Abstract
Background
Evaluating diet quality is a way to monitor a population’s adherence to dietary guidelines.
Objective
To adapt the Healthy Eating Index-2015 (HEI-2015) to the Brazilian population, to
evaluate the validity and reliability of the adapted HEI-2015, and to assess diet
quality of Brazilian adults as well as socioeconomic and demographic factors associated
with diet quality.
Design
In this cross-sectional study, two dietary records from nonconsecutive days were used
to obtain food intake information. The collected socioeconomic and demographic data
included sex, age, education, per capita income, and residence area.
Participants/setting
A representative sample (n=27,760) of the Brazilian adult population participated
in the Nutrition Dietary Survey 2008-2009.
Main outcome measures
Total and component scores for the adapted HEI-2015. The validity and reliability
of the index were tested.
Statistical analysis performed
Mean total and component scores were estimated for the adapted HEI-2015. Also, the
proportion of subjects that achieved the maximum score for each component was calculated.
Regarding validity and reliability analysis, principal components analysis examined
the number of dimensions; Pearson correlations were estimated between total score,
components, and energy, and Cronbach’s coefficient α was estimated. Diet quality was
compared among socioeconomic and demographic categories.
Results
The mean total score for the adapted HEI-2015 was 45.7 (95% CI: 45.4 to 46.0). Women
had higher diet quality scores (46.4; 95% CI: 46.1 to 46.7) than men (44.9; 95% CI:
44.6 to 45.3). Age, education, and per capita income were directly associated with
the adapted HEI-2015 total score. Greater than or equal to 50% of subjects received
the maximum adapted HEI-2015 component scores for “total protein foods,” “seafood
and plant proteins,” “fatty acids,” and “sodium.” In contrast, less than 30% of subjects
received the maximum component scores for “total vegetables,” “dairy,” and “saturated
fats.” Higher percentages of women received the maximum component scores for “total
fruits,” “whole fruits,” “total vegetables,” “greens,” “dairy,” and “sodium,” whereas
higher percentages of men received the maximum component scores for “total protein
foods,” “seafood and plant proteins,” “fatty acids,” “added sugars,” and “saturated
fats” components. Finally, validity analysis revealed weak correlations between component
scores and energy and weak to moderate correlations with total scores; six dimensions
were responsible for the total variance in diet quality and the standardized Cronbach’s
coefficient α was .65 (unstandardized=.64).
Conclusions
Brazilian adults have suboptimal diet quality as assessed by the adapted HEI-2015.
Diet quality varied by socioeconomic and demographic factors. Results support the
validity and the reliability of the index.
Keywords
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Biography
J. de Paula Matos Souza is a nutritionist, Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Biography
M. Magela de Lima is a nutritionist, Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Biography
P. Martins Horta is a nutritionist, Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Article info
Publication history
Published online: June 24, 2019
Accepted:
April 18,
2019
Received:
June 27,
2018
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT The survey that serves as the basis for this study was funded by the Brazilian Ministry of Health.
AUTHOR CONTRIBUTIONS J. de Paula Matos Souza and M. Magela de Lima participated in data analysis and manuscript writing. P. Martins Horta participated in data analysis and manuscript writing revision.
Identification
Copyright
© 2019 by the Academy of Nutrition and Dietetics.
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