Modifications to the Healthy Eating Index and its ability to predict obesity: the Multi-Ethnic Study of Atherosclerosis

Department of Epidemiology, University of Washington, Seattle, WA, USA.
American Journal of Clinical Nutrition (Impact Factor: 6.77). 07/2008; 88(1):64-9.
Source: PubMed


The Healthy Eating Index (HEI) is a measure of diet quality developed based on the Dietary Guidelines for Americans (DGA).
The objective was to assess the diet quality of a multi-ethnic population using and comparing the 2 HEIs, the updated HEI (HEI-05) based on the 2005 DGA and the original 1990 HEI (HEI-90), with the objective of predicting obesity outcomes.
A longitudinal analysis of survey and clinical data from 6236 middle-aged and elderly white, African American, Hispanic, and Chinese participants of the Multi-Ethnic Study of Atherosclerosis (MESA) was conducted. Baseline diet quality was assessed with the use of HEI-90 and HEI-05. Baseline and 18-mo follow-up body mass index (BMI) and waist circumference (WC) data were predicted by using z score multiple regression models, and categorical obesity status was predicted by using multinomial logistic regression.
Overall, the HEI-05 had larger z score beta coefficients than did the HEI-90 (eg, in whites, -0.53 compared with -0.48 in baseline BMI, -0.54 compared with -0.47 in follow-up BMI, -1.67 compared with -1.56 in baseline WC, and -1.57 compared with -1.44 in follow-up WC). Among whites only, both HEIs were significant predictors of BMI and WC (all P < 0.001). The odds of being obese rather than normal weight were inversely related to HEI z scores primarily in whites (P < 0.05).
The changes to the 2005 DGA, as reflected by HEI-05, appear to better predict obesity outcomes in this multi-ethnic population, primarily in whites. Additional research on ethnic-specific DGA adherence and its relation to health outcomes is needed.

13 Reads
    • "In the present study, we related people's self-and peer-perception of healthy eating to the objective indicator BMI and the frequency of eating healthy or unhealthy foods. However, evidence about the relationship between healthy eating and BMI is mixed, with some papers pointing to a negative relationship (e.g., Gao et al., 2008; Haslam & James, 2005) whereas others do not find an association (e.g., Beydoun & Wang, 2010; Kleiser et al., 2009). In our study, people with higher BMI might have eaten as healthily as people with lower BMI, with their higher body weight resulting, for example, from a lower level of energy expenditure or unhealthy eating in the past. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The present study investigated people's perception of their own as compared to their peers' healthy eating and related these perceptions to actual healthy eating, BMI, and subsequent healthy eating behavior. Data was collected within the framework of the longitudinal cohort study Konstanz Life Study (T1: N = 770; T2: N = 510). Our results demonstrated an optimistic bias on the group level. Specifically, people rated their own eating behavior as healthier on average than that of their average peers. This comparative optimism occurred even when actual healthy eating was unfavorable and BMI was high. However, it increased with actual healthy eating behavior. Importantly, optimistic perceptions were positively related to the intention to eat healthily and healthy eating six months later. Hence, the results suggest that an optimistic comparative view of one's own healthy eating is grounded in reality and boosts rather than deters subsequent health behavior. This implies that there might not be a need to reduce optimistic perceptions of healthy eating behavior. Copyright © 2015. Published by Elsevier Ltd.
    Appetite 03/2015; 90. DOI:10.1016/j.appet.2015.03.008 · 2.69 Impact Factor
  • Source
    • "In the present study, the previously described HEI-2005 (Guenther et al. 2007, 2008), adapted to Brazilian dietary guidelines (B-HEI), was applied in an attempt to establish this relationship. The finding that the subset of individuals with the highest B-HEI values had better measures of body adiposity (lower BMI and waist circumference) is in agreement with the results of 2 other studies (Guo et al. 2004; Gao et al. 2008). It is noteworthy that in our analysis of single components, saturated fatty acids intake, which has been recognized as a major nutrient responsible for weight gain in modern societies, may have contributed to the finding of an inverse association with waist circumference (WHO 2003; Hooper et al. 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Eating habits may influence inflammatory status and insulin resistance, both involved in the genesis of cardiometabolic diseases; an index of overall diet quality may be useful to identify risk for these diseases. We investigated whether the Healthy Eating Index (HEI-2005), adapted to Brazilian habits (B-HEI), was associated with markers of inflammation, insulin resistance and lipid profile in individuals at cardiometabolic risk. Two hundred and four prediabetic individuals (64.7% women) were enrolled in this cross-sectional study. Anthropometric measurements, 24-h dietary recalls used to calculate the B-HEI, and blood samples were collected. ANOVA was used for comparisons of clinical variables across the B-HEI tertiles and multiple linear regressions employed to test associations between clinical variables and B-HEI total score. Significant trends to decrease mean values of body mass index (BMI) (p = 0.03) and C-reactive protein concentrations (p = 0.02) across the tertiles of B-HEI, but not other biomarkers, were observed. Waist circumference, HOMA-IR and C-reactive protein were inversely associated with the B-HEI (p < 0.05), after adjusting for age, sex, BMI, and physical activity level. Also, a direct association of adiponectin concentrations with B-HEI was detected after adjustments (p = 0.001). Data from this study indicate that the B-HEI may be useful to identify the body adiposity-induced pro-inflammatory status and insulin resistance in individuals at cardiometabolic risk.
    Applied Physiology Nutrition and Metabolism 04/2014; 39(4):497-502. DOI:10.1139/apnm-2013-0279 · 2.34 Impact Factor
    • "Notably, these inverse associations of the HEI-NFG and HEI-NNR with weight retention after birth appeared to be independent of total energy intake, implying that not only total diet quantity but also diet quality plays a role for weight management. There are also some previous studies that suggested a protective role of adhering to specific dietary guidelines for subsequent weight gain, independent of total caloric intake, in white adult cohort populations [29-31]. However, we are not aware of comparable studies being conducted within the specific population group of pregnant women. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Pregnancy is a major life event for women and often connected with changes in diet and lifestyle and natural gestational weight gain. However, excessive weight gain during pregnancy may lead to postpartum weight retention and add to the burden of increasing obesity prevalence. Therefore, it is of interest to examine whether adherence to nutrient recommendations or food-based guidelines is associated with postpartum weight retention 6 months after birth. This analysis is based on data from the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. Diet during the first 4-5 months of pregnancy was assessed by a food-frequency questionnaire and maternal weight before pregnancy as well as in the postpartum period was assessed by questionnaires. Two Healthy Eating Index (HEI) scores were applied to measure compliance with either the official Norwegian food-based guidelines (HEI-NFG) or the Nordic Nutrition Recommendations (HEI-NNR) during pregnancy. The considered outcome, i.e. weight retention 6 months after birth, was modelled in two ways: continuously (in kg) and categorically (risk of substantial postpartum weight retention, i.e. >=5% gain to pre-pregnancy weight). Associations between the HEI-NFG and HEI-NNR score with postpartum weight retention on the continuous scale were estimated by linear regression models. Relationships of both HEI scores with the categorical outcome variable were evaluated using logistic regression. In the continuous model without adjustment for gestational weight gain (GWG), the HEI-NFG score but not the HEI-NNR score was inversely related to postpartum weight retention. However, after additional adjustment for GWG as potential intermediate the HEI-NFG score was marginally inversely and the HEI-NNR score was inversely associated with postpartum weight retention. In the categorical model, both HEI scores were inversely related with risk of substantial postpartum weight retention, independent of adjustment for GWG. Higher adherence to either the official Norwegian food guidelines or possibly also to Nordic Nutrition Recommendations during pregnancy appears to be associated with lower postpartum weight retention.
    BMC Public Health 01/2014; 14(1):75. DOI:10.1186/1471-2458-14-75 · 2.26 Impact Factor
Show more

Similar Publications


13 Reads
Available from