Evaluating Diet Quality with HEI-2010 for a Diverse Sample of Low-income Mothers

Introduction: The Healthy Eating Index-2010 (HEI-2010) measures diet quality based on the 2010 Dietary Guidelines for Americans. So far, few, if any, studies have evaluated diet quality using the HEI-2010 for low-income mothers, who are often targeted by policies and interventions.

Methods: Low-income mothers (<200% of federal poverty line) were enrolled in a prospective study; they completed surveys and >2 dietary recalls (n=101). We used the HEI-2010 to evaluate diet quality and compare adequacy and moderation component and total scores for study participants and the general population.   

Results: The HEI-2010 total score was 49.7%. Participants were close to meeting recommendations for total proteins (92.6%) and minimizing refined grains (97.9%). However, total and whole fruit, and seafood/plant protein scores were far from recommended intakes (scores <33%); remaining component scores <55%. Compared to HEI-2010 scores for the general population (>2 years), participants had significantly lower total scores (49.7%, compared to 53.5% for general population, p<0.05), with lower scores for most adequacy components (p<0.05), and higher scores for some moderation components (p<0.05).

Discussion: Our results suggest that participants are minimizing empty calories and refined grains. However, participants fell short of meeting recommendations for nutritious foods, especially fruits and seafood/plant proteins. Based on qualitative interviews with participants, we hypothesize that participants’ individual efforts are insufficient to overcome structural constraints, including low incomes, limited food resources, and disparities in local food environments. Our findings point to the need to consider the complex interplay of individual, social, and environmental factors that contribute to lower diet quality.