Associations between healthy eating index and anthropometric outcomes in multiethnic elementary-aged children.

Introduction: High adiposity in children can predict cardiometabolic risk in adulthood. This study investigated if changes in dietary quality, measured by the Healthy Eating Index (HEI), are associated with changes in anthropometric measurements in children.

Methods: This secondary analysis used data from TX Sprouts, a cluster randomized controlled trial that investigated the effects of a 1-year school nutrition program on child diet and obesity. 24-hour dietary recalls were used to measure HEI-2020 at baseline and post-intervention. Anthropometric outcomes were BMI, waist circumference, and body fat percentage via bioelectrical impedance. Linear regression models assessed associations between changes in HEI-2020 total and component scores and anthropometrics.

Results: Participants (n = 424) were 53% male, 56% Hispanic, and the average age was 9.3 years. A 10-point increase in total HEI-2020 score was associated with a 0.4% (95% CI: 0.1%-0.6%) decrease in body fat percentage. Increases in whole grain and decreases in refined grain component scores were associated with decreases in body fat percentage. Changes in total or component scores were not associated with changes in BMI, BMI-Z, or waist circumference.

Conclusion: This study found associations between increased diet quality and decreased body fat percentage in a primarily low-income, multi-ethnic population of children.