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Epidemiology and Genomics Research Program

# Steps for Calculating Healthy Eating Index Scores

## Steps for Calculating HEI Scores

An overview of the basic steps for calculating HEI scores are below. The steps below are applicable to both the HEI for 2 years and older and the HEI-Toddlers-2020 for 12 through 23 months. See SAS code ReadMe files for steps necessary to calculate scores. Data preparation steps to remove infant formulas and imputed human milk nutrient values are needed prior to calculating HEI-Toddlers-2020 scores.

Additional resources are available to provide an overview of methods and calculations, to help choose a method, to learn more about how the HEI is used in research, to provide sample SAS code, and to help visualize and interpret scores.

Figure 1: HEI Scoring Illustration

Figure 1: summarizing the three steps for deriving HEI scores across each of the four levels of the food stream. Read the following sections for a complete explanation.

### 1. Identify the set of foods under consideration:

The set of foods considered could include, for example, the entire US food supply, the sum of choices available, marketed, or sold in a particular environment, or the foods consumed by a person or group of people on a day or over a longer period of time.

### 2. Determine the amount of each relevant dietary constituent in the set of foods:

The expandable table below shows an example of dietary constituents as labeled in the Food Patterns Equivalents Database (FPED) and the Food and Nutrient Database for Dietary Studies (FNDDS). This table describes the types of dietary variables needed to calculate the score and indicates examples of databases that contain this information. Though energy is included in the table, it is not a component in and of itself, but rather comprises the denominator of most of the component scoring equations.

## Dietary Constituents for HEI–2020

HEI Component Dietary Constituents1 Additional Information
From FPED2 (or other food-based database)
Total Fruits Total Fruits in cup equivalents Includes whole fruits and fruit juice.
Whole Fruits Citrus, Melons, Berries + Other Intact Fruits in cup equivalents Excludes fruit juice.
Total Vegetables Total Vegetables + Legumes (Beans and Peas) in cup equivalents
Greens and Beans Dark Green Vegetables + Legumes (Beans and Peas) in cup equivalents
Whole Grains Whole Grains in ounce equivalents
Dairy Total Dairy in cup equivalents Includes all milk products (e.g., fluid milk, yogurt, and cheese). Includes fortified soy milk. Excludes other plant-based milks.
Total Protein Foods Total Meat, Poultry, and Seafood (including organ meats and cured meats) + Eggs + Nuts and Seeds + Soy + Legumes (Beans and Peas) in ounce equivalents Excludes fortified soy milk (which is included in Dairy). Does not include protein from all sources (e.g., does not include protein from dairy); rather, this component includes foods considered to be part of the food group Protein Foods. Lean faction only (saturated/solid fats are counted separately).
Seafood and Plant Proteins Seafood (high in omega-3) + Seafood (low in omega-3) + Soy + Nuts and Seeds + Legumes (Beans and Peas) in ounce equivalents Excludes fortified soy milk (which is included in Dairy).
Refined Grains Refined Grains in ounce equivalents
Added Sugars Added Sugars Includes caloric sweeteners and syrups used as sweeteners in other food products, and sugar added in food preparation, processing, and at the table. Teaspoon equivalents are converted to energy (kcal) in the scoring process.
From FNDDS3 (or other nutrient database)
Energy Energy (kilocalories) Energy from foods and drinks, including alcohol. Does not include energy from supplements or nutritional supplement beverages or formulas. Does not include energy from human milk or infant/toddler formula.
Sodium Sodium Sodium is converted from milligrams to grams in scoring process.
Saturated Fats Total Saturated Fatty Acids Saturated fats are calculated in grams but converted to energy (kcal) in the scoring process.
Fatty Acids (Total Monounsaturated Fatty Acids + Total Polyunsaturated Fatty Acids)/Total Saturated Fatty Acids Calculated as a ratio.

1 = Dietary constituents in this table come from the Food Patterns Equivalents Database (FPED) and the Food and Nutrient Database for Dietary Studies (FNDDS).
2 = See the FPED overview. Detailed information about the FPED food groups can be found in FPED documentation.
3 = See the FNDDS overview. Detailed information about the FNDDS food groups can be found in FNDDS documentation.

#### How to Determine Amounts of Each Dietary Constituent

Determining the amounts of each dietary constituent contained in the total quantity of foods under consideration requires linking to relevant databases, as information on nutrients, certain food ingredients (such as added sugars) and food groups are needed to calculate HEI scores. To appropriately capture the amount of each of the guidance-based food groups of interest, foods and beverages must be disaggregated. Such disaggregation allows for estimated amounts to reflect only the constituent of interest and not the total amount of the foods and beverages in which it may be contained. See Figures 2 & 3.

For example, the fruit juice fraction of a juice drink -- which may represent only 10% of the total product -- counts toward total fruit, but the remainder of the beverage counts toward added sugars. Likewise, the skim milk fraction of whole milk counts toward the dairy constituent, but the butterfat in whole milk counts toward calories from solid fat.

Figure 2: Lasagna 100g

Figure 2: Lasagna 100g [D]

Figure 3: Example of Food Linkage from Reported Intakes

Figure 3: Example of food linkage from reported intakes. The intakes could be reported on a 24-hour recall or food record or derived from FFQ line items. Once the intakes are assigned to a food code, they can be linked to nutrients and food consumption amounts for use in HEI scoring.

* Nutrient data from FNDDS
** Food group data from FPED

Note: There are other dietary constituents relevant to the HEI-2015 that are not included here because they are not in the three sample foods. The HEI-2015 includes 13 components (Total Fruit, Whole Fruit, Total Vegetables, Greens & Beans, Whole Grains, Total Protein Foods, Seafood and Plant Proteins, Dairy, Fatty Acid Ratio, Refined Grains, Sodium, Saturated Fats, Added Sugars). Some constituents of foods will need to be summed to create the component variables to calculate the HEI. For example, Total Protein Foods is calculated by summing together all animal and plant proteins, including meat, poultry, fish, eggs, nuts, seeds, soy, and legumes. [D]

### 3. Derive pertinent ratios and score each HEI component using the relevant standard:

HEI scores are based on density values or ratios of intake per total energy. The resulting ratios are compared with the applicable standards for scoring.

For more information on choosing a method for scoring, see the Choosing a Method page.