Healthy Eating Index-2015 Scores Among Adults Based on Observed vs Recalled Dietary Intake

J Acad Nutr Diet. 2021 Nov;121(11):2233-2241.e1. doi: 10.1016/j.jand.2021.06.009. Epub 2021 Aug 4.


Background: The construct and predictive validity of the Healthy Eating Index (HEI) have been demonstrated, but how error in reported dietary intake may affect scores is unclear.

Objective: These analyses examined concordance between HEI-2015 scores based on observed vs reported intake among adults.

Design: Data were from two feeding studies (Food and Eating Assessment STudy, or FEAST, I and II) in which true intake was observed for three meals on 1 day. The following day, participants completed an unannounced 24-hour dietary recall.

Participants/setting: FEAST I (2012) included 81 men and women, aged 20 to 70 years, living in the Washington, DC, area. FEAST II (2016) included 302 women, aged 18 years or older, with low household incomes and living in the Washington, DC, area. In FEAST I, recalls were completed independently using the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24-2011) or interviewer-administered using the Automated Multiple-Pass Method. In FEAST II, recalls were completed using ASA24-2016, independently or in a small group setting with assistance.

Main outcome measures: HEI-2015 scores were calculated using the population ratio method.

Statistical analyses performed: T-tests determined whether differences between scores based on observed and reported intake were different from zero. FEAST I data were stratified by sex, and in FEAST II, analyses were repeated by education and body mass index (BMI).

Results: Differences in total HEI-2015 scores between observed and reported intake ranged from -1.3 to 5.8 points among those completing ASA24 independently in both studies, compared with -2.5 points in the small group setting. For interviewer-administered recalls, the differences were -1.1 for men and 2.3 for women. In FEAST II, total HEI-2015 scores derived from observed intake were lower than scores derived from reported intake among those who had completed high school or less (-3.2, SE 1.1, P<0.01) and those with BMI ≥ 30 (-2.8, SE 1.1, P = 0.01).

Conclusions: HEI-2015 scores based on 24-hour dietary recall data are generally well estimated.

Keywords: 24-hour recall; Dietary intake; Dietary patterns; Healthy Eating Index; Validation.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Behavior Observation Techniques / methods
  • Behavior Observation Techniques / statistics & numerical data*
  • Diet Surveys / methods
  • Diet Surveys / statistics & numerical data*
  • Diet, Healthy / psychology
  • Diet, Healthy / statistics & numerical data*
  • District of Columbia
  • Eating / psychology*
  • Female
  • Humans
  • Male
  • Mental Recall*
  • Middle Aged
  • Poverty / psychology
  • Poverty / statistics & numerical data
  • Reproducibility of Results
  • Young Adult