The Healthy Eating Index (HEI) measures how well American

diets conform to recommended healthy eating patterns. Developed

by the U.S. Department of Agriculture (USDA), the HEI provides a

measure of overall dietary quality based on 10 dietary components.

Five food-based components of the HEI (grains, vegetables, fruits,

dairy, and meat) evaluate food consumption patterns against the

Food Guide Pyramid recommendations. Four nutrient-based components assess compliance with the Dietary Guidelines for

Americans recommendations for maximum daily intake of fat and

saturated fat, as well as the National Research Council’s (NRC)

recommendations for maximum daily intake of cholesterol and

sodium (USDA and U.S. Department of Health and Human

Services, 2000; NRC, 1989). The analysis does not use the

Acceptable Macronutrient Distribution Range for total fat and

Upper Limits for sodium, released by the Institute of Medicine in

2002. The tenth component score assesses the level of variety in

the diet. Each of the 10 dietary components has a scoring range of

0 to 10. The overall HEI scores are the simple sum of the scores

from the 10 components. Total HEI scores over 80 imply a “good”

diet. Scores between 51 and 80 indicate a “need for improvement.”

And scores below 51 indicate a “poor” diet. The Nutrition and

Health Characteristics of Low-Income Populations study examined

the Healthy Eating Index using 1988-94 National Health and

Nutrition Examination Survey (NHANES) data. The measures provide a baseline to monitor the dietary quality of Americans, focusing on the low-income population. Major findings are highlighted

in this summary. 

All Americans Ages 2 and Older

For Americans 2 years and older, the mean overall HEI score was

64.0 (fig. 1). The majority of Americans need to improve their

diets; only 12 percent of the population was deemed to have a good

diet (fig. 2). More females than males had a good diet (13 percent

vs. 10 percent), and more males than females had a poor diet (18

percent vs. 15 percent).

Consuming the recommended servings of fruits and vegetables

were two difficult dietary tasks for Americans (fig. 3). Americans

scored less than 40 percent (3.9 HEI score) in fruit consumption.

Fewer than 20 percent of Americans consumed the recommended

United States

Department of

Agriculture

Economic 

Research

Service

Agriculture Information Bulletin 796-1 February 2005

Nutrition and Health Characteristics of

Low-Income Populations

Healthy Eating Index

Biing-Hwan Lin, (202) 694-5458, blin@ers.usda.gov

Figure 1

Healthy Eating Index 

scores for all Americans, and by Food Stamp 

Program participation 

Figure 2

Diet quality based on Healthy Eating Index scores for all Americans and by 

Food Stamp Program participation status, age adjusted

All, ages 2 and up FSP participants

Overall Good Poor Need improvement

Income-eligible nonparticants Higher income nonparticipants

*Statistically significant difference from FSP participants at the 0.05 level or better.

Source: National Health and Nutrition Examination Survey, 1988-94.

64

60.2

11.6

72.2 70.1 69.2

72.9

6.3 9.3* 12.4*

21.5

14.7* 16.2

23.6

60.8* 64.8*

Points

Percent of U.S. population
fruit servings. The HEI score on vegetable consumption averaged 5.7, and only one in four Americans consumed the recommended servings of vegetables. The average scores ranged from

6.6 to 6.8 for dairy, grains, and meat components.

Many Americans consume excessive amounts of total and saturated fat, cholesterol, and sodium. Thirty-four percent of

Americans consumed a diet of no more than 30 percent of calories from total fat, and 37 percent of Americans met the recommendation for limiting saturated fat intake to less than 10 percent of total energy. The recommended intakes for cholesterol

and sodium are set at no more than 300 and 1,500 milligrams

(mg) per day, regardless of age and gender. Partly because

females tend to consume fewer calories than males, females tend

to do better than males in meeting these two recommendations.

About 70 percent of Americans met the cholesterol recommendation, and the average HEI score was 7.8. Thirty-four percent

of Americans met the sodium recommendation, and the HEI

score for sodium averaged 6.1.

Food Stamp Program (FSP) Participants 

The U.S. population is separated into FSP participants and nonparticipants. The FSP income eligibility cutoff (130 percent

poverty level) is used to separate nonparticipants into incomeeligible and higher income groups. On average, FSP participants

2 Economic Research Service / USDA

Agriculture Information Bulletin 796-1

Figure 3

HEI scores on food components for all Americans and by Food Stamp Program participation status, age adjusted

All, ages 2 and up FSP participants

Grains Vegetables Fruits Dairy Meat Variety

Points

Income-eligible nonparticants Higher income nonparticipants

*Statistically significant difference from FSP participants at the 0.05 level or better.

Source: National Health and Nutrition Examination Survey, 1988-94.

6.8* 6.5* 6.7

5.7

5.4*

5.8*

5

3.9

3.5*

4.1*

3

7

8* 7.7

7.1*

6.6

6.3

6.8* 6.8 6.7* 6.8

6.1

6.6

5.8

All, ages 2-4 WIC participants

Grains Fruits Vegetables Dairy Meats Variety Total fat Saturated fat Cholesterol Sodium

Points

Income-eligible nonparticants Higher income nonparticipants

*Statistically significant difference from lowest income at the 0.05 level or better.

Source: National Health and Nutrition Examination Survey, 1988-94.

Figure 4

HEI component scores among children ages 2-4 and by WIC participation status, age adjusted

7

5.2 5.5

8.6 8.5

8.98.1

8.2

8.7

4.9

4.8

6.6

7.4*

9.3*

7.6 7.37.8

7.7 8.2*

7.8

7

5.7*

7.9

6.3

6.9 6.8

5.3*

5.3

6.4 6.2

7.9 8 7.8 8

5 4.8 5.1
scored lower on the overall HEI than either income-eligible or

higher income nonparticipants (60.2 vs. 61.8 and 64.8, see fig.

1). This pattern was observed for both males and females. A

lower percentage of FSP participants had a “good” diet than

income-eligible nonparticipants (6 percent vs. 9 percent).

Compared with higher income nonparticipants, FSP participants

were more likely to have “poor” diets (24 percent vs. 15 percent)

and less likely to have “good” diets (6 percent vs. 12 percent).

Consuming the recommended servings of fruits and vegetables

was particularly unlikely among FSP participants, who scored a

3 for fruits and a 5 for vegetables, lower than the scores for

income-eligible and higher income nonparticipants (fig. 3). FSP

participants also scored lower on grains and variety than both

groups of nonparticipants. FSP participants scored higher on

meat consumption than income-eligible nonparticipants. 

With respect to the four nutrient components, FSP participants

scored similar to income-eligible nonparticipants. Compared

with higher income nonparticipants, FSP participants scored

higher on sodium but lower on cholesterol.

Special Supplemental Nutrition Program for Women,

Infants, and Children (WIC) Children Ages 2-4

The income eligibility cutoff for WIC (185 percent poverty level) is

used to separate WIC nonparticipants into income-eligible and

higher income groups. Infants and children under age 2 were

excluded from the analysis because the HEI applies only to individuals ages 2 and older. There were no significant differences in

overall HEI scores and diet ratings between children ages 2-4 who

were WIC participants, income-eligible nonparticipants, or higher

income nonparticipants. Children ages 2-4 averaged 70 points on

their overall HEI—26 percent had a good diet, 66 percent needed

improvement, and 8 percent had a poor diet. 

There were only a few significant differences in HEI component

scores among the three groups of children (fig. 4). No differences

were found for grains, vegetables, and variety. WIC children and

income-eligible children differed in only 1 of the 10 components.

WIC children scored a 6.4 on fruit consumption, higher than the

5.3 for income-eligible nonparticipants. Children ages 2-4 as a

whole scored quite high on dairy consumption, averaging 7.9.

Higher income nonparticipating children scored higher than WIC

children (8.2 vs. 7.8). On the other hand, WIC children scored

higher on meat consumption than higher income nonparticipants (7

vs. 5.7). There were no differences in scores for saturated fat and

sodium among the three groups of children. However, higher

income children scored higher on total fat and cholesterol than

WIC children.

School-Age Children Ages 5-18

Children ages 5-18 who were attending school during the survey

were classified into three income groups: “lowest income” (with

household income not exceeding 130 percent of poverty level),

“low income” (with household income falling between 131 percent

and 185 percent of poverty level), and “higher income” (with

household income higher than 185 percent of poverty level). 

School-age children scored 62.8 points on the overall HEI, compared with 64 for all Americans older than 2 and 70 for children

aged 2-4. The majority of school-age children (78 percent) needed

to improve their diets, and more school-age children had a poor

diet than had a good diet (15.8 percent vs. 6.2 percent). The overall

HEI scores and diet ratings did not vary by income level. 

School-age children did better in meeting the recommendations for

dairy, grains, meats, and variety than for fruits and vegetables (fig.

5). They scored 3.7 on fruits and 4.4 on vegetables, compared with

7.2 on dairy and 7 on grains. Children of different income levels 

Economic Research Service / USDA 3

Agriculture Information Bulletin 796-1

All, ages 5-18 Lowest income

Grains Fruits Vegetables Dairy Meats Variety Total fat Saturated fat Cholesterol Sodium

Points

Low income Higher income

*Statistically significant difference from lowest income at the 0.05 level or better.

Source: National Health and Nutrition Examination Survey, 1988-94.

Figure 5

HEI component scores among school-age children and by income, age adjusted

7 7.1 7

3.73.6

3.1 4

6.7 6.4 6.9*

7.4

7.7

6.5

7.6 7.9

7.2 7

7.3

6.6

6.1 5.8*

5.9*

4.4 4.3 4.5

5.5 5.4

5.3 5.7

8.3 8.3

8.1

8.4

6.1 6.2 6

5.9
scored similarly their consumption of food components, with the

exception of the meat component. Meat-component scores for the

lowest income children were higher than the meat-component

scores for other children. Looking at the four nutrient components,

children scored best in cholesterol (8.3 HEI score) and worst in saturated fat (5.5 HEI score). The only significant difference was found

in total-fat consumption, with the higher income children scoring

higher than the lowest income children (6.9 vs. 6.5).

Older Americans

Americans ages 60 and older were classified into three income

groups, using the same cutoffs as for school-age children. Older

Americans scored 68.4 points in the overall HEI, compared with

64 for all Americans older than 2. The dietary quality of older

Americans appeared to improve with income status. The lowest

income group scored 64.3, lower than the 67 for the low income

and the 70 for the higher income. Twenty-five percent of higher

income older Americans had a good diet, compared with only 13

percent for the lowest income group. A larger proportion of the

lowest income older Americans had a poor diet, compared with

others (18.5 percent vs. 13.1 percent for low income and 9.2 percent for higher income). Female elders had a better diet than male

elders, scoring higher on the HEI and having higher diet ratings.

Older Americans did better than other age groups in the consumption of fruits and vegetables, scoring 5.3 for fruits and 6.5

for vegetables (fig. 6). The scores on food components rose with

income status, with the higher income group scoring higher than

the lowest income group in all five food components. Female

elders scored higher than males on grains, fruits, and vegetables,

but males scored higher on dairy and meats. With the exception

of sodium, there was no difference in nutrient scores by income

status among elders.

Information Sources

Institute of Medicine, Food and Nutrition Board (2002). Dietary

Reference Intakes: Energy, Carbohydrate, Fiber, Fat, Fatty

Acids, Cholesterol, Protein, and Amino Acids (Macronutrients).

Washington, DC: National Academy Press.

National Research Council (1989). Diet and Health:

Implications for Reducing Chronic Disease. Washington, DC:

National Academy Press.

U.S. Department of Agriculture, Center for Nutrition Policy and

Promotion (1995). The Healthy Eating Index. CNPP-1.

U.S. Department of Agriculture and U.S. Department of Health

and Human Services (2000). Nutrition and Your Health: Dietary

Guidelines for Americans, 4th edition.

4 Economic Research Service / USDA

Agriculture Information Bulletin 796-1

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, sex,

religion, age, disability, political beliefs, sexual orientation, or marital or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET

Center at (202) 720-2600 (voice and TDD).

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 14th and Independence Avenue,

SW, Washington, DC 20250-9410, or call (202) 720-5964 (voice and TDD). USDA is an equal opportunity provider and employer.

Figure 6

HEI component scores among older Americans by income, age adjusted

All, ages 60+ Lowest income

Grains Fruits Vegetables Dairy Meats Variety Total fat Saturated fat Cholesterol Sodium

Points

Low income Higher income 

*Statistically significant difference from lowest income group at the 0.05 level or better.

Source: National Health and Nutrition Examination Survey, 1988-94.

6.5 6.5 6.4

6.9 6.9 6.9 6.9 6.8 6.7

7.9 7.7*

8.4* 8.4 8.3

8

7.6

7*

7.3

8.4

6.8*

5.3

5.8

4.5 5.6*

6.6

5.2*

5.2

5.9*

6.6*

6 6 6.2 6.2 6.2 6.3

6.6* 6.6*

For more information, see www.ers.usda.gov/publications/ 

efan04014-1, 04014-2, 04014-3, 04014-4

NOTE: These studies were not designed to assess program

impacts. Do not interpret any reported differences between 

program participants and nonparticipants as impacts of food

assistance programs.