smith is chief, Risk Factor Monitoring and
Methods Branch, Applied Research Program, Division of
Cancer Control and Population Sciences, National Can-
cer Institute, Bethesda, MD.
Address correspondence to: Patricia M. Guenther,
PhD, RD, Center for Nutrition Policy and Promotion,
US Department of Agriculture, 3101 Park Center Drive,
Suite 1034, Alexandria, VA 22302. E-mail: Patricia.
Manuscript accepted: April 11, 2008.
Published by Elsevier Inc. on behalf of the American
Journal of the AMERICAN DIETETIC ASSOCIATION
of calories from solid fats, alcoholic beverages, and added
sugars were estimated.
RESULTS AND DISCUSSION
Components of the Index
Because the recommendations found in MyPyramid were
set to ensure adequate nutrient intake (9), the components
MyPyramid; that is, total fruit, total vegetables, total
grains, milk, and meat and beans (Table 1). Additional
components were created to represent whole fruit, because
the 2005 Dietary Guidelines suggest that the majority of
fruit intake should be whole fruit rather than fruit juice;
dark green and orange vegetables and legumes, because
those are the three subgroups of vegetables for which cur-
rent intake is furthest from recommended levels; whole
grains, because the 2005 Dietary Guidelines specify that at
least half of grain intake should be whole; oils, because
recommendations for oil are found in MyPyramid; and cal-
ories from solid fats, alcoholic beverages, and added sugars,
which serves as a proxy for discretionary calories. The HEI-
2005 also includes components for saturated fat and sodium
to capture the 2005 Dietary Guidelines regarding them.
Details and SAS code for creating HEI-2005 components
are found at http://www.cnpp.usda.gov/HealthyEatingIndex-
The components do not necessarily directly represent
foods as eaten. For example, all components include foods
that are ingredients in mixed foods. Whole grains include
only the whole-grain portions of foods that contain both
whole and refined grains. Only the lowest fat portions of
milk and meat products are included in the milk and meat
and beans components, respectively. The fatty portions of
Table 1. Original Healthy Eating Index (HEI) and Healthy Eating Index-2005 (HEI-2005) components and standards for scoring
Meat (and beans)
Dark green and orange vegetables and legumesf
Meat and beansh
Calories from solid fats, alcoholic beverages,
and added sugars
0 4 ™™™™™™™™™™™™™™™™ 3 2-4 servings (approx. 1-2 cupsa)
0 4 ™™™™™™™™™™™™™™™™3 3-5 servings (approx. 1.5-2.5 cupsa)
0 4 ™™™™™™™™™™™™™™™™3 6-11 servings (approx. 6-11 oz eqa)
0 4 ™™™™™™™™™™™™™™™™3 2-3 servings (2-3 cupsb)
0 4™™™™™™™™™™™™™™™3 2-3 servings (approx. 5.5-7.0 oz eqa)
?6 4™™™™™™™™™™™™™™™™ 3 ?16 different foods in 3 daysc
?4.8 4™™™™™™™™™™™™™™3 ?2.4 g
?15 4 ™™™™™™™™™™™™™™™™ 3 ?10% energy
?45 4 ™™™™™™™™™™™™™™™™ 3 ?30% energy
?450 4 ™™™™™™™™™™™™™™™™ 3 ?300 mg
0 4 ™™™™™™™™™™ 3 ?0.8 cup eq/1,000 kcal
0 4 ™™™™™™™™™™ 3 ?0.4 cup eq/1,000 kcal
0 4 ™™™™™™™™™™ 3 ?1.1 cup eq/1,000 kcal
0 4 ™™™™™™™™™™ 3 ?0.4 cup eq/1,000 kcal
0 4 ™™™™™™™™™™ 3 ?3.0 oz eq/1,000 kcal
0 4 ™™™™™™™™™™ 3 ?1.5 oz eq/1,000 kcal
0 4™™™™™™™™™™™™™™™™ 3 ?1.3 cup eq/1,000 kcal
0 4™™™™™™™™™™™™™™™™ 3 ?2.5 oz eq/1,000 kcal
0 4 ™™™™™™™™™™™™™™™™ 3 ?12 g/1,000 kcal
?15 4 ™™™™™™™™™™™™™ 3 10 4™™™™™™™™™™™™ 3 7% of energy
?2.0 4 ™™™™™™™™™™™™3 1.1 4™™™™™™™™™™ 3 ?0.7 g/1,000 kcal
?50 4™™™™™™™™™™™™™™™™™™™™™™™™™™™™™™3 ?20% of energy
aAccording to sex and age.
bAccording to age.
cIn 1994-96 and 1999-2000, 8 or more different foods in 1 day.
dIncludes 100% juice.
eIncludes all forms except juice.
fIncludes legumes only after meat and beans standard is met.
gIncludes all milk products, such as fluid milk, yogurt and cheese, and soy beverages.
hIncludes legumes only if the meat and beans standard is otherwise not met.
iIncludes nonhydrogenated vegetable oils and oils in fish, nuts, and seeds.
November 2008 ● Journal of the AMERICAN DIETETIC ASSOCIATION
milk and meat products count as solid fat, whereas the fatty
portions of fish, nuts, and seeds count as oils, as do nonhy-
drogenated vegetable oils. Alcoholic beverages includes
beer, wine, and distilled spirits consumed as beverages, but
not as ingredients in mixed dishes.
Standards for Scoring Adequacy Components
In MyPyramid, recommendations for the amounts of food
groups, oils, and discretionary calories are expressed in
terms of absolute amounts (9); however, on a density
basis, many of the recommendations are similar across
energy levels (Table 2). Therefore, in the HEI-2005, in-
takes of foods and nutrients are assessed on a density
basis, that is, as a ratio to energy intake. The nutrient
adequacy components (food groups and oils) were based
on the 1,200- to 2,400-calorie patterns, which meet the
recommended nutrient intakes of nearly everyone. They
meet the needs of people who have higher energy require-
ments because the higher-calorie patterns had the same
nutrient goals (9). The 1,000-calorie pattern was not used
because it is aimed at only 2- to 3-year-olds, whose rec-
ommended nutrient intakes are lower than the rest of the
population, even when expressed on a density basis.
Among the 1,200- to 2,400-calorie patterns, the lowest
amount per 1,000 calories (ie, the least restrictive or
easiest to achieve) was selected as the standard for the
maximum score for each of these components.
For dark green vegetables, orange vegetables, and le-
gumes, the standard is the sum of the weekly recommen-
dations for those three subgroups of vegetables, expressed
on a per 1,000-calorie basis. Any combination of them
counts toward meeting the vegetable subgroup standard,
meat and beans standard has been met (11).
For all the components, intakes at the level of the stan-
dard or better are assigned the maximum number of total
points allotted (5, 10, or 20 points) (Table 1). Scoring the
adequacy components is straightforward because there is a
logical score of zero for no intake and the scores increase as
intakes increase up to the standard. Scores for amounts
between zero and the standard are prorated linearly.
Standards for Scoring Moderation Components
In the 2005 Dietary Guidelines, the recommendation for
saturated fat is not expressed as a single value, but
rather as “less than 10% of energy intake.” The 2005
Dietary Guidelines highlight two exemplary food guides
as being consistent with its guidance, MyPyramid, devel-
oped by the USDA Center for Nutrition Policy and Pro-
motion, and the Dietary Approaches to Stop Hyperten-
sion (DASH) Eating Plan, developed by the National
Heart, Lung, and Blood Institute. The examples of these
guides in the 2005 Dietary Guidelines have saturated fat
levels of 7% to 8% of energy (1). Both the Dietary Guide-
lines Advisory Committee and the Institute of Medicine
have recommended that saturated fat consumption be as
low as possible, suggesting that lower is better (12,13).
The DASH plan aims for 7%, and the 2006 American
Heart Association guidelines call for “7% or less” (14).
Based on these sources, 7% of calories was chosen as the
standard for the maximum score of 10 for the saturated
fat component. The 2005 Dietary Guideline is recognized
by assigning a score of 8, which, by convention, had indi-
cated a good score, to the level of 10% of calories, which
does not, however, represent an optimal intake level.
For the moderation components, it is less clear where to
assign a zero score than it is for the adequacy components
because increasing levels of intake get decreasing scores.
This reverse scoring for the moderation components has no
obvious mathematical equivalent to the zero for the ade-
quacy components, and no scientific evidence clearly speci-
fies how high an intake deserves a score of zero. If a stan-
dard were to be set such that a large proportion of the
population would get a score of zero, it would be difficult to
detect differences among individuals and groups and
changes over time at the low end of the scoring range. To
Table 2. Recommended amounts of food groups, expressed per 1,000 kcal, and discretionary calorie allowances, expressed as a percentage
of total calories, found in MyPyramid
2,000 1,000 1,200 1,4001,6001,8002,2002,400 2,600 2,8003,000 3,200
Fruits (cup eq/1,000 kcal)
Vegetables (cup eq/1,000 kcal)
Dark green vegetables
Grains (oz eq/1,000 kcal)
Milk (cup eq/1,000 kcal)
Meat and Beans (oz eq/1,000 kcal)
Oils (g/1,000 kcal)
Discretionary calories (%)
NOTE: Information from this table is available online at www.adajournal.org as part of a PowerPoint presentation.
November 2008 Volume 108 Number 11
mitigate this problem, a value at approximately the 85th
percentile of the population distribution was selected as the
Figure 1 presents the probability density of calories from
saturated fat, expressed as a percentage of energy. In 2001-
2002, 42% of 1-day intakes met the 2005 Dietary Guideline
of 10% of calories from saturated fat or lower and 16% of
intakes met the standard of 7% or lower of calories. At the
other end of the distribution, 15% of intakes were at 15% of
calories from saturated fat or higher. The minimum score of
zero was set at that level. Amounts between 7% and 10%
and between 10% and 15% are prorated linearly.
The 2005 Dietary Guidelines recommendation for so-
dium for most individuals is “less than 2,300 mg/day,” but
for individuals with hypertension, blacks, and middle-
aged and older adults, the recommendation is “no more
than 1,500 mg/day.” These values represent the UL and
AI, respectively, set by the Food and Nutrition Board
(15). In light of these recommendations, 1,500 mg was
chosen as the basis for the maximum score of 10, and
2,300 mg was chosen as the basis for the relatively good
score of 8 for the sodium component because it does not
represent an optimal intake level.
The sodium standard was set by using the approach
used by the Institute of Medicine to set the Dietary Ref-
erence Intakes (DRIs) for older adults and children. The
DRI panel divided the DRIs they had set for young and
middle-aged adults by the estimated median energy in-
take for that age group (2,150 calories per day) and then
used those same densities (milligrams of sodium per cal-
orie) to set the DRIs for younger and older individuals.
The density standards for the sodium component of the
HEI-2005 were determined the same way. The highest
possible score of 10 is assigned to diets that have ?700
mg sodium per 1,000 calories (1,500 mg sodium [AI level]/
2,150 calories), and a score of 8 is assigned to 1,100 mg of
sodium per 1,000 calories (2,300 mg sodium [UL and 2005
Dietary Guidelines level]/2,150 calories).
The probability density of the population’s 1-day intake
of sodium per 1,000 calories is shown in Figure 2. The AI
is the basis for the standard of 700 mg/1,000 calories for
the maximum score; 2.5% of intakes are at that level or
lower. The 2005 Dietary Guideline limit is recognized by
giving a score of 8 to 2,300 mg, converted to a density of
1,100 mg/1,000 calories; 18% of 1-day intakes are at that
level or lower. The minimum score was set at 2,000 mg of
sodium per 1,000 calories because about 15% (17%) of
1-day intakes are at that level or higher. The amounts
between 700 mg and 1,100 mg/1,000 calories and between
1,100 and 2,000 mg/1,000 calories are prorated linearly.
The 2005 Dietary Guidelines Advisory Committee intro-
duced the concept of “discretionary calories,” defined as the
“difference between total energy requirements and the en-
ergy consumed to meet recommended nutrient intakes”
(12). The 2005 Dietary Guidelines further explain that
added fats or sugars per se are not directly limited. Rather,
the discretionary calories allowance is a defined number of
calories that may come from any mix of solid fat, added
sugar, alcohol, or additional amounts of nutrient-rich foods
beyond the recommended levels (1).
Nonetheless, the population generally consumes more
calories from solid fats, added sugars, and/or alcoholic
beverages than the allowance permits (16), so a compo-
nent that specifically captured the calories from solid
fats, alcoholic beverages, and added sugars was devel-
oped. This component is not intended to be a measure of
solid fat, alcohol, and/or added sugar per se, but rather a
measure of the calories in the diet that are obtained from
dietary constituents other than nutrient-dense foods. The
standard for the maximum score is the least restrictive,
or easiest to achieve, of all the discretionary calorie al-
lowances found in MyPyramid, 20% of calories (Table 2).
For calories from solid fats, alcoholic beverages, and
added sugars, about 10% of 1-day intakes were below the
standard of 20% of calories, and 14% were above 50% of
calories. The maximum score of 20 and the minimum of 0
were set at these levels, respectively. The amounts in
between are prorated linearly.
Weighting of the HEI-2005 Total Score
The HEI-2005 components should be considered to be a
set of scores that measure compliance with the many
(16th pct)(42nd pct)(85th pct)
Figure 1. Distribution of 1-day saturated fat intake as a percentage of
energy, United States, 2001-2002. NOTE: Information from this figure
is available online at www.adajournal.org as part of a PowerPoint
(85th pct)(2nd pct)
Figure 2. Distribution of 1-day sodium intake per 1,000 kcal energy,
United States, 2001-2002.
November 2008 ● Journal of the AMERICAN DIETETIC ASSOCIATION
different aspects of the 2005 Dietary Guidelines. When a
single summation score is also needed, the HEI-2005
component scores can be weighted to derive a total HEI-
2005 score. The maximum value of each component effec-
tively serves as the weight; that is, the total score can be
considered to be a weighted sum of the component scores.
Although the HEI-2005 weighting may seem arbitrary,
it reflects the directive found in the 2005 Dietary Guide-
lines to take all the guidance as a whole. Therefore, most
components of the HEI-2005 are weighted equally. Fruit,
vegetables, and grains each have two components (total
and a subgroup) that get 5 points each, so these three food
groups effectively are allotted 10 points each. The one
exception is calories from solid fats, alcoholic beverages,
and added sugars, which is weighted twice as heavily as
any other component (20 points), because 1) the 2005
Dietary Guidelines encourage the selection of “low-fat
forms of foods in each food group and forms free of added
sugar,” and 2) solid fats, alcoholic beverages, and added
sugars may displace nutrient-dense foods in the diet, add
energy without adding nutrients, and are currently con-
sumed in amounts that far exceed the discretionary cal-
orie allowances (16).
Implications of Truncated Scores
The ability to detect meaningful changes over time or dif-
ferences among groups at one point in time in the score is
especially important when scores are truncated as they are
effects, when scores bunch at the low end (0) of the scale, or
depending on the component). This point was addressed in
two ways. First, the minimum score for saturated fat; so-
dium; and calories from solid fats, alcoholic beverages, and
added sugars, was set at about the 85th percentile of the
intake distribution. The scoring system was designed so
that a large proportion of the population would not get a
zero so that future changes in diets, however subtle, could
be detected. Second, because the range of scores applied to
each component is relatively large, each 1-point change or
difference is indicative of a small change in intake. The
ability of the HEI to detect changes and differences is de-
termined not only by the scoring system, but also by the
study sample size, the precision of the dietary assessment
instrument, and the ability of the coding system to capture
the dietary components of interest.
If the HEI weretobeusedwithdietarydatathatrepresent
observation periods longer than 1 day, such as might be col-
naire, the floor and ceiling effects would be mitigated. More
days of intake data or estimates of usual intake would reduce
within-person variance and result in fewer component scores
at the minimum and maximum levels. However, the greater
accuracy and precision of 24-hour recall data compared to, for
example, what can be expected from a food frequency ques-
tionnaire, may well be of greater value than any concomitant
loss of precision that may be attributable to a floor or ceiling
effect in the distribution of the scores.
The major strengths of the HEI-2005 are that it: 1) as-
sesses diets on a per 1,000 calorie basis in order to char-
acterize diet quality while controlling for diet quantity; 2)
addresses the consumption of energy-dense, nutrient-
poor foods and ingredients; and 3) emphasizes those as-
pects of the American diet that are furthest from current
recommendations (1). The reliance on food-group rather
than nutrient standards reflects a basic premise of the
2005 Dietary Guidelines, which is that nutrient needs
should be met primarily through consuming foods. The
HEI-2005 also is consistent with the assertion that the
2005 Dietary Guidelines are interrelated and mutually
dependent and should be used together.
Density standards are useful not only because they
allow common standards to be used, but also because they
are independent of an individual’s energy requirement,
which is difficult to measure precisely. In effect, the den-
sity approach to setting standards uncouples diet quality
from diet quantity by allowing the assessment of the
quality of the mix of foods consumed, rather than the
absolute amounts of foods consumed.
The HEI-2005 does not apply to children younger than 2
years of age; its validity for specific ethnic and cultural
groups whose dietary patterns are markedly different
from the US norm remains to be determined (17); and it
does not directly capture excess intake of the major food
groups, oils, total fat, cholesterol, or trans fat. To reflect
the 2005 Dietary Guidelines related to fat, the HEI-2005
has one component for saturated fat and one for oils from
fish, nuts, and nonhydrogenated vegetable oils. Although
several types of fat are mentioned in the 2005 Dietary
Guidelines (total fat, saturated fat, trans fat, and choles-
terol), limiting saturated fat is considered the most im-
portant because current intake is more excessive than
that of trans fat or cholesterol (1). Separate components
for total fat and cholesterol were considered to be unnec-
essary in the HEI-2005 because intakes of both are sig-
nificantly correlated with saturated fat (0.92 and 0.59,
respectively). The HEI-2005 also captures solid fats,
which include hydrogenated vegetable oils. Solid fats are
important sources of both trans-fatty acids and choles-
terol. It would be very difficult to monitor intake of trans
fats because the food industry is working to reduce their
levels in the US food supply (18).
Because the food patterns in MyPyramid did not meet Rec-
potassium, a perfect score on the HEI may not ensure ade-
nutrients. The recommendations in MyPyramid were set to
meet the RDAs and AIs established by the Institute of Medi-
cine. The RDAs are appropriate standards for MyPyramid
because the patterns provide plans for individuals to follow to
ensure nutrient adequacy (19). However, the RDAs are too
Estimated Average Requirements (EARs) would be more ap-
propriate for use in the HEI. We cannot, however, set food-
group?based standards that would provide average nutrient
requirements until EARs are available for all nutrients of
interest. Lacking EAR-based standards, we set the standards
at the lowest level among the MyPyramid recommendations
for sedentary individuals.
The density standards have limitations. The meat and
beans and the milk recommendations in MyPyramid,
November 2008 Volume 108 Number 11
when expressed per 1,000 calories, vary more than the Download full-text
other food groups. Iron and calcium requirements are
much higher for some age/sex groups who have relatively
low energy requirements; therefore, iron and calcium re-
quirements are generally inversely correlated with en-
ergy requirements. The discretionary calorie allowances
also vary more than the food-group recommendations
because energy and nutrient requirements are not well-
correlated. For example, the lowest discretionary calorie
allowance is found in the 1,600-calorie MyPyramid pat-
tern and reflects the low energy but high nutrient needs
of women. In contrast, the highest allowance, found at
3,200 calories, reflects the high energy needs and, in
comparison to their energy needs, the relatively lower
nutrient requirements of active teenage boys.
The choice of the least restrictive of the various MyPyramid
food intake recommendations as the basis for the density
standards led to the scores being higher than they might
be otherwise. This means the scores are more specific,
and less sensitive, when identifying intakes that do not
meet recommendations. Nonetheless, except for total
grains and meat and beans, very high component and
total scores are quite rare. This suggests that, as a prac-
tical matter, choosing the least restrictive standard did
not limit the range of scores appreciably.
The objectives for revision of the HEI have been met. The
HEI-2005 is a tool that was designed to assess diet qual-
ity as described in the 2005 Dietary Guidelines and has a
variety of potential uses. It is used by the USDA for
population monitoring (20). Other potential uses include
evaluation of menus and other diet plans, evaluation of
nutrition interventions, epidemiologic research, economic
research, and other types of research. HEI-2005 scores
might also serve as a measure of nutrient density of diets
as defined by the 2005 Dietary Guidelines because the
food group components are all in their most nutrient-
dense form—without added sugar or fat—and the calories
from the solid fats, alcoholic beverages, and added sugars
component of the HEI-2005 captures the foods and ingre-
dients of foods that decrease the nutrient density of diets.
Possibilities for further research include adaptations of
the HEI-2005 for specific subpopulations, such as Alaska
Natives (17). Research is needed to determine the best
statistical method for estimating HEI-2005 scores at the
population level for nutrition-monitoring purposes.
There are no potential conflicts of interest, funding, or
gifts to disclose.
The authors gratefully acknowledge the contributions
of Anne Rodgers for editorial assistance; Lisa Kahle, Infor-
mation Management Services, Inc, for SAS programming
and data analysis; WenYen Juan, USDA Center for Nutri-
tion Policy and Promotion, for producing the figures and
creating the whole fruit component; Thea Palmer Zim-
merman, Westat, Inc, for coding the exemplary menus;
Meredith Morrissette, NCI, for table preparation; Molly
Kretsch, USDA Agricultural Research Service, Richard
Troiano, National Cancer Institute, Pamela Haines, Uni-
versity of North Carolina, Eileen Kennedy, Tufts Univer-
sity, and Laurence Freedman, Gertner Institute for Epi-
demiology, Israel, for expert consultation; and the other
members (in addition to the authors) of the 2005 HEI
Working Group: Peter Basiotis, Patricia Britten, Andrea
Carlson, Carole Davis, Eric Hentges, Hazel Hiza,
WenYen Juan, and Mark Lino, Center for Nutrition Pol-
icy and Promotion; and Jay Hirschman and Patricia
McKinney, USDA Food and Nutrition Service.
1. US Health and Human Services and US Department of Agriculture.
Dietary Guidelines for Americans 2005. 6th ed. Washington, DC: US
Government Printing Office; 2005.
2. Nutrition and Your Health: Dietary Guidelines for Americans. 3rd ed.
Washington, DC: US Department of Agriculture/Department of
Health and Human Services; 1990. Home and Garden Bulletin No.
3. US Department of Agriculture, Center for Nutrition Policy and Promo-
tion. The Food Guide Pyramid. Washington, DC: US Department of
Agriculture; 1992 (sl. rev. 1996). Home and Garden Bulletin No. 252.
4. Kennedy ET, Ohls J, Carlson S, Fleming K. The Healthy Eating
Index: Design and applications. J Am Diet Assoc. 1995;95:1103-1108.
5. US Department of Agriculture, Center for Nutrition Policy and Pro-
motion. The Healthy Eating Index. Washington, DC: CNPP-1; 1995.
6. Bowman SA, Lino M, Gerrior SA, Basiotis PP. The Healthy Eating
Index: 1994-96. US Department of Agriculture, Center for Nutrition
Policy and Promotion. Washington, DC: CNPP-5; 1998.
7. Basiotis PP, Carlson A, Gerrior SA, Juan WY, Lino M. The Healthy
Eating Index: 1999-2000. US Department of Agriculture, Center for
Nutrition Policy and Promotion. Washington, DC: CNPP-12; 2002.
8. Guenther PM, Reedy J, Krebs-Smith SM, Reeve BB. Evaluation of the
Healthy Eating Index-2005. J Am Diet Assoc. 2008;108:1854-1864.
9. Britten P, Marcoe K, Yamini S, Davis C. Development of food intake
patterns for the MyPyramid food guidance system. J Nutr Educ
Behav. 2006;38(suppl S6):S78-S92.
10. National Center for Health Statistics. NHANES 2001-2002 Public
Data General Release File Documentation; 2004. National Center for
Health Statistics Web site. http://www.cdc.gov/nchs/data/nhanes/
nhanse_01_02/general_data_release_doc.pdf. Accessed January 25,
11. US Department of Agriculture, Center for Nutrition Policy and Pro-
motion. How to count dry peas and beans in the Food Guide; 2005.
MyPyramid.gov Web site. http://www.mypyramid.gov/pyramid/dry_
beans_peas_table.html. Accessed January 25, 2008.
12. Dietary Guidelines Advisory Committee. Report of the Dietary Guide-
lines Advisory Committee on the Dietary Guidelines for Americans.
2005. Washington, DC: US Department of Agriculture, Agricultural
Research Service; 2004.
13. Institute of Medicine, Food and Nutrition Board, Dietary Reference
Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol,
Protein, and Amino Acids. Washington, DC: The National Academies
14. Lichtenstein AH, Appel LJ, Brands M, Carnethon M, Daniels S,
Franch HA, Franklin B, Kris-Etherton P, Harris WS, Howard B,
Karaja N, Lefevre M, Rudel L, Sacks F, Van Horn L, Winston M,
Wylie-Rosett J. Diet and lifestyle recommendations revision 2006: A
scientific statement from the American Heart Association Nutrition
Committee. Circulation. 2006;114:82-96.
15. Institute of Medicine, Food and Nutrition Board. Dietary Reference
Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Wash-
ington, DC: The National Academies Press; 2004.
16. Basiotis PP, Guenther PM, Lino M, Britten P. Americans consume too
many calories from solid fat, alcohol, and added sugar. US Depart-
ment of Agriculture, Center for Nutrition Policy and Promotion. Nu-
trition Insight. 2006;33.
17. Bersamin A, Luick BR, Ruppert E, Stern JS, Zidenberg-Cherr S. Diet
quality among Yup’ik Eskimos living in rural communities is low: The
Center for Alaska Native Health Research Pilot Study. J Am Diet
18. Hunter JE. Dietary levels of trans fatty acids: Basis for health con-
cerns and industry efforts to limit use. Nutr Res. 2005;25:499-513.
19. Institute of Medicine, Food and Nutrition Board. Dietary Reference
Intakes: Applications in Dietary Assessment. Washington, DC: The
National Academies Press; 2000.
20. US Department of Agriculture. USDA Strategic Plan for FY 2005-
2010; 2006. USDA Office of the Chief Financial Officer Web site.
http://www.ocfo.usda.gov/usdasp/sp2005/sp2005.pdf. Accessed Janu-
ary 25, 2008.
November 2008 ● Journal of the AMERICAN DIETETIC ASSOCIATION