Diet quality of Japanese preschool children assessed by the Healthy Eating Index-2020: Nutrient and food group intake, as well as weekday-weekend differences.

BACKGROUND AND OBJECTIVES: In Japan, there are no official dietary guidelines for young children and nutrients may be insufficient on weekends, compared to weekdays at nursery schools. To ensure adequate nutrition, an appropriate dietary evaluation method is required. This study used the Healthy Eating Index (HEI)-2020, which is based on the Dietary Guidelines for Americans, to evaluate the diet quality of Japanese children, examine its validity through associations with nutrient and food group intake, and compare dietary characteristics on weekdays and weekends. METHODS AND STUDY DESIGN: The participants were 669 children aged 3 to 5 years attending nursery schools across Japan. Relationships of HEI-2020 scores with nutrient and food group intake, and comparisons between weekdays and weekends were evaluated. RESULTS: The median HEI-2020 score was 50/100, with almost maximum scores for Total Protein Foods, Seafood and Plant Pro-teins, and Added Sugars, while Whole Grains and Refined Grains scored zero. Additionally, the largest score differences between weekdays and weekends were found in Dairy and Greens and Beans. Higher HEI-2020 scores correlated with lower saturated fatty acids intake and higher intakes of dietary fiber, vitamins, and minerals. Weekday scores were significantly higher and less varied than weekend scores. CONCLUSIONS: HEI-2020 can identify nutrient intake challenges in Japanese children. Greater consumption of Dairy and Greens and Beans-components that showed large weekday-weekend differences-may improve diet quality.