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

Abstract Objective 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. Methods 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. Results 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. Conclusions 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.