The United States, and many modern nations, represent assemblies of many cultural groups. Such groups are often influenced, sometimes profoundly, by the culinary traditions of their countries of origin, resulting in a diversity of cultural dietary patterns. Such patterns all derive key elements of nutritional quality from essential food groups-such as vegetables and fruits-but vary in their inclusion of "discretionary" food groups, such as dairy. The application of robust, validated, and standardized diet quality scoring is important in nutrition research, and in the food-as-medicine movement at large if what is being "managed" is to be measured. While robustly validated, the Healthy Eating Index is closely aligned with the