Evaluation of the Healthy Eating Index-Toddlers-2020

Background With the addition of new guidance for children from birth to 24 months in the Dietary Guidelines for Americans, 2020-2025 (DGA), a Healthy Eating Index (HEI) was developed for toddlers. Objective To evaluate the psychometric properties of the HEI-Toddlers-2020, 5 ana-lyses relevant to construct and concurrent validity and 2 related to reliability were examined. Design Twenty-four-hour diet recall data from the cross-sectional National Health and Nutrition Examination Survey (2011-2018) were used. In addition, exemplary menus were analyzed. Participants/setting The main analytic sample included toddlers aged 12 through 23 months (n = 838), with additional analyses of toddlers aged 12 through 35 months (n = 1,717) from the United States. Included participants had valid diet recalls and available weight-for-age data. Main outcome measures Outcomes measures included HEI-Toddlers-2020 total and component scores on menus, population distributions, and correlations. Statistical analyses HEI total and component scores were calculated using menus from the American Academy of Pediatrics and Healthy Eating Research. Score means and distributions were estimated using a Markov Chain Monte Carlo approach with National Health and Nutrition Examination Survey data (2011-2018). Principal component analysis explored dimensions and Pearson correlations examined components, energy, and Cronbach a. In addition, HEI-Toddlers-2020 and HEI-2020 scores were compared for identical intakes at age 24 months. Results For validity, exemplary menus received high scores with the HEI-Toddlers-2020. The mean +/- SE total HEI-Toddlers-2020 score for toddlers aged 12 through 23 months was 62.9 +/- 0.78 and ranged from 40.1 to 84.4 (1st to 99th percentile). Corre-lation between diet quality and diet quantity was low (-0.15); the scree plot revealed multiple factors. In addition, total scores for identical intakes were approximately 1.5 points higher for HEI-Toddlers-2020 compared with HEI-2020 (difference range for component scores,-4.97 to 4.89). For reliability, most of the intercorrelations among components were low to moderate (0 to 0.49), with a few exceptions among related components. Cronbach a was .48. These results indicate that the index is multidimen-sional, with no single component driving the total score, and no unnecessary compo-nents that are highly correlated with another component. Conclusions The results demonstrated evidence supportive of validity and reliability. The HEI-Toddlers-2020 can be used to assess alignment with the DGA for toddlers. J Acad Nutr Diet. 2023;123(9):1307-1319.