Diet Quality, Measured Using the Healthy Eating Index‐2010, Varies by Source Where Food is Obtained in the United States
Authors: Wilson Magdalena , Krebs‐Smith Susan , Reedy Jill , Story Mary , Britten Patricia , Juan Wenyen 
Published: November 2023

Diet quality in the United States is improving over time but remains poor, with a majority of Americans not meeting national dietary recommendations. The food environment is an important influence on diet quality as it encompasses the different settings in which individuals make choices about food purchases and intake. Settings themselves can be examined in terms of the diet quality of the foods offered, served, or sold in each, but another way their influence can be evaluated is in terms of the foods consumed by individuals. The National Health and Nutrition Examination Survey (NHANES) provides a rich source of data to answer that question because it includes nationally‐representative data on food consumption by individuals in the population and captures information regarding where each food item reported in the dietary recall was obtained. This analysis uses NHANES data from participants ages two and older, from the years 2003–04 to 2011–12, to compare diet quality over time across the four major sources of food: stores, schools, full‐service restaurants, and quick‐service restaurants. The total Healthy Eating Index‐2010 (HEI‐2010) score, a measure of overall diet quality, and the pattern of HEI‐2010 component scores, depicted using radar plots, are used to compare diet quality between sources. The HEI‐2010 is scored so that high total and component scores indicate high diet quality and low scores indicate poor diet quality.

Overall diet quality is improving over time, but varies by source and remains below 70 points out of 100 across all sources of food. Foods from stores have the highest diet quality, with HEI‐2010 scores over time ranging from 57 to 66 out of 100, and foods from quick‐service restaurants have the lowest diet quality, with scores over time ranging from 35 to 42 out of 100. The pattern of HEI‐2010 component scores also varies substantially by where food was obtained. In 2011–2012, foods consumed from stores scored well in total fruit, whole fruit, total protein foods and seafood and plant protein, but poor in whole grains. Foods consumed from schools scored well in total fruit, whole fruit, dairy, total protein foods, and empty calories, but poor in greens and beans, whole grains, seafood and plant protein, fatty acids, and sodium. Foods from full‐service restaurants scored well in total vegetables, greens and beans, total protein foods, seafood and plant proteins, and empty calories, but poor in total fruit, whole fruit, whole grains, and sodium. Foods from quick‐service restaurants scored well in total protein foods, but poor in in total fruit, whole fruit, whole grains, seafood and plant proteins, refined grains, and sodium.

The overall HEI‐2010 scores and patterns of component scores show that no one source of food is providing a high quality diet. The patterns of component scores from different sources seem to complement each other to some degree, in that some sources score relatively high on components for which other sources score low. However, they do not do so sufficiently to result in overall healthy diets. The patterns also identify restaurants, particularly quick‐service restaurants, as a source of foods which collectively represent poor diet quality. These patterns can be used to identify foods and nutrients to target to improve diet quality from each of the four main sources where food is obtained in the U.S. food environment.