The Healthy Eating Index 2010 (HEI-2010) and Alternative Healthy Eating Index 2010 (AHEI-2010) are commonly used to measure dietary quality in research settings. Neither index is designed specifically to compare diet quality between low-carbohydrate (LC) and low-fat (LF) diets. It is unknown whether biases exist in making these comparisons. The aim was to determine whether HEI-2010 and AHEI-2010 contain biases when scoring LC and LF diets. Secondary analyses of the Diet Intervention Examining the Factors Interacting With Treatment Success (DIETFITS) weight loss trial were conducted. The trial was conducted in the San Francisco Bay Area of California between January 2013 and May 2016. Three approaches were used to investigate whether biases existed for HEI-2010 and AHEI-2010 when scoring LC and LF diets. DIETFITS participants were assigned to follow healthy LC or healthy LF diets for 12 months (n = 609). Mean diet quality index scores for each diet were measured. Approach 1 examined both diet quality indices’ scoring criteria. Approach 2 compared scores garnered by exemplary quality LC and LF menus created by registered dietitian nutritionists. Approach 3 used 2-sided tests to compare the HEI-2010 and AHEI-2010 scores calculated from 24-hour dietary recalls of DIETFITS trial participants (n = 608). Scoring criteria for both HEI-2010 (100 possible points) and AHEI-2010 (110 possible points) were estimated to favor an LF diet by 10 points. Mean scores for exemplary quality LF menus were higher than for LC menus using both HEI-2010 (91.8 vs 76.8) and AHEI-2010 (71.7 vs 64.4, adjusted to 100 possible points). DIETFITS participants assigned to a healthy LF diet scored significantly higher on HEI and AHEI than those assigned to a healthy LC diet at 3, 6, and 12 months (all, < .001). Mean baseline scores were lower than mean scores at all follow-up time points regardless of diet assignment or diet quality index used. Commonly used diet quality indices, HEI-2010 and AHEI-2010, showed biases toward LF vs LC diets. However, both indices detected expected changes in diet quality within each diet, with HEI-2010 yielding greater variation in scores. Findings support the use of these indices in measuring diet quality differences within, but not between, LC and LF diets.

中文翻译：

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探索低碳水化合物和低脂肪饮食评分时健康饮食指数和替代健康饮食指数的偏差

2010 年健康饮食指数 (HEI-2010) 和 2010 年替代健康饮食指数 (AHEI-2010) 通常用于衡量研究环境中的饮食质量。这两个指数都不是专门为比较低碳水化合物（LC）和低脂肪（LF）饮食之间的饮食质量而设计的。目前尚不清楚进行这些比较是否存在偏见。目的是确定 HEI-2010 和 AHEI-2010 在对 LC 和 LF 饮食进行评分时是否存在偏差。对饮食干预检查与治疗成功相互作用的因素 (DIETFITS) 减肥试验进行了二次分析。该试验于 2013 年 1 月至 2016 年 5 月在加利福尼亚州旧金山湾区进行。使用三种方法来调查 HEI-2010 和 AHEI-2010 在对 LC 和 LF 饮食进行评分时是否存在偏差。 DIETFITS 参与者被分配遵循健康 LC 或健康 LF 饮食 12 个月 (n = 609)。测量了每种饮食的平均饮食质量指数得分。方法 1 检查了两种饮食质量指数的评分标准。方法 2 比较了注册营养师创建的优质 LC 和 LF 菜单所获得的分数。方法 3 使用双边检验来比较根据 DIETFITS 试验参与者 (n = 608) 24 小时饮食回忆计算得出的 HEI-2010 和 AHEI-2010 分数。 HEI-2010（100 分）和 AHEI-2010（110 分）的评分标准估计有利于 LF 饮食 10 分。使用 HEI-2010（91.8 vs 76.8）和 AHEI-2010（71.7 vs 64.4，调整为 100 可能分）时，示范性质量 LF 菜单的平均得分高于 LC 菜单。分配到健康 LF 饮食的 DIETFITS 参与者在 3、6 和 12 个月时的 HEI 和 AHEI 得分显着高于分配到健康 LC 饮食的参与者（全部 < .001）。无论使用何种饮食分配或饮食质量指数，平均基线分数均低于所有随访时间点的平均分数。常用的饮食质量指数 HEI-2010 和 AHEI-2010 显示 LF 饮食与 LC 饮食存在偏差。然而，这两个指数都检测到了每种饮食中饮食质量的预期变化，其中 HEI-2010 的得分差异更大。研究结果支持使用这些指数来衡量 LC 和 LF 饮食内部而非之间的饮食质量差异。