Longitudinal Changes in Healthy Eating Index-2020 Score and Impacts on Body Mass Index Among Adolescents in the Growing Up Today Study: A Prospective Cohort Study.

Authors

Matthew M Lee, Mary Kathryn Poole, Jarvis T Chen, Steven L Gortmaker, Briana Joy K Stephenson, Jess Haines, Jorge E Chavarro, Dimitrios V Diamantis, Erica L Kenney

Published in

The Journal of nutrition. Pages 101735. Jul 17, 2026. Epub Jul 17, 2026.

Abstract

The Dietary Guidelines for Americans informs the design of nutrition programs targeted at improving health across the lifecourse, including for adolescents, a population with sub-optimal diet quality. The associations between adherence to the Guidelines and longitudinal health outcomes among adolescents, however, is unclear.
We leveraged seven years of data from the Growing Up Today Study, a prospective cohort study, to evaluate associations between concurrent changes in total or component Healthy Eating Index-2020 (HEI-2020) scores, a measure of adherence to the Guidelines, and changes in body mass index (BMI), a targeted outcome of the Guidelines, in U.S. adolescents.
We analyzed data from a prospective longitudinal cohort with enrollment cycles in 1996 (n=14,233) and 2004 (n=7,898). We calculated HEI-2020 and BMI from validated food frequency questionnaires and self-reported height/weight. Multivariate fixed effects regression models, stratified by sex, were used to estimate associations between within-child changes in HEI-2020 and changes in BMI. We assessed interactions by concurrent adolescent BMI category and age.
After covariate adjustment, a 10-point increase in total HEI-2020 was associated with 0.09 (95%CI: 0.051, 0.121) and 0.04 (0.011, 0.066) kg/m² decreases in BMI for boys and girls, respectively. Of the 13 HEI-2020 components, only the greens/beans, fatty acids adequacy scores, and saturated fatty acid moderation scores were inversely related to BMI. A 1-point increase in the dairy component was associated with mean increases of 0.02 kg/m² for boys and girls. Associations between total HEI-2020 and BMI were stronger for youth classified as overweight/obesity and for older age, though associations were still relatively small.
Improved adherence to the Dietary Guidelines, 2020-2025, was associated with small, though clinically insignificant, decreases in mean BMI among adolescents. Relationships for specific HEI components were heterogeneous and warrant further study.

PMID:
42468724
Bibliographic data and abstract were imported from PubMed on 18 Jul 2026.

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