Diet Quality Among Hungarian Children Assessed Using the Healthy Eating Index-2020: Associations with...

Background: Assessing overall diet quality has become increasingly important in nutritional epidemiology. The Healthy Eating Index (HEI) is one of the most widely used measures of diet quality; however, comparable data on Hungarian children are scarce. The current study aimed to assess the diet quality of Hungarian children using the Healthy Eating Index and to examine demographic factors associated with diet quality. Methods: This cross-sectional study included 666 children aged 4-10 years. Dietary intake was measured using three-day dietary records, and sociodemographic factors were collected via parental questionnaires. Diet quality was assessed using the Healthy Eating Index-2020 (HEI-2020). For the statistical analysis, linear regression, random forest models and one-way ANOVA with Tukey's post hoc test were used. Results: The mean HEI score was 48.2 (SD 8.02), indicating low diet quality. Settlement type was significantly associated with the HEI score (p = 0.009). The multiplicity-corrected p-values for pairwise comparisons showed that children living in towns had significantly lower HEI scores (44.9, SD 7.97) than those living in county capitals (3.9, 95% CI:0.8-7.0, p = 0.006) and villages (-3.6, 95% CI: -0.61--6.6, p = 0.011), but not significantly lower than those living in the capital (3.09, 95% CI: -0.25-6.4, p = 0.08). These differences were primarily related to whole-fruit and whole-grain component scores. Sex, age, and maternal education were not significantly associated with HEI score. The random forest model showed weak predictive performance (RMSE = 7.66). Conclusions: Diet quality among Hungarian children was generally suboptimal. The examined sociodemographic characteristics accounted for only a small proportion of the variability in the HEI score. This highlights the importance of ongoing research to understand dietary patterns and to uncover additional social, environmental, and behavioral aspects of dietary habits across cultures. Furthermore, the results indicate that interventions should also consider local food environments.