Small changes can add up to a big difference in the HEI score. For example, cereal with milk is the centerpiece of each of the breakfasts. However, the choices of fat-free rather than 2 percent milk, whole grain cereal rather than sugar-sweetened refined grain cereal, whole wheat instead of white toast, and the addition of fruit and juice improve the HEI scores significantly.
The "high" menu gets the top HEI score because of the inclusion of vegetables and/or fruits at each meal and snack. All of the grains are whole grains, the dairy products are all low-fat or fat-free, and the protein choices include fish as well as poultry. Few of the day's calories are empty calories.
The "above average" menu contains fruits and vegetables at each meal as well as fat-free milk and lower-fat chicken choices. However, the refined grains and somewhat larger number of empty calories reduce this day's HEI score.
The "below average" menu contains no whole fruit but some fruit juice. Most of the grains are refined grains. This menu's overall HEI score is less than the "above average" menu's because it has fewer vegetables and fruit and more empty calories. On the other hand, one reason the score for this menu is higher than the score for the "low" menu is because the dairy products shift away from cheese, which is high in solid fats and sodium, to fluid 2% milk, which has less sodium and somewhat less fat.
The "low" menu gets the lowest HEI score because it contains no fruit, few vegetables, very few dairy products, all refined grains, and many empty calories.