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(OR27-06-26) Participation in the Supplemental Nutrition Assistance Program and Diet Quality Measured by the Healthy Eating Index: A Systematic Review and Meta-analysis

Tuesday, July 28, 2026
11:00 AM - 11:12 AM ET
Location: National Harbor 4-5
Disclosure(s):
Cassi N. Leta, PhD: No relevant financial relationship(s) with ineligible companies to disclose.
Lauren E. O'Connor, PhD, MPH: No relevant financial relationship(s) with ineligible companies to disclose.
Objectives: This systematic review assessed relationships between Supplemental Nutrition Assistance Program (SNAP) participation and diet quality via the Healthy Eating Index (HEI) which can assess alignment with the US Dietary Guidelines for Americans (DGA).

Methods: The protocol was informed by technical experts (PROSPERO: CRD42023440343). We searched 9 databases and 2 government websites from Jan 1980-Nov 2025 for peer-reviewed articles and government reports comparing total HEI scores (0-100; 100=highest diet quality) between SNAP participants and non-participants with income ≤200% of the federal poverty level. Randomized controlled trials, non-randomized interventions, prospective and retrospective cohorts, and cross-sectional studies were eligible if results were adjusted for confounding or non-random selection bias (NRSB). We used ROBINS-I and GRADE to assess risk of bias (RoB) and certainty of evidence (CoE), respectively. Data were meta-analyzed using multilevel-multivariate models with robust variance estimation, with comparator group and age as potential moderators.

Results: From 8080 records reviewed, 16 articles from 4 cross-sectional studies met inclusion criteria. Articles reported total HEI (1995, 2005, 2010, and 2015 versions) for ages 2-60+ y from 1989-2018 from 2 national (NHANES (n=12) and Continuing Survey of Food Intakes by Individuals (n=2)) and 2 state (TX, ME) datasets. Total HEI scores for participants and non-participants ranged from 42-69. SNAP participants had a lower total HEI compared to non-participants (standardized mean difference = -0.06, 95% CI: -0.09, -0.02), with no difference (p > 0.05) by comparison group (n=10 income-eligible and n=3 income-ineligible non-participants) or age (CoE: low). Three articles were not pooled due to missing variability; differences in total HEI between groups were small, supporting the meta-analysis results. Most articles were rated ‘serious’ for RoB and only one controlled for NRSB.

Conclusions: SNAP participants had lower diet quality than income-comparable non-SNAP participants. However, the difference was small and likely has little practical implications given the diet quality of both groups suggested poor alignment with the DGAs.

Funding Sources: No external funding