Evaluating the Diet Quality of Preschoolers in a High‐Risk Community Using the HEI‐2010
Authors: Page Jessi deGruy , Crixell Sylvia Hurd , Markides Brittany Reese , Biediger‐Friedman Lesli 
Published: November 2023

Poor diet quality during childhood is associated with significant short‐term and long‐term health consequences. Of particular concern are poor dietary practices that can lead to childhood obesity. Obese youth are at greater risk of experiencing conditions such as hypertension, high cholesterol, insulin resistance, fatty liver disease, and myriad social and psychological problems. Childhood obesity is a strong predictor of obesity in adulthood; thus, obese children are more likely to experience serious health conditions as adults. These risks highlight the need for early obesity interventions. Rates of overweight and obesity among children in San Marcos, Texas are higher than state and national averages. Previous studies in this region have found that many toddlers and preschoolers are not meeting dietary recommendations either at childcare centers or at home. The city's population is ethnically diverse, with 37.8% of residents identifying as Hispanic or Latino, and the poverty rate is more than double national and state rates. These characteristics place the children of San Marcos at increased risk of obesity and malnutrition.

This study aimed to contribute to a community needs assessment by highlighting areas of concern within the diets of this high‐risk population and identifying potential foci for future nutrition interventions. The Healthy Eating Index‐2010 (HEI‐2010) was used to assess the diet quality of a convenience sample of 185 children aged 2–5 who were enrolled in child care centers in San Marcos, Texas. The HEI‐2010 is a tool for evaluating compliance with the recommendations of the 2010 Dietary Guidelines for Americans and the USDA Food Patterns. The maximum HEI‐2010 score, tallied from 12 dietary components, is 100. Generally, HEI‐2010 scores greater than 80 indicate a good diet, scores between 51 and 80 suggest a need for improvement, and scores below 51 denote a poor diet.

Dietary intake was collected in spring 2014 via telephone interviews with the children's parents. Trained interviewers used Nutrition Data System for Research 2013 (NDSR) software, which employed a multiple‐pass 24‐hour recall method to record all dietary intake data from the previous day. NDSR output was then used to calculate HEI‐2010 scores. The mean total HEI‐2010 score was 62, and average scores for all components were below the standards. Nonetheless, over half the children met the maximum component scores for Total Fruit, Whole Fruit, Dairy, and Total Protein Foods. Scores for Dairy (8.6/10) and Empty Calories (17.5/20) were closest to the standards. Scores for Greens and Beans (.9/5) and Fatty Acids (3.4/10) were farthest from the standards, indicating the children ate far less than the recommended amounts of dark‐green vegetables, beans, and unsaturated fatty acids.

The results suggest the need to improve many preschoolers’ dietary intake. Total HEI‐2010 scores would be improved by increasing the intake of vegetables, replacing refined grains with whole grains, and replacing sources of saturated fatty acids with unsaturated fatty acids.

Support or Funding Information

This research was funded by a Research Enhancement Grant from Texas State University.