The development, application, and validation of a Healthy eating index for Australian Adults (HEIFA-2013)

Diet quality indices are used to assess dietary behavior and adherence to dietary guideline recommendations. The aim of this study was to develop, apply, and validate a Healthy Eating Index for Australian Adults (HEIFA-2013) based on the updated Dietary Guidelines for Australians 2013.

The HEIFA-2013 used an 11-component system of 5 food groups, 4 nutrients, water intake, and a measure of dietary variety. The total possible index score was 100. The HEIFA-2013 was applied to weighed food record (WFR) and food frequency questionnaire (FFQ) data of a sample (n = 100) of young adults. The HEIFA-2013 was assessed using principal components analysis (PCA), Cronbach's coefficient, and correlation coefficient with nutrient intakes. Scores for HEIFA-2013 components were compared between methods using means, frequencies, 95% limits of agreement, Bland and Altman methods, and weighted kappa.

PCA indicated that multiple underlying dimensions compose the index, and Cronbach's coefficient α was 0.41. A higher HEIFA-2013 was associated with higher dietary quality, including a low intake of saturated fat and sodium and a high intake of selected vitamins and minerals. Low correlations with energy were observed. The mean HEIFA-2013 score ± standard error (SE) for the WFR was 53.84 ± 1 and for the FFQ was 54.82 ± 0.9. The total mean scores were 54.33 ± 0.1. Young adults had the lowest mean scores for sodium (2.9 ± 0.2), fat (3.0 ± 0.0), vegetables (4.7 ± 0.1), and grains (5.1 ± 0.1). The WFR and FFQ scored individual components differently, but at the group level the differences were not significant.

The HEIFA-2013 will need to be catered for different diet collection methods. It is a useful index of overall diet quality and can be used to monitor changes in dietary intake of adults over time. The findings infer that even a highly educated affluent group of young adults fails to meet recommended dietary guidelines.