Adapting the Healthy Eating Index 2010 for the Canadian Population: Evidence from the Canadian Community Health Survey

Abstract

The Healthy Eating Index (HEI) is a diet quality index shown to be associated with reduced chronic disease risk. Older versions of the HEI have been adapted for Canadian populations; however, no Canadian modification of the Healthy Eating Index-2010 (HEI-2010) has been made. The aims of this study were: (a) to develop a Canadian adaptation of the HEI-2010 (i.e., Healthy Eating Index-Canada 2010 (HEI-C 2010)) by adapting the recommendations of the HEI-2010 to Canada’s Food Guide (CFG) 2007; (b) to evaluate the validity and reliability of the HEI-C 2010; and (c) to examine relationships between HEI-C 2010 scores with diet quality and the likelihood of being obese. Data from 12,805 participants (≥18 years) were obtained from the Canadian Community Health Survey Cycle 2.2. Weighted multivariate logistic regression was used to test the association between compliance to the HEI-C 2010 recommendations and the likelihood of being obese, adjusting for errors in self-reported dietary data. The total mean error-corrected HEI-C 2010 score was 50.85 ± 0.35 out of 100. Principal component analysis confirmed multidimensionality of the HEI-C 2010, while Cronbach’s α = 0.78 demonstrated internal reliability. Participants in the fourth quartile of the HEI-C 2010 with the healthiest diets were less likely to consume refined grains and empty calories and more likely to consume beneficial nutrients and foods (p-trend < 0.0001). Lower adherence to the index recommendations was inversely associated with the likelihood of being obese; this association strengthened after correction for measurement error (Odds Ratio: 1.41; 95% Confidence Interval: 1.17–1.71). Closer adherence to Canada’s Food Guide 2007 assessed through the HEI-C 2010 was associated with improved diet quality and reductions in the likelihood of obesity when energy intake and measurement errors were taken into account. Consideration of energy requirements and energy density in future updates of Canada’s Food Guide are important and necessary to ensure broader application and usability of dietary quality indexes developed based on this national nutrition guideline.

Screening for Anemia among Children Attending Mansoura University Children’s Hospital

“…Our study was in agreement with Jessri et al [10] who reported that, HEI is diet quality index which measure diet quality and associated with decreased risk of chronic disease. HEI-score showed significant positive correlation with prevalence and incidence of anemia as children who intake healthy foods (contain essential nutrients) had good HEI-score and decreased risk of their anemia…”

“…Higher HEI-scores indicate the consumption of healthy foods and detect eating behaviors [9]. The risk of chronic disease decreased after using HEI as an index of diet quality (Table 1) [10].…”

Evaluating Diet Quality of Canadian Adults Using Health Canada’s Surveillance Tool Tier System: Findings from the 2015 Canadian Community Health Survey-Nutrition

“…Updated evidence based on consumption of nutrients to limit and on adherence to the recently released 2019 Canada's Food Guide are warranted to assess the progress towards achieving the WHO "best buy" policies [22]. Results from this study provide such evidence for Canadians, and can be used to improve the nutritional quality of the food supply and develop targeted policies supporting healthier food choices for the population [6,7,15,16,[30][31][32][33][34].…”

Diet Quality among Cancer Survivors and Participants without Cancer: A Population-Based, Cross-Sectional Study in the Atlantic Partnership for Tomorrow’s Health Project

“…A diet quality score was specifically developed for the Atlantic PATH study using criteria adapted from the US and Canadian HEI (HEI-C) [29,30] as not all information was available to construct the HEI-C. Details of the Atlantic PATH diet quality score derivation have been previously published [27].…”