Healthy Eating Index scores are associated with blood nutrient concentrations in the third National Health And Nutrition Examination Survey

J Am Diet Assoc. 2004 Apr;104(4):576-84. doi: 10.1016/j.jada.2004.01.005.


Objectives: The Healthy Eating Index (HEI) is a summary measure of dietary quality, based on a 100-point scale. Our objectives were to assess the HEI as a measure of dietary status through its correlation with nutritional biomarkers and to identify those biomarkers most associated with diet quality and healthful food intake patterns.

Design: National Health and Nutrition Examination Survey (NHANES) III, 1988-94.

Subjects: Adults (> or =17 years) with calculated HEI scores and blood nutrient data (n=16,467).

Statistical analyses performed: Weighted crude and partial Pearson correlation coefficients (r) between HEI scores and blood nutrients were calculated. Geometric mean blood nutrient concentrations were calculated for five HEI score categories (ranging from < or =50 to >80).

Results: HEI score was positively correlated with serum (r=0.25) and red blood cell (r=0.27) folate, serum vitamins C (r=0.30) and E (r=0.21), and all serum carotenoids except lycopene (r=0.17 to 0.27). These blood nutrient concentrations were 21% to 175% higher for participants in the highest HEI score group (>80) compared with those in the lowest group (< or =50). Mean HEI scores were significantly (P<.0001) greater among the 42% of participants who took dietary supplements. Most correlations were attenuated when adjusted for additional factors.

Conclusions: HEI score is correlated with a wide range of blood nutrients; the strongest relationships are with biomarkers of fruit and vegetable intake. These results are an important step in the validation of the HEI, emphasizing its potential as a tool for nutrition and health studies.

MeSH terms

  • Adolescent
  • Adult
  • Ascorbic Acid / blood
  • Biomarkers / blood*
  • Carotenoids / blood
  • Diet / standards*
  • Dietary Supplements
  • Eating*
  • Female
  • Folic Acid / blood
  • Fruit
  • Health Status Indicators*
  • Humans
  • Male
  • Middle Aged
  • Nutrition Policy
  • Nutrition Surveys
  • Nutritional Status
  • Reference Standards
  • United States
  • United States Department of Agriculture
  • Vegetables
  • Vitamin E


  • Biomarkers
  • Vitamin E
  • Carotenoids
  • Folic Acid
  • Ascorbic Acid