Evaluation of Bangladesh Healthy Eating Index (BD-HEI).

Background: The Healthy Eating index can be used to evaluate overall diet quality. Based on the methodological approaches published recently, we assessed the validity of the Bangladesh Healthy Eating Index (BD-HEI) as an indicator of dietary quality.

Methods: A cross-sectional survey was conducted among 1080 reproductive-aged women of Bangladesh. Quantitative dietary data were collected following multiple pass 24-h dietary recall method. Repeated 24-h dietary data (of two consecutive days) were collected from almost one-third of the respondents. Evaluating usual food and nutrient intake utilizing the Multiple Source method (MSM), the study examined the validity of the index. To measure the construct validity, the HEI score was compared with scores obtained from sample menus using the same scoring standards. In addition, correlation analyses were performed between the HEI score and energy and nutrient intake. Principal Component analysis (PCA) was performed on dietary data to explore whether more than one item underlies the total score. As a part of the reliability analysis, Cronbach's alpha was calculated.

Results: The mean HEI total score was 44.45 (range of 25.22-67.33) among the study population. The first and fifth-percentile scores were consistently low across all component categories, while the component scores for the 99th percentile were generally high suggesting that the index shows a lot of individual diversity. However, a moderate to weak correlation was found between the total HEI score, index component, and calorie consumption. A weak to moderate correlation was observed between HEI score and nutrient intake (both macro and micronutrients), suggesting that the index can evaluate dietary quality apart from quantity. A high value was observed for the sample menu provided in Food-based dietary guideline (FBDG). In principal component analysis, it has been found that a minimum of five factors were required to account for 55% of the total score variation, indicating the multidimensional nature of the index. The standardized Cronbach's alpha of 0.66 indicates moderate consistency among the index items.

Conclusion: The study findings indicate that the BD-HEI is a trustworthy index for evaluating diet quality. It can help policymakers and public health officials understand the current state of dietary habits and identify areas needing improvement.

Clinical trial number: Not applicable.