Number 44 n December 13, 2011

Healthy Eating Index–2005 Total and Component

Scores for Adults Aged 20 and Over: National Health

and Nutrition Examination Survey, 2003–2004

by R. Bethene Ervin, Ph.D., R.D.
 

Division of Health and Nutrition Examination Surveys
 

Abstract

Objective—This report provides Healthy Eating Index–2005 (HEI–2005)

scores for adults aged 20 and over, by sex, age groups, race and ethnicity, and

level of education in the 2003–2004 National Health and Nutrition Examination

Survey (NHANES 2003–2004).

Methods—The analytic sample consisted of 4,448 adults aged 20 and over

from NHANES 2003–2004. The Day 1 dietary recall was used to estimate the

HEI–2005 scores. Food and nutrient intakes were assessed on a density basis.

The population’s mean usual HEI–2005 component and total scores were

calculated using a population ratio method based on programs written by the

U.S. Department of Agriculture’s Center for Nutrition Policy and Promotion. A

two-tailed t-test was used to test significant differences between sexes, age and

race, and ethnic groups and levels of education. Statistical hypotheses were tested

at the p < 0.05 level of significance using a t statistic. The t-value at 0.975 with

15 degrees of freedom was 2.131. The Bonferroni method of adjustment was

used to adjust the critical value for the family of pairwise comparisons for age,

race and ethnicity, and education.

Results—Adults were below the maximum standard for all the HEI–2005

component scores except for total grains and meat and beans. Females and the

oldest age group were more successful in meeting the Dietary Guidelines for

Americans 2005 recommendations for the fruit and vegetable components and

discretionary calories, and had a slightly higher overall diet quality score than

their counterparts. Adults with more than a high school education more closely

complied with the recommendations for many of the components compared with

those with less education. No one racial and ethnic group stood out as having the

highest HEI–2005 scores across most of the components.

Conclusions—These results demonstrate that adults continue to fall short in

meeting the Dietary Guidelines for Americans 2005 recommendations, and that

sociodemographic characteristics influence their food choices and overall diet

quality.

Keywords: diets c dietary intakes c Dietary Guidelines for Americans 2005

Introduction

The Dietary Guidelines for

Americans are the basis of the nutrition

policy for the U.S. government and are

the foundation for all federal nutrition

guidance. The U.S. Department of

Agriculture’s (USDA) Center for

Nutrition Policy and Promotion (CNPP)

developed a tool called the Healthy

Eating Index (HEI) that is used to

measure compliance with federal

nutrition guidance. CNPP revised the

original HEI to reflect the 2005 Dietary

Guidelines and developed a new scoring

system to evaluate the diet (1,2). The

new HEI is called the HEI–2005. Food

and nutrient intakes on the HEI–2005

are expressed on a density basis, that is,

as amounts per 1,000 calories of intake,

in order to characterize diet quality

while controlling for diet quantity (1).

CNPP has reported HEI–2005

scores for the 2003–2004 National

Health and Nutrition Examination

Survey (NHANES 2003–2004) for the

U.S. population aged 2 and over by

level of income (3), but not by other

sociodemographic characteristics.

Intakes may vary by sex. Women tend

to have a higher store of nutrient

knowledge and diet-health awareness

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for Health Statistics 
Page 2 National Health Statistics Reports n Number 44 n December 13, 2011

than men, which may translate into

better diets (4). Tastes change with age

and people with fewer teeth, such as

older adults, may change the types of

foods they consume based on limited

dentition (4,5). Individuals with more

education may acquire more nutrition

information, which may induce them to

improve the quality of their diets.

Differences in nutrition knowledge and

diet-health awareness may play roles in

race and ethnic differences, but

differences in food choices may also be

rooted in traditional food customs (4).

The purpose of this report is to

provide HEI–2005 scores for adults

aged 20 and over, in the NHANES

2003–2004, and to examine the effects

of sex, age groups, race and ethnicity,

and level of education on these scores.

Methods

NHANES is a cross-sectional

nationally representative health and

nutrition examination survey conducted

by the Centers for Disease Control and

Prevention’s National Center for Health

Statistics. The survey design is a

complex, stratified, multistage

probability sample of the civilian

noninstitutionalized U.S. population.

NHANES 2003–2004 includes

oversamples of low-income persons,

adolescents aged 12–19, adults aged 60

and over, African-American persons, and

Mexican-American persons to improve

the precision of the estimates for these

groups.

Sample population

A total of 6,916 adults aged 20 and

over were eligible to participate in

NHANES 2003–2004. The survey

includes an interview conducted in the

home and a subsequent health

examination performed at a mobile

examination center (MEC). Of the

eligible sample, 5,041 adults aged 20

and over (73%) participated in the

household interview and 4,742 (69%)

also participated in the MEC exam. Two

hundred ninety-four (294) adults with a

MEC exam were removed from the

sample because they did not have

complete and reliable Day 1 dietary

recalls. The final analytic sample

consisted of 4,448 adults aged 20 and

over.

Dietary data

Trained interviewers conducted

dietary recall interviews using an

automated data collection system during

the MEC examination. Detailed

descriptions of the 2003–2004 dietary

interview and data processing

procedures can be found under the

dietary interview components on the

NHANES website (6). NHANES

2003–2004 dietary recall data were used

instead of more recent data because one

needs to use USDA’s MyPyramid

Equivalents Database (MPED) in

CNPP’s program for calculating the

HEI–2005. The MPED is currently only

available through 2003–2004. Two

dietary recalls were collected about

3–10 days apart. The Day 1 recall was

used to estimate the HEI–2005 scores

similar to a report by Guenther et al.

(3).

HEI–2005

The HEI–2005 is based on the food

patterns found in USDA’s MyPyramid

food guidance system (1,2). MyPyramid

translates key recommendations in the

2005 Dietary Guidelines into specific,

quantifiable dietary recommendations

(7). The HEI–2005 is composed of 12

components (Table 1). Five components

represent the major food groups found

in MyPyramid, that is, total fruit, total

vegetables, total grains, milk, and meat

and beans. Seven additional components

were created to represent whole fruit;

dark green and orange vegetables and

legumes; whole grains; oils; saturated

fat; sodium; and calories from solid fat,

alcohol, and added sugar (SoFAAS),

which serves as a proxy for

discretionary calories found in

MyPyramid. These 12 components can

be grouped into two types (9 adequacy

components): total fruit (including 100%

juice); whole fruit; total vegetables; dark

green and orange vegetables and

legumes; total grains; whole grains;

milk; meat and beans; and oils and 3

moderation components including

saturated fat, sodium, and calories from

SoFAAS (1,2).

Standards for scoring the

adequacy components

Foods and nutrients in the HEI–

2005 are expressed on a density basis,

that is, as amounts per 1,000 calories of

intake. The recommended amounts of

the food groups, oils, and discretionary

calories to consume for the 12 different

calorie levels (1,000–3,200 calories)

found in MyPyramid can also be

expressed on a density basis. When the

MyPyramid intakes are expressed on a

density basis, many of the

recommendations are similar across the

energy levels. CNPP based the standard

for the adequacy components (food

groups and oils) on the 1,200- to

2,400-calorie patterns, a range that

meets the recommended nutrient intakes

of nearly everyone aged 4 and over.

CNPP selected the lowest amount per

1,000 calories (that is, the least

restrictive or easiest to achieve) within

this calorie range as the standard for the

maximum score for each of these

components (1,2).

The standard for dark green

vegetables, orange vegetables, and

legumes is the sum of the weekly

recommendations for those three

subgroups of vegetables, expressed on a

per 1,000-calorie basis. Any

combination of these three subgroups

counts toward meeting this vegetable

subgroup standard, except that legumes

are counted as vegetables only after the

meat and beans standard has been met

(1,2,8).

For all the components (adequacy

and moderation), intakes at the level of

the standard or better were assigned the

maximum number of total points

allotted (Table 1). The maximum score

for the adequacy components was 5 or

10 points (1,2). No extra credit was

given for consuming more than the

recommended amounts (personal

communication). Zero was assigned if

there was no intake. Scores for amounts

between zero and the standard were

prorated linearly (1,2).
National Health Statistics Reports n Number 44 n December 13, 2011 Page 3

Standards for scoring the

moderation components

Lower intakes of the moderation

components are assigned higher scores.

The 2005 Dietary Guidelines

recommend consuming less than 10% of

calories from saturated fat (9). Both the

Dietary Guidelines Advisory Committee

and the Food and Nutrition Board of the

Institute of Medicine (IOM) recommend

that saturated fat consumption be as low

as possible (10,11). The Dietary

Approaches to Stop Hypertension

(DASH) Eating Plan, developed by the

National Heart, Lung, and Blood

Institute, aims for 7%, and the 2006

American Heart Association guidelines

call for ‘‘7% or less’’ (12). Based on

these sources, CNPP chose 7% of

calories as the standard for the

maximum score of 10 for the saturated

fat component. The 2005 Dietary

Guidelines recommendation of 10% of

calories was assigned a score of 8,

indicating a good score. Intakes of 15%

or more of calories from saturated fat

were given the minimum score of zero.

Amounts between 7% and 10% and

between 10% and 15% were prorated

linearly (1,2).

The 2005 Dietary Guidelines

recommendation for sodium intake for

most individuals is less than 2.3 grams

(g) per day, but for individuals with

hypertension, black persons, and

middle-aged and older adults, the

recommendation is no more than 1.5 g

per day (9). Taking these

recommendations into consideration,

CNPP chose 1.5 g as the basis for the

maximum score of 10, and 2.3 g as the

basis for the relatively good score of 8

for the sodium component. In order to

express sodium on a density basis,

CNPP used the same approach that the

IOM used to set the Dietary Reference

Intakes (DRIs) for sodium for children

and older adults. The DRI panel divided

the DRIs they had set for young and

middle-aged adults by the estimated

median energy intake for that age group

(2,150 calories per day) and then used

those same densities to set the DRIs for

children and older adults. To create the

HEI–2005 standard for sodium

expressed on a density basis, CNPP

assigned the highest possible score of 10

to diets that had less than 0.7 g sodium

per 1,000 calories (1.5 g sodium per

2,150 calories) and a score of 8 to diets

that had 1.1 g of sodium per 1,000

calories (2.3 g sodium per 2,150

calories). The minimum score of zero

was set at 2.0 g per 1,000 calories. The

amounts between 0.7 g and 1.1 g per

1,000 calories and between 1.1 g and

2.0 g per 1,000 calories are prorated

linearly (1,2).

The 2005 Dietary Guidelines

Advisory Committee introduced the

concept of ‘‘discretionary calories,’’

defined as the ‘‘difference between total

energy requirements and the energy

consumed to meet recommended

nutrient intakes’’ (10). 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 (9).

CNPP developed a component in

the HEI–2005 that specifically captures

the calories from SoFAAS. The standard

for the maximum score of 20 was

assigned to intakes of 20% of calories

or less. This is the least restrictive, or

easiest to achieve, of all the

discretionary calorie allowances found

in the MyPyramid food intake patterns.

Zero was assigned to intakes of 50% of

energy or more, and amounts in between

were prorated linearly (1,2). For an

in-depth discussion of the development

of the HEI–2005 scoring system, see

references 1 and 2.

Calculating the HEI–2005

component and total scores

When only 1 day of intake data are

used, CNPP recommends estimating the

HEI–2005 component and total scores

based on the population’s usual intake.

These scores are calculated using the

population ratio method (2,13). The

population ratio is computed by

summing all the individual scores for a

component, expressed on a density

basis, summing the total caloric intakes

for all the individuals, and dividing the

total component score by the total

number of calories. The total HEI score

is the sum of the 12 population

component scores (2).

CNPP provides a SAS/SUDAAN

program and Excel spreadsheet for

calculating the HEI–2005 component

and total scores on a population density

basis. Additional information on this

program is available on the CNPP

website (14). Although CNPP used this

program to calculate the HEI–2005

component and total scores for

NHANES 2001–2002, CNPP states that

it can be used to calculate the HEI–2005

scores for NHANES 2003–2004. CNPP

also provides a detailed description of

how to calculate the HEI–2005

component and total scores (see readme

file, 15).

This paragraph briefly describes

CNPP’s programs for calculating the

HEI–2005 component and total scores

using the population ratio method. This

approach was used in this report.

Specifically, the MyPyramid Equivalents

Database for USDA survey food codes,

2003–2004, version 2.0; CNPP’s

2003–2004 MyPyramid Equivalents

Database for whole fruit and fruit juice;

and the Day 1 food and nutrient files

from NHANES 2003–2004 were used to

calculate the population mean intakes.

The mean density ratios, standard errors,

and 95% confidence intervals for the 12

food and nutrient groups were calculated

based on the population ratio method in

CNPP’s SAS/SUDAAN program. These

values were exported into CNPP’s Excel

spreadsheet where the standards for

scoring, described earlier, were applied

to the mean density ratios and

confidence intervals to produce the

nontruncated HEI–2005 component

scores. Next, the scoring standards for

the minimum and maximum levels for

each component were applied to the

nontruncated scores to produce the

truncated scores. These scores are used

to compute the total HEI–2005 score. If

a nontruncated component score was

equal to or greater than the standard for

the maximum score, then the truncated

score was set at the maximum score.

Likewise, if the 95% confidence

intervals were equal to or greater than

the standard for the maximum score,

then they were also set at the maximum

score. The population HEI–2005 total
Page 4 National Health Statistics Reports n Number 44 n December 13, 2011

score is the sum of the truncated

population HEI–2005 component scores

from the spreadsheet. The final section

in CNPP’s SAS/SUDAAN program

calculates the standard error for the

population HEI–2005 total score based

on the nontruncated HEI–2005

component scores.

Descriptive characteristics

Age was categorized into three

groups based on the recommendations in

the NHANES Analytic Guidelines (16).

These age categories were: 20–39,

40–59, and 60 and over. These three age

categories were also used in the

age-adjustment procedure. Results for

non-Hispanic white, non-Hispanic black,

and Mexican-American persons were

included. Individuals who did not

identify themselves as belonging to one

of these categories were not analyzed

separately but were included in the

‘‘total’’ category. Results for race and

ethnicity were age adjusted using the

direct method of adjustment to the U.S.

resident population aged 20 and over,

estimated by the U.S. Census Bureau in

the year 2000 (17). Education was

categorized into three groups: less than

high school, high school diploma

including a General Education

Development high school equivalency

degree (GED), or more than high

school.

Data analyses

The HEI–2005 component and total

scores were estimated using the

SAS/SUDAAN program and Excel

spreadsheet that CNPP provided. SAS

for Windows (release 9.2; SAS Institute,

Cary, N.C.) and SUDAAN (release 10.0;

RTI International, Research Triangle

Park, N.C.) statistical software programs

were used in these analyses. Sample

weights were included in the estimation

process for all analyses in order to take

into account the differential probabilities

of selection, nonresponse, and

noncoverage. The Day 1 dietary recall

sample weights were used in these

analyses.

The CNPP program uses

SUDAAN’s Proc Ratio procedure to

calculate the mean density ratios,

standard errors, and 95% confidence

intervals for the 12 food and nutrient

groups. The standard errors were

estimated using the Taylor series

linearization, a method that incorporates

the sample weights and accounts for the

sample design (18). A formula in the

Excel spreadsheet converted the mean

density ratios to nontruncated and

truncated component and total HEI

scores and the 95% confidence intervals.

The spreadsheet does not include a

calculation of the standard errors for the

nontruncated and truncated component

scores. In order to calculate these

standard errors, the same formula used

to convert the mean density ratios to

component HEI scores was used to

convert the standard error of the mean

density ratios to the standard error of

the component HEI scores. A different

approach was used to calculate the

standard errors for saturated fat, sodium,

and SoFAAS from the other components

because CNPP used a more complicated

algorithm for calculating the HEI–2005

scores for these three components. The

standard errors for these components

were obtained using the formula for

calculating the confidence limits for a

mean and the nontruncated HEI

component score, the 95% confidence

intervals, and the t-value. The t-value at

0.975 with 15 degrees of freedom for

NHANES 2003–2004 is 2.131. The

population HEI–2005 total score is the

sum of the truncated population

HEI–2005 component scores from the

spreadsheet, but the standard error for

the population HEI–2005 total score is

derived from the part of the SAS/

SUDAAN program that calculates the

HEI–2005 nontruncated total score (see

readme file) (15).

When the component score was

equal to or greater than the standard for

the maximum score, the truncated score

was set at the maximum score. At the

same time one or both of the confidence

intervals were equal to or greater than

the standard for the maximum score and

they were also set at the maximum

score. In this situation, CNPP has shown

the maximum value for the component

score and the confidence intervals in its

report using the HEI–2005 (3). In these

instances, the maximum score is shown

and a standard error is not reported. If

the score rounds up to the maximum

score, the score and the standard error

are shown (Table 2).

A two-tailed t-test was used to test

significant differences between sexes,

age, racial and ethnic groups, and levels

of education. Statistical hypotheses were

tested at the p < 0.05 level of

significance using a t statistic. The

t-value at 0.975 with 15 degrees of

freedom for NHANES 2003–2004 was

2.131. The Bonferroni method of

adjustment was used to adjust the

critical value for the family of pairwise

comparisons across the three levels for

age, race and ethnicity, and education

(19). The adjusted critical value was

0.0167 and the interpolated t-value was

2.717. Statistical tests were not

performed on component scores in cases

where the maximum total point value

was assigned and the standard error is

not shown. All differences described in

the findings are statistically significant

unless indicated otherwise.

Results

The HEI–2005 component scores

measure compliance with key dietrelated recommendations from the 2005

Dietary Guidelines. The HEI–2005

component scores for adults aged 20

and over in NHANES 2003–2004 were

below the maximum scores for all of the

components except for total grains and

meats and beans (Table 2). The scores

for dark green and orange vegetables

and legumes (1.3), whole grains (1.0),

sodium (3.8), and calories from

SoFAAS (7.8), were especially low.

Each one was less than one-half of the

standard for a maximum score for that

component. Lower scores for the

adequacy components indicate lower

intakes of these foods, while lower

scores for the moderation components

indicate higher intakes of those foods or

nutrients. Higher scores indicate closer

compliance with diet-related

recommendations in the 2005 Dietary

Guidelines. The overall HEI score,

which is a measure of the overall

quality of the diet, was 57.2 out of a

possible 100.
National Health Statistics Reports n Number 44 n December 13, 2011	 Page 5

The following sections describe the

HEI–2005 component scores based on

selected demographic characteristics.

Sex

+ Females had slightly higher mean

scores for total fruit, whole fruit, total

vegetables, dark green and orange

vegetables and legumes, oils, and

calories from SoFAAS than males.

The higher scores indicate that

females had higher intakes of the

fruits, vegetables and legumes, and

oils than males, but consumed fewer

calories from solid fats, alcoholic

beverages, and added sugars than

males. Also, the overall quality of

their diets was slightly higher than

that of males (60.3 compared with

54.8) (Table 2).

+ Both sexes met or exceeded the

standards for a maximum score for

total grains and meats and beans.

Age

+ Adults aged 60 and over had higher

mean component scores for total fruit,

total vegetables, dark green and

orange vegetables and legumes,

calories from SoFAAS, and the

overall HEI score than the two

younger age groups (Table 2).

+ Adults aged 40–59 had a higher mean

whole fruit score than adults aged

20–39 (3.5 compared with 2.0) and,

even though it could not be tested

statistically, adults aged 60 and over

had a whole fruit score that reached

the maximum score (5.0).

+ The whole grains scores for all three

age groups were different from each

other. Those aged 40–59 had a higher

mean score than those aged 20–39

(1.0 compared with 0.7), and those

aged 60 and over had a higher mean

score (1.5) than those aged 40–59.

+ All three age groups met or exceeded

the standards for a maximum score

for total grains and meats and beans.

Race and ethnicity

+ The mean total vegetable scores for

non-Hispanic white (3.6) and

Mexican-American (3.8) persons were

higher than the score for

non-Hispanic black persons (3.0), but

not significantly different from each

other (Table 2). Mexican-American

persons (1.9) had a higher mean score

for the dark green and orange

vegetables and legumes component

than the other two racial and ethnic

groups (1.3 and 1.4) who were not

significantly different from each

other.

+	 Non-Hispanic white persons had a

higher mean whole grains score than

Mexican-American persons (1.1

compared with 0.7), but non-Hispanic

black persons (0.8) were not

significantly different from either of

the other two groups.

+	 Non-Hispanic white persons had a

higher mean milk component score

than non-Hispanic black persons (6.0

compared with 4.0), but MexicanAmerican persons were not

significantly different from either of

the other two groups (5.0).

+	 Mexican-American persons had a

lower mean oils component score

(5.1) than the other two racial and

ethnic groups (7.3 for each group).

Non-Hispanic white persons (5.6) had

a lower mean saturated fat score than

non-Hispanic black (6.6) or MexicanAmerican (7.0) persons; the latter two

groups were not significantly different

from each other.

+	 Non-Hispanic white persons had a

lower mean sodium component score

than Mexican-American persons (3.7

compared with 4.3), but non-Hispanic

black persons (4.4) were not

significantly different from either of

the other two groups.

+	 Non-Hispanic white and MexicanAmerican persons met or exceeded

the standards for a maximum score

for total grains. All three racial and

ethnic groups met or exceeded the

standards for a maximum score for

meats and beans.

Education

+	 Those with more than a high school

education had the highest mean

scores and those with a high school

education or GED had the lowest

mean scores for whole fruit (3.6

compared with 2.5), total vegetables

(3.7 compared with 3.3), dark green

and orange vegetables and legumes

(1.5 compared with 1.1), calories

from SoFAAS (8.6 compared with

6.3), and the overall HEI score (59.5

compared with 53.0) (Table 2). The

scores for those with less than a high

school education fell between these

two groups and were not significantly

different from them.

+	 Those with more than a high school

education had the highest mean

scores and those with less than a high

school education had the lowest mean

scores for the whole grains (1.1

compared with 0.8) and oils (7.7

compared with 5.7) components, but

had the lowest mean score for sodium

while those with less than a high

school education had the highest

mean score (3.6 compared with 4.4).

The scores for those with a high

school education or GED fell

between these two groups and were

not significantly different from them.

+	 Those with less than or more than a

high school education had higher

mean total fruit component scores

than those with a high school

education or GED (3.0, 3.0, and 2.1,

respectively).

+	 Those with less than a high school

education had a higher mean

saturated fat score than those with a

high school education or GED (6.9

compared with 5.4). The score for

those with more than a high school

education fell between these two

groups and was not significantly

different from them.

+	 All three educational groups met or

exceeded the standards for a

maximum score for total grains and

meats and beans.

Summary and

Conclusions

The Dietary Guidelines for

Americans are the basis of the nutrition

policy for the U.S. government and are

the foundation for all federal nutrition

guidance. The HEI is a tool to evaluate

the quality of the diet in terms of its

conformity to the Dietary Guidelines for

Americans. The original HEI was

revised to reflect the 2005 Dietary

Guidelines, and a new scoring system
Page 6	 National Health Statistics Reports n Number 44 n December 13, 2011

was developed (1,2). Food and nutrient

intakes are expressed on a density basis

in the revised HEI, that is, as amounts

per 1,000 calories of intake, in order to

characterize diet quality while

controlling for diet quantity (1).

Adults aged 20 years and over were

below the maximum standard for all the

HEI–2005 component scores except for

total grains and meat and beans. Those

components that were especially low

were dark green and orange vegetables

and legumes, whole grains, sodium, and

calories from SoFAAS (calories from

solid fats, alcoholic beverages, and

added sugars). Scores for each of these

components were less than one-half of

the standard, indicating dietary intakes

were less than one-half of the Dietary

Guidelines recommendations. Scores for

the remaining components indicate

intakes between 50% and 70% of the

Dietary Guidelines recommendations.

The overall HEI score, which is a sum

of the component scores and serves as a

measure of diet quality, was 57.2 out of

100, indicating Americans’ diets need

improvement. Examining the component

and total scores by sex, age, race and

ethnicity, and education did not

substantially alter these results.

Females had slightly higher intakes

than males of total and whole fruit, total

and dark green and orange vegetables

and legumes, and oils, and slightly

lower intakes of calories from SoFAAS.

They also had a slightly higher overall

score than males. In general, the oldest

age group (60 and over) was more

successful at adhering to the Dietary

Guidelines’ recommendations for the

fruit and vegetable components, whole

grains, and calories from SoFAAS, and

had a slightly higher overall score than

the younger age groups.

The HEI component scores varied

by race and ethnicity across all 12

components, with no one group having

the highest scores. Many of the

differences may be rooted in cultural

differences in the types of foods

consumed and cooking styles. NonHispanic white and non-Hispanic black

persons had slightly higher mean intakes

of total vegetables than did MexicanAmerican persons, but MexicanAmerican persons had slightly higher

mean intakes of dark green and orange

vegetables and legumes. Non-Hispanic

white persons were more successful at

consuming whole grains than were

Mexican-American persons, but the

opposite was true for reducing sodium

intake. Non-Hispanic white persons

were also more successful in consuming

milk and milk products than were

non-Hispanic black persons, but this

may be because lactose intolerance is

common in black, Asian, and Middle

Eastern populations (20). Non-Hispanic

white and non-Hispanic black persons

consumed more vegetable oils and oils

in fish, nuts, and seeds than did

Mexican-American persons, but

non-Hispanic black and MexicanAmerican persons were more successful

in reducing the saturated fat in their

diets.

Adults with more than a high

school education had higher scores for

many of the HEI–2005 components than

those with less education. Specifically,

those with more than a high school

education had higher mean intakes of

whole fruit, both vegetable components,

and calories from SoFAAS, and had a

higher overall HEI score than those with

a high school education or GED. They

also had higher mean intakes of whole

grains and oils that those with less than

a high school education. Those with

more than and less than a high school

education had higher mean total fruit

intakes than those with a high school

education or GED. On the other hand,

those with less than a high school

education were more successful in

reducing their saturated fat intakes than

those with a high school education or

GED, and were also more successful in

reducing their sodium intake than those

with more than a high school education.

These results demonstrate that

adults continue to fall short of federal

dietary guidance and sociodemographic

characteristics influence their food

choices and overall diet quality. To

improve their HEI–2005 scores and their

compliance with federal dietary

recommendations, adults need to

increase their intake of most of these

components except for total grains and

meat and beans, but they especially need

to increase their intake of dark green

and orange vegetables and legumes and

whole grains, and reduce their intake of

sodium and calories from SoFAAS.

References

1.	 Guenther PM, Reedy J, Krebs-Smith

SM. Development of the Healthy

Eating Index 2005. J Am Diet Assoc

108(11):1896–901. 2008.

2.	 Guenther PM, Reedy J, Krebs-Smith

SM, Reeve BB, Basiotis PP.

Development and evaluation of the

Healthy Eating Index-2005. U.S.

Department of Agriculture, Center

for Nutrition Policy and Promotion.

Available from: http://

www.cnpp.usda.gov/Publications/

HEI/HEI-2005/HEI2005TechnicalReport.pdf [Accessed

10/1/09].

3.	 Guenther PM, Juan WY, Lino M,

Hiza HA, Fungwe T, Lucas R. Diet

quality of low-income and higher

income Americans in 2003–04 as

measured by the Healthy Eating

Index-2005. U.S. Department of

Agriculture, Center for Nutrition

Policy and Promotion. Nutrition

Insight 42. 2008. Available from:

http://www.cnpp.usda.gov/
 

Publications/NutritionInsights/
 

Insight42.pdf.
 

4.	 Variyam JN, Blaylock J, Smallwood

D, Basiotis PP. USDA’s Healthy

Eating Index and nutrition

information. Technical Bulletin 1866.

1998.

5.	 Ervin RB. Healthy Eating Index

scores among adults, 60 years of age

and over, by sociodemographic and

health characteristics: United States,

1999–2002. Advance data from vital

and health statistics; no 395.

Hyattsville, MD: National Center for

Health Statistics. 2008.

6.	 National Center for Health Statistics.

NHANES 2003–2004 examination

files. Available from: http://

www.cdc.gov/nchs/nhanes/

nhanes2003-2004/exam03_04.htm.

7.	 Britten P, Marcoe K, Yamini S, Davis

C. Development of food intake

patterns for the MyPyramid food

guidance system. J Nutr Educ Behav

38(6 Suppl):S78–S92. 2006.

8.	 U.S. Department of Agriculture,

Center for Nutrition Policy and

Promotion. How to count dry peas

and beans in the Food Guide; 2005.
National Health Statistics Reports

n Number 44n December 13, 2011	 Page7

MyPyramid.gov. Available from:

http://www.choosemyplate.gov/
 

foodgroups/
 

proteinfoods_beanspeas.html.
 

9.	 U.S. Department of Health and

Human Services and U.S.

Department of Agriculture. Dietary

guidelines for Americans 2005. 6th

ed. Washington, DC: U.S.

Government Printing Office. 2005.

10. Dietary Guidelines Advisory

Committee. Report of the Dietary

Guidelines Advisory Committee on

the dietary guidelines for Americans.

2005. Washington, DC: U.S.

Department of Agriculture,

Agricultural Research Service. 2004.

11. National Academy of Sciences,

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 Press. 2005.

12. Lichtenstein AH, Appel LJ, Brands

M, Carnethon M, Daniels S, Franch

HA, et al. Diet and lifestyle

recommendations revision 2006:A

scientific statement from the

American Heart Association Nutrition

Committee. Circulation 114(1):82–

96. 2006.

13. Freedman LS, Guenther PM,

Krebs-Smith SM, Kott PS.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. J Nutr 138(9):1725–9. 2008.

14. U.S. Department of Agriculture,

Center for Nutrition Policy and

Promotion. Healthy Eating Index.

2003–2004. Available from: http://

www.cnpp.usda.gov/

HealthyEatingIndexSupportFiles0304.htm.

15. U.S. Department of Agriculture,

Center for Nutrition Policy and

Promotion. Healthy Eating Index.

2001–2002. Available from: http://

www.cnpp.usda.gov/

HealthyEatingIndexSupportFiles0102.htm.

16. Centers for Disease Control and

Prevention, National Center for

Health Statistics. NHANES 1999–

2000 addendum to the NHANES III

analytic guidelines. 2002. Available

from: http://www.cdc.gov/nchs/data/

nhanes/guidelines1.pdf [Accessed

12/1/10].

17. Klein RJ, Schoenborn CA. Age

adjustment using the 2000 projected

U.S. population. Healthy People

statistical notes; no 20. Hyattsville,

MD: National Center for Health

Statistics. 2001.

18. Wolter KM. Introduction to variance

estimation. New York, NY: SpringerVerlag. 1985.

19. Neter J, Wasserman W, Kutner MH.

Applied linear statistical models:

Regression, analysis of variance, and

experimental designs. 2nd ed.

Homewood, IL: Richard D. Irwin,

Inc. 1985.

20. Adams EJ, Mahan LK. Nutritional

care in food allergy and food

intolerance. In: Food, nutrition, and

diet therapy, 7th ed:633–53. Krause

MV, Mahan LK (eds). Philadelphia,

PA: W.B. Saunders Company. 1984.
Page 8 National Health Statistics Reports n Number 44 n December 13, 2011

Table 1. Healthy Eating Index–2005: Components and standards for scoring

Maximum

Components points Standard for maximum score Standard for minimum score of zero

Total fruit (included 100% juice) ............... 5 ≥ 0.8 cup equiv. per 1,000 kcal No fruit

Whole fruit (not juice) ..................... 5 ≥ 0.4 cup equiv. per 1,000 kcal No whole fruit

Total vegetables ......................... 5 ≥ 1.1 cup equiv. per 1,000 kcal No vegetables

Dark green and orange vegetables and legumes1 . . 5 ≥ 0.4 cup equiv. per 1,000 kcal No dark green or orange vegetables or legumes

Total grains ............................ 5 ≥ 3.0 oz equiv. per 1,000 kcal No grains

Whole grains........................... 5 ≥ 1.5 oz equiv. per 1,000 kcal No whole grains

Milk2 ............... ............... 10 ≥ 1.3 cup equiv. per 1,000 kcal No milk

Meat and beans ......................... 10 ≥ 2.5 oz equiv. per 1,000 kcal No meat or beans

Oils3 ............... ............... 10 ≥ 12 grams per 1,000 kcal No oil

Saturated fat ........................... 10 ≤ 7% of energy4 ≥ 15% of energy

Sodium .............................. 10 ≥ 0.7 grams per 1,000 kcal4 ≥ 2.0 grams per 1,000 kcal

Calories from solid fat, alcohol, and added sugar

(SoFAAS) ............................ 20 ≤ 20% of energy ≥ 50% of energy

1

Legumes counted as vegetables only after meat and beans standard is met. 2

Includes all milk products, such as fluid milk, yogurt, cheese, and soy beverages. 3

Includes nonhydrogenated vegetable oils and oils in fish, nuts, and seeds. 4

Saturated fat and sodium get a score of 8 for the intake levels that reflect the 2005 Dietary Guidelines: less than 10% of calories from saturated fat and 1.1 grams of sodium per 1,000

kilocalories, respectively.

NOTE: Intakes between the minimum and maximum levels are scored proportionately, except for saturated fat and sodium (see footnote 4).

SOURCE: Center for Nutrition Policy and Promotion (CNPP) Fact Sheet No. 1. Healthy Eating Index-2005, available from: http://www.cnpp.usda.gov/Publications/HEI/healthyeatingindex

2005factsheet.pdf.
National Health Statistics Reports

n Number 44n December 13, 2011 Page9

omponent and overall scores for adults aged 20 and over, by age, race and ethnicity, and education: United States, 2003–2004

l

Whole

fruit

Total

vegetables

Dark

green and

orange

vegetables

and

legumes

Total

grains

Whole

grains Milk

Meat

and

beans Oils

Saturated

fat Sodium

Calories

from

solid fats,

alcoholic

beverages,

and added

sugars

(SoFAAS)

Overall

HEI

6) 3.3 (0.20) 3.5 (0.05) 1.3 (0.06) 5.0 (–)2

Mean (standard error)

1.0 (0.04) 5.6 (0.19) 10.0 (–)2 7.1 (0.17) 6.0 (0.18) 3.8 (0.10) 7.8 (0.27) 57.2 (0.76)

7)a,3

20)b

2.8 (0.21)a3.9 (0.25)b

3.3 (0.06)a3.8 (0.09)b

1.2 (0.06)a1.5 (0.12)b

5.0 (–)25.0 (–)2

0.9 (0.04)1.0 (0.05)

5.4 (0.19)5.9 (0.22)

10.0 (–)2

10.0 (–)2

6.7 (0.23)a7.6 (0.16)b

6.2 (0.16)5.8 (0.28)

3.9 (0.12)3.8 (0.16)

7.0 (0.30)a

8.8 (0.35)b

54.8 (0.78)a60.3 (1.12)b

21)a

9)a

7)b

2.0 (0.19)a3.5 (0.29)b5.0 (–)2

3.3 (0.09)a3.5 (0.08)a4.1 (0.08)b

1.2 (0.07)a1.3 (0.07)a1.7 (0.13)b

5.0 (–)25.0 (0.14)25.0 (–)2

0.7 (0.06)a1.0 (0.05)b1.5 (0.08)c

5.8 (0.22)5.3 (0.24)5.8 (0.23)

10.0 (–)2

10.0 (–)210.0 (–)2

6.8 (0.26)7.4 (0.26)7.0 (0.31)

6.2 (0.23)5.7 (0.31)6.1 (0.25)

3.9 (0.17)3.9 (0.16)3.4 (0.18)

6.9 (0.33)a

7.5 (0.42)a

10.2 (0.28)b

54.2 (0.88)a57.0 (0.76)a63.8 (0.72)b

7)

6)

31)

3.4 (0.22)

2.9 (0.18)

3.6 (0.38)

3.6 (0.06)a

3.0 (0.09)b

3.8 (0.08)a

1.3 (0.06)a1.4 (0.07)a1.9 (0.15)b

5.0 (–)24.8 (0.11)25.0 (–)2

1.1 (0.05)a0.8 (0.07)a,b0.7 (0.11)b

6.0 (0.20)a4.0 (0.18)b5.0 (0.37)a,b

10.0 (–)210.0 (–)210.0 (–)2

7.3 (0.14)a7.3 (0.45)a5.1 (0.52)b

5.6 (0.22)a6.6 (0.18)b7.0 (0.34)b

3.7 (0.10)a4.4 (0.27)a,b4.3 (0.12)b

7.7 (0.27)6.9 (0.69)8.6 (0.56)

57.3 (0.84)55.0 (1.51)58.3 (1.65)

28)a

5)b

20)a

3.4 (0.34)a,b2.5 (0.24)a3.6 (0.21)b

3.3 (0.13)a,b3.3 (0.07)a3.7 (0.06)b

1.3 (0.13)a,b1.1 (0.07)a1.5 (0.08)b

5.0 (–)25.0 (–)25.0 (–)2

0.8 (0.06)a0.9 (0.05)a,b1.1 (0.06)b

5.0 (0.25)5.6 (0.28)5.8 (0.21)

10.0 (–)2

10.0 (–)210.0 (–)2

5.7 (0.48)a6.8 (0.25)a,b7.7 (0.26)b

6.9 (0.31)a5.4 (0.30)b6.1 (0.21)a,b

4.4 (0.19)a4.0 (0.16)a,b3.6 (0.13)b

7.4 (0.43)a,b6.3 (0.43)a8.6 (0.31)b

56.2 (1.09)a,b53.0 (1.17)a59.5 (0.78)b

parately and missing or unknown responses for education.

a component then the score shown on the table is changed to the maximum points and the SEM is not reported. If a score rounded up to the maximum score, then the maximum score and the SEM are

d of adjusting for the family of pairwise comparisons was used when a characteristic was composed of three levels (adjusted p-value: p < 0.0167). Means with different letters are siginficantly different

e component score is the maximum points and there is no test for significant differences between groups.

to the U.S. resident population, aged 20 and over, estimated by the U.S. Census Bureau in the year 2000.

ool equivalency diploma.
U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road

Hyattsville, MD 20782

FIRST CLASS MAIL
 

POSTAGE & FEES PAID
 

CDC/NCHS
 

PERMIT NO. G-284
 

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

National Health Statistics Reports n Number 44 n December 13, 2011

Suggested citation

Ervin RB. Healthy Eating Index–2005 total and

component scores for adults aged 20 and

over: National Health and Nutrition

Examination Survey, 2003–2004. National

health statistics reports; no 44. Hyattsville,

MD: National Center for Health Statistics.

2011.

Copyright information

All material appearing in this report is in the

public domain and may be reproduced or

copied without permission; citation as to

source, however, is appreciated.

National Center for Health Statistics

Edward J. Sondik, Ph.D., Director
 

Jennifer H. Madans, Ph.D., Associate Director
 

for Science
 

Division of Health and Nutrition
 

Examination Surveys
 

Clifford L. Johnson, M.S.P.H., Director

For e-mail updates on NCHS publication releases, subscribe online at: http://www.cdc.gov/nchs/govdelivery.htm.
 

For questions or general information about NCHS: Tel: 1–800–232–4636 • E-mail: cdcinfo@cdc.gov • Internet: http://www.cdc.gov/nchs
 

DHHS Publication No. (PHS) 2012–1250 • CS226840