Evaluation of dietary quality of adolescents using Healthy Eating Index

  • Tek, Nilufer Acar (Department of Nutrition and Dietetics Besevler, Gazi University Faculty of Health Sciences) ;
  • Yildiran, Hilal (Department of Nutrition and Dietetics Besevler, Gazi University Faculty of Health Sciences) ;
  • Akbulut, Gamze (Department of Nutrition and Dietetics Besevler, Gazi University Faculty of Health Sciences) ;
  • Bilici, Saniye (Department of Nutrition and Dietetics Besevler, Gazi University Faculty of Health Sciences) ;
  • Koksal, Eda (Department of Nutrition and Dietetics Besevler, Gazi University Faculty of Health Sciences) ;
  • Karadag, Makbule Gezmen (Department of Nutrition and Dietetics Besevler, Gazi University Faculty of Health Sciences) ;
  • Sanher, Nevin (Department of Nutrition and Dietetics Besevler, Gazi University Faculty of Health Sciences)
  • Received : 2011.01.13
  • Accepted : 2011.04.13
  • Published : 2011.08.31


The aim of this study was to use the Healthy Eating Index-2005 (HEI-2005) to assess diet quality and determine the relationship between the HEI-2005 and the energy and nutrient intakes of adolescents. A cross-sectional study was conducted on 1,104 healthy adolescents, mean age of $15.8{\pm}1.24$ years. Dietary intake was measured with the 24-hour dietary recall method, and dietary quality was assessed by means of the HEI-2005. Diet quality scores ranged from 23.7 to 77.5. The mean score was found to be $51.5{\pm}9.07$ according to the HEI-2005. There were no differences according to gender, 42.8% had a poor diet and 57.2% had a diet that needs improvement. No subjects had a "good diet". Lower mean subgroup scores were found for whole grains, total vegetables, total fruits, dairy products, and meat and beans. Fruits and vegetables scores were significantly high in girls, whereas sodium, oil, and meat and beans scores were significantly high in boys. Total HEI-2005 scores were increasingly associated with parental education level when age and gender were adjusted. There was a negative correlation between HEI-2005 scores and age, total energy intake, and fat intake. Positive correlation was only observed in the HEI-2005 scores for protein and dietary fibre intakes. Consequently, the overall diet quality and nutritional habits of Turkish adolescents need modification and improvement. In the family, measures should be initiated by the government, including advertisements and campaigns.


Adolescent;diet quality;healthy eating index;nutrition


  1. Miller PE, Mitchell DC, Harala PL, Pettit JM, Smiciklas-Wright H, Hartman TJ. Development and evaluation of a method for calculating the Healthy Eating Index-2005 using the Nutrition Data System for Research. Public Health Nutr 2011;14:306-13.
  2. McCabe-Sellers BJ, Bowman S, Stuff JE, Champagne CM, Simpson PM, Bogle ML. Assessment of the diet quality of US adults in the Lower Mississippi Delta. Am J Clin Nutr 2007; 86:697-706.
  3. Pick ME, Edwards M, Moreau D, Ryan EA. Assessment of diet quality in pregnant women using the Healthy Eating Index. J Am Diet Assoc 2005;105:240-6.
  4. Guenther PM, Reedy J, Krebs-Smith SM. Development of the Healthy Eating Index-2005. J Am Diet Assoc 2008;108:1896-1901.
  5. Khalil CB, Johnson-Down L, Egeland GM. Emerging obesity and dietary habits among James Bay Cree youth. Public Health Nutr 2010;13:1829-37.
  6. Shahar DR, Yu B, Houston DK, Kritchevsky SB, Lee JS, Rubin SM, Sellmeyer DE, Tylavsky FA, Harris TB; Health, Aging and Body Composition Study. Dietary factors in relation to daily activity energy expenditure and mortality among older adults. J Nutr Health Aging 2009;13:414-20.
  7. Breslow RA, Guenther PM, Juan W, Graubard BI. Alcoholic beverage consumption, nutrient intakes, and diet quality in the US adult population, 1999-2006. J Am Diet Assoc 2010;110:551-62.
  8. Feskanich D, Rockett HR, Colditz GA. Modifying the Healthy Eating Index to Assess Diet quality in children and adolescents. J Am Diet Assoc 2004;104:1375-83.
  9. Mirmiran P, Azadbakht L, Azizi F. Dietary quality-adherence to the dietary guidelines in Tehranian adolescents: Tehran Lipid and Glucose Study. Int J Vitam Nutr Res 2005;75:195-200.
  10. Hurley KM, Oberlander SE, Merry BC, Wrobleski MM, Klassen AC, Black MM. The Healthy Eating Index and Youth Healthy Eating Index are unique, nonredundant measures of diet quality among low-income, African American Adolescents. J Nutr 2009;139:359-64.
  11. Story M, Holt K, Sofka D. Bright Futures in Practice: Nutrition. 2nd ed. Arlington VA: National Center for Education in Maternal and Child Health; 2002.
  12. Katz DL, Friedman RSC. Diet and Adolescence. Nutrition in Clinical Practice. 2nd ed. Philadelphia: Wolters Kluwer, Lippincot Williams & Wilkins; 2008. p.326-7.
  13. Lohman TG, Roche AF, Martorell R. Anthropometric Standardization Reference Manual. Champaign, Illinois: Kinetics Books; 1988.
  14. Rakıcıoglu N, Tek-Acar N, Ayaz A, Pekcan G. Meal and Food Catalog: Measurements and Quantities. 2nd ed. Ankara: Ata Ofset publications; 2009.
  15. Bebis Nutrition Data Base Software Data Base 2004. The German Food Code and Nutrient Data Base (BLS II.3, 1999) with additions from USDA-sr and other sources. Istanbul, Turkey.
  16. Freedman LS, Guenther PM, Krebs-Smith SM, Kott PS. A population's mean Healthy Eating Index-2005 scores are best estimated by the score of the population ratio when one 24-hour recall is available. J Nutr 2008;138:1725-9.
  17. Woodruff SJ, Hanning RM, McGoldrick K, Brown KS. Healthy eating index-C is positively associated with family dinner frequency among students in grades 6-8 from Southern Ontario, Canada. Eur J Clin Nutr 2010;64:454-60.
  18. Monge-Rojas R, Smith-Castro V, Colon-Ramos U, Garita-Arce C, Sanchez-Lopez M, Chinnock A. Parental feeding styles and adolescents' healthy eating habits. Structure and correlates of a Costa Rican questionnaire. Appetite 2010;55:253-62.
  19. Serra-Majema L, Ribasb L, Pérez-Rodrigoc C, García-Closasd R, Peña-Quintanaa L, Arancetac J. Determinants of nutrient intake among children and adolescents: Results from the enKid Study. Ann Nutr Metab 2002;46 (Suppl 1):31-8.
  20. Woodruff SJ, Hanning RM, Lambraki I, Storey KE, McCargar L. Healthy Eating Index-C is compromised among adolescents with body weight concerns, weight loss dieting, and meal skipping. Body Image 2008;5:404-8.
  21. de Andrade SC, de Azevedo Barros MB, Carandina L, Goldbaum M, Cesar CL, Fisberg RM. Dietary quality index and associated factors among adolescents of the state of Sao Paulo, Brazil. J Pediatr 2010;156:456-60.
  22. Wang Y, Jahns L, Tussing-Humphreys L, Xie B, Rockett H, Liang H, Johnson L. Dietary intake patterns of low-income urban african-american adolescents. J Am Diet Assoc 2010;110:1340-5.
  23. Guo X, Warden BA, Paeratakul S, Bray GA. Healthy Eating Index and obesity. Eur J Clin Nutr 2008;58:1580-6.
  24. Kuhnlein HV, Receveur O, Chan HM. Traditional food systems research with Canadian Indigenous Peoples. Int J Circumpolar Health 2001;60:112-22.
  25. Goodwin DK, Knol LK, Eddy JM, Fitzhugh EC, Kendrick O, Donohue RE. Sociodemographic correlates of overall quality of dietary intake of US adolescents. Nutr Res 2006;26:105-10.
  26. Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The Relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics 1999;103:1175-82.
  27. Pekcan G. Food and nutrition policies: what's being done in Turkey. Public Health Nutr 2006;9:158-62.
  28. U.S. Department of Health and Human Services. Healthy People 2010. Washington, DC: U.S. Government Printing Office; 2000.
  29. O'Neil CE, Nicklas TA, Zanovec M, Cho SS, Kleinman R. Consumption of whole grains is associated with improved diet quality and nutrient intake in children and adolescents: the National Health and Nutrition Examination Survey 1999-2004. Public Health Nutr 2011;14:347-55.
  30. Harnack L, Walters SA, Jacobs DR Jr. Dietary intake and food sources of whole grains among US children and adolescents: data from the 1994-1996 Continuing Survey of Food Intakes by Individuals. J Am Diet Assoc 2003;103:1015-9.
  31. Larson NI, Neumark-Sztainer D, Story M, Burgess-Champoux T. Whole-grain intake correlates among adolescents and young adults: findings from Project EAT. J Am Diet Assoc 2010;110:230-7.
  32. Unusan N. Fruit and vegetable consumption among Turkish university students. Int J Vitam Nutr Res 2004;74:341-8.
  33. Bas M, Altan T, Dincer D, Aran E, Kaya HG, Yuksek O. Determination of dietary habits as a risk factor of cardiovascular heart disease in Turkish adolescents. Eur J Nutr 2005;44:174-82.
  34. Neumark-Sztainer D, Story M, Resnick MD, Blum RW. Correlates of inadequate fruit and vegetable consumption among adolescents. Prev Med 1996;25:497-505.
  35. Krebs-Smith SM, Cook A, Subar AF, Cleveland L, Friday J, Kahle LL. Fruit and vegetable intakes of children and adolescents in the United States. Arch Pediatr Adolesc Med 1996;150:81-6.
  36. Food and Agriculture Organization (FAO). Nutrition Country Profiles-Turkey (2001). Prepared in the collaboration of Pekcan G (Turkey) and Marchesich R (ESNA-FAO). [accessed 8 October 2010] Available from:
  37. Dwyer J, Cosentino C, Li D, Feldman H, Garceau A, Stevens M, Perry C, Hoelscher D, Webber LS, Zive M. Evaluating school-based interventions using the Healthy Eating Index. J Am Diet Assoc 2002;102:257-9.
  38. Pekcan G, Karaagaoglu N. State of nutrition in Turkey. Nutr Health 2000;14:41-52.
  39. Larowe TL, Moeller SM, Adams AK. Beverage patterns, diet quality, and body mass index of US preschool and school-aged children. J Am Diet Assoc 2007;107:1124-33.
  40. Troiano RP, Briefel RR, Carroll MD, Bialostosky K. Energy and fat intakes of children and adolescents in the United States: data from the National Health and Nutrition Examination Surveys. Am J Clin Nutr 2000;72(5 Suppl):1343S-1353S.
  41. Marshall TA, Eichenberger Gilmore JM, Broffitt B, Stumbo PJ, Levy SM. Diet quality in young children is influenced by beverage consumption. J Am Coll Nutr 2005;24:65-75.

Cited by

  1. A Randomized Clinical Trial of Nutrition Education for Improvement of Diet Quality and Inflammation in Iranian Obese Women vol.2014, pp.2090-0732, 2014,
  2. Diet quality among Iranian adolescents needs improvement vol.18, pp.04, 2015,
  3. Diet quality is associated with measures of body fat in adolescents from Otago, New Zealand vol.18, pp.08, 2015,
  4. Qualidade da dieta de jovens aos 18 anos de idade, pertencentes à coorte de nascimentos de 1993 da cidade de Pelotas (RS), Brasil vol.20, pp.11, 2015,
  5. Evaluation of diet quality and its associated factors among adolescents in Kuala Lumpur, Malaysia vol.9, pp.5, 2015,
  6. Nutritional intake and overall diet quality of female soccer players before the competition period vol.29, pp.4, 2016,
  7. Socioeconomic status and dietary patterns in children from around the world: different associations by levels of country human development? vol.17, pp.1, 2017,
  8. Description of the healthy eating indices-based diet quality in Turkish adults: a cross-sectional study vol.22, pp.1, 2017,
  9. Validation of the Brazilian Healthy Eating Index-Revised Using Biomarkers in Children and Adolescents vol.10, pp.2, 2018,
  10. An Evaluation of Factors Predicting Diet Quality among Cancer Patients vol.10, pp.8, 2018,