Development of the Saudi healthy eating index (SHEI): a first step toward national diet quality monitoring

Abstract

Background: Diet quality indices serve as standardized tools to evaluate adherence to dietary guidelines and inform nutrition and public health research. The present study aimed to develop the Saudi Healthy Eating Index (SHEI) to assess adherence to the 2024 version of the Saudi Healthy Plate (SHP) guide. Methods: Twelve components were selected for the SHEI based on the key dietary recommendations of the SHP guide. All components are scored between zero and ten points, except for components measuring the same dietary aspect, which are assigned up to five points. The total adherence score ranges between zero (no adherence) and 100 (complete adherence). Results: Maximum scores and standards were assigned to each component as follows: fruits (ten points, ≥ 0.6 servings/1000 kcal), vegetables (ten points, ≥ 1.1 servings/1000 kcal), grains (five points, ≥ 3.5 servings/1000 kcal), whole grain ratio (five points, ratio of whole grains to total grains ≥ 0.5), protein foods (five points, ≥ 2.2 servings/1000 kcal), seafood and plant-based protein foods (five points, ≥ 0.9 servings/1000 kcal), dairy products (ten points, ≥ 0.8 servings/1000 kcal), beverages (ten points, only water or non-sweetened beverages consumed), fatty acid ratio (ten points, ratio of unsaturated to saturated fatty acids ≥ 2.6), saturated fats (ten points, ≤ 7% of energy intake), added sugar (ten points, ≤ 5% of energy intake), and sodium (ten points, ≤ 0.8 g of sodium per 1000 kcal). Conclusion: The SHEI was designed to measure diet quality by determining adherence to the SHP guide recommendations. Future research is needed to evaluate its validity and reliability and to explore its potential applications in public health nutrition.