Abstract
Monitoring and assessing dietary intake may favor the promotion of healthy choices and the indexes that assess the quality of the diet contribute to this purpose. The Diet Quality Index associated with the Digital Food Guide (DQI-DFG) was developed from guidelines of the School of Public Health at Harvard University, adjusted for the Brazilian food habits. Based on new studies on prevention of chronic non-communicable diseases, the objective of this study was to improve and validate the DQI-DFG for a second version. The following psychometric properties were used: (a) content validation: consensus on healthy eating and DQI among experts; (b) construct validation: enhancement of a reference diet to determine recommended serving sizes and consumption ranges; correlation between each group score and energy value; comparative analyses between menu assessment by experts and DQI-DGF results to confirm the score criterion; (c) reliability: agreement between the result shown by the evaluators and the result presented by DQI-DFG; correlation between each food group score and total DQI score to understand the relationship between these variables. The energetic values do not influence the DQI score. There is a high correlation between the score attributed by experts and the result of DQI-DFG (r = 0.78 until r = 0.97). The Index components have a balanced score of influence in its final result (r = 0.49 until r = 0.10). Consensus result performed among experts legitimates the concepts that justify DQI-DFG. There was an agreement between menu quality evaluation by experts and the results shown by DQI-DFG.
Highlights
Brazil experiences, as other countries, the effects of the double burden of diseases caused by eating errors: nutritional deficiencies in addition to obesity and comorbidities 1,2,3; while 2.7% of the infant population shows low weight, obesity already reaches 14.8% of the population 4
The theoretical framework and the conception that support the Diet Quality Index (DQI)-Digital Food Guide (DFG) were examined in the validation and reliability study, as shown below
It is the opinion of the experts that composing a DQI using food groups enables to emphasize foods and not nutrients 21, to the precepts of the Food Guide for the Brazilian Population 6: (i) Sugars and sweets: sugar-rich foods like sodas, chocolates, ice cream, or cookies can bring risks to health when there is excessive intake; to be part of a healthy eating, they should not be of frequent intake, and in small portion sizes 31,32
Summary
As other countries, the effects of the double burden of diseases caused by eating errors: nutritional deficiencies in addition to obesity and comorbidities 1,2,3; while 2.7% of the infant population shows low weight, obesity already reaches 14.8% of the population 4. Several studies bring evidence of relationships between consumption of specific food groups, as well as their degree of processing and the occurrence of chronic non-communicable diseases. These findings subsidize the national and international dietary guidelines for the prevention of chronic non-communicable diseases 5. Food guides provide guidelines to assist citizens, the productive sector, health professionals, and public administrators in promoting adequate nutrition 6. The Health Eating Index (HEI) 9 is updated at every revision of the Dietary Guidelines for Americans 11. It incorporates advances regarding the relationship between diet and health and enhances its psychometric properties. Its second version was adapted for the use in Brazil and considered the first version of the Food Guide for the Brazilian Population as a reference for its calculations
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