Índice de Calidad de la Dieta asociado a la Guía Digital de Alimentos: actualización y validación

Caivano, Simone; Colugnati, Fernando Antonio Basile; Domene, Semíramis Martins Álvares

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METHOLOGICAL ISSUES • Cad. Saúde Pública 35 (9) • 2019 • https://doi.org/10.1590/0102-311X00043419 copiar

Índice de Calidad de la Dieta asociado a la Guía Digital de Alimentos: actualización y validación

Autoría SCIMAGO INSTITUTIONS RANKINGS

Supervisar y evaluar la ingesta de alimentos podría favorecer la promoción en la elección de alternativas saludables, por este motivo, son importantes los índices que evalúan la calidad de la dieta. El Índice de Calidad de la Dieta, asociado a la Guía Digital de Alimentos (ICD-GDA), se desarrolló a partir de las directrices de la Escuela Pública de Salud de la Universidad de Harvard, ajustadas a los hábitos alimentarios brasileños. Basado en los nuevos estudios sobre la prevención de enfermedades crónicas no transmisibles, el objetivo de este estudio fue mejorar y validar la segunda versión del ICD-GDA. Se utilizaron las siguientes propiedades psicométricas: (a) validación del contenido: consenso sobre comer sano y el índice de calidad de la dieta entre expertos; (b) validación del constructo: mejora de la dieta de referencia para determinar el tamaño de las porciones recomendadas y rangos de consumo; correlación entre la puntuación de cada grupo y valor de la energía; análisis comparativos entre la evaluación del menú por parte de expertos y resultados del ICD-GDA para confirmar los criterios de puntuación; (c) fiabilidad: concordancia entre el resultado mostrado por los evaluadores y el resultado presentado por ICD-GDA; correlación entre la puntuación de cada grupo de comida y la puntuación total del ICD para comprender la relación entre estas variables. Los valores energéticos no influencian la puntuación del ICD. Existe una alta correlación entre la puntuación atribuida por expertos y el resultado del ICD-GDA (r = 0,78 hasta r = 0,97). Los componentes del índice poseen una puntuación equilibrada de influencia en su resultado final (r = 0,49 hasta r = 0,10). El resultado de consenso entre expertos legitima los conceptos que justifican el ICD-GDA. Existe acuerdo entre la evaluación por parte de expertos de un menú de calidad y los resultados mostrados por el ICD-GDA.

Palabras-clave:
Guías Alimentarias; Índice; Educación Alimentaria y Nutricional; Psicometría

Food groups	Examples of foods
Moderation components
Sugars and sweets	Sugar (vanilla, coconut, confectioner, demerara, brown, corn or refined sugar), processed acai berry, chocolate milk, sweetener/industrialized sweetener, tonic water, carob, taffy, cereal bar, sugar based energy drink, chocolate flavored milk drink, cookies (with and without filling), industrialized cake (simple and with filling), syrup, hominy, cappuccino, tea ready to drink, chocolate, flan, sweetened corn flakes of several flavors, canned fruit in syrup, canned fruit, candied fruit, gelatin, jelly fruit, chewing gum, currant drink, chocolate milk, condensed milk, marshmallows, honey, local recipes of sweets and desserts, chikki, molasses, artificial juice, soda, ice cream, soy-based juice, industrialized juice, Nougat - in all versions: traditional and diet/light
Dairy drinks and sweetened yogurts	Fruit-flavored yogurt - in all versions: traditional and diet/light
Bovine and pork meat	Chuck steak, lamb chops, pork chop, tripe, lamb, beef, lamb, beef jerky, veal, rabbit, ribs, sirloin steak, carpaccio, veal, rabbit, topside, hump, liver, filet mignon, flank, boar, pork knee, tongue, loin, rump skirt, molejjas, black pudding, muscle, panceta [streaky bacon], pastrami, knuckle, pig feet, pork ham, top sirloin, brisket, oxtail, kidney, pork backbone
Processed meats	Ham, turkey blanquette, coppa, hamburger (beef, pepperoni) sausage (Calabrese sausage, pork, large pork sausage, Portuguese, Tuscan), pork loin and smoked pork loin, mortadella, pepperoni, roast beef, salami, hot-dog sausage, steak, tender
Cereals, grains, potatoes and flours	Cornstarch, arrowroot, rice (arboreal, type 1, oriental, parboiled, basmati, jasmine), cereal bar based on refined cereal, potato, rice and corn powder, flour), starch (potato and cassava), cornflakes, cornmeal, pasta, puff pastry, bread (baguette, Beirut, small roll, yam, ciabatta, sliced, roll, Italian, hot-dog/hamburger, milk, corn, egg, kneaded, Syrian, Swedish bread, wrap), cheese bread, tapioca, toast, wheat
Crackers and snacks	Crackers (water crackers, water and sesame crackers, saltine, salty crackers), cassava flour crackers, industrialized snacks (bacon snacks, potato chips, onion snacks, corn snacks)
Processed fats	Bacon, lard, whipped cream ready for consumption, vegetable cream, mayonnaise, margarine, sauce ready for consumption, pastes and pâtés - in all versions: traditional and light
Adequacy components
Poultry, fish and eggs	Haddock, anchovies, herring, tuna, ostrich, cod, dogfish, shrimp, crab, carp, chester, chicken heart, croaker, corimba, golden, swordsish, chicken, haddock, kani kama, lobster, herring, halibut, squid, shellfish, hake, grouper, mussel, gizzard, namorado, turkey, hake, white hake, whiting, neck, pintado, pirarucu, octopus, porquinho, oyster, egg (quail, chicken, duck), duck, sea bass, saint peter, salmon, sardines, crab, tambaqui, tilapia, trout
Cereals and whole grains	Amaranth, rice, oats, cereal bar based on whole cereal, whole oat biscuit, quinoa, bran (oat, wheat), flour (rye, flaxseed, quinoa, whole wheat), sesame seeds, granola, linseed, popcorn, cereal mixture, whole wheat bread (sliced bread, bread roll), popcorn, seeds (sesame, sunflower, chia), whole-wheat toast
Tubers and roots	Yams, manioc starch, yams, manioc, pine
Fruits	Avocado, pineapple, abiu, acai, acerola, coconut water, plum, red plum, blackberry, atemóia, avocado, bacuri, banana, buriti, hog plum, cajá-manga, cashew, persimmon, star fruit, cherry, coconut, ciriguela, cupuaçu, damascus, figs, raspberries, sweetsop, breadfruit, grapefruit, guava, guanabana, jaboticaba, jackfruit, jambo, kiwi, orange, lychee, lemon, apple, macaúba, papaya, mango, quince, passion fruit, watermelon, melon, tangerine, blueberry, strawberry, nectarine, loquat, pequi, pear, peach, pine cones, dragon fruit, pitanga, pomegranate, sapoti, date, tamarind, tangerine, tucuman, umbu, grape
Vegetables	Pumpkin, zucchini, artichoke, garlic, leeks, asparagus, olives, eggplant, beets, broccoli, sprouts (alfava, bamboo), onions, carrots, chayote, mushrooms, Brussels sprouts, cauliflower, endive, jambu, eggplant, gherkin, tomato sauce, turnip greens, hearts of palm, cucumber, bell pepper, okra, radishes, pumpkin seed, tomatoes, string beans
Leafy vegetables	Chard, watercress, celery, lettuce, alfava, kelp, seaweed, catalonha, chicory, collards, endive, spinach, mustard leaf, radicchio, cabbage, arugula, parsley, milkweed, taro
Legumes	Bean sprouts, soy cream, peas, soy flour, fava beans, chickpeas, soya milk, lentils, natto, soy protein, soybean curd cheese, soy, tofu
Oilseeds	Almond, peanut, hazelnut, chestnut of baru, Brazilian nut, cashew nuts, milk of almonds, macadamia nuts, pecan walnut, walnuts, pistachios, lupine
Milks and yogurts	Milk (skimmed, semi-skimmed or whole), plain yogurt (low fat, semi-skimmed or whole)
Cheeses	Brie, camembert, burrata cheese, cheddar, shanklish, chèvre or goat’s milk, rennet, cottage, cream cheese, cream of ricotta cheese, emmental, fetta, fused, gorgonzola, gouda, grana padano, gruyere, half cure, minas frescal, standard Minas cheese, mozzarella, buffalo milk mozzarella, parmesan, pingo de leite, port salut, queijo prato, provolone, quark, cottage cheese, ricotta, reino, roquefort, tilsit with kümmel, trança
Oils and fats	Palm oil, olive oil, extra virgin olive oil, vegetable oil (peanut, babassu, canola, coconut, toasted sesame, sunflower, flaxseed, corn, palm, pequi, soy), butter
Milk cream	Milk cream - in all versions: traditional and light

Food groups	EC	II	Score according to the intake interval
Food groups	EC	II	Below	Inside	Above
Moderation components
Sugar and sweets	155	0.0-0.5	-	0.5	≤ 1.00: 0.5 + (0.5 - portion)
Dairy drinks and sweetened yogurts	120	0.0-0.5	-	0.5	> 1.00: 0.00
Meats: beef, pork and processed meat
Bovine and pork meat	100	0.0-0.5	-	0.5	≤ 1.00: 0.5 + (0.5 - portion)
Processed meats	50	0.0-0.5	-	0.5	> 1.00: 0.00
Refined cereals
Cereal, grains, potatoes and flours	140	0.0-1.0	-	0.5	≤ 2.00: 0.5 + (0.5 x (1 - portion)
Crackers and snacks	60	0.0-1.0	-	0.5	> 2.00: 0.00
Processed fats	90	0.0-0.5	-	0.5	≤ 1.00: 0.5 + (0.5 - portion)
Adequacy components					> 1.00: 0.00
Poultry, fish and eggs	140	0.5-1.0	(portion x 1.25)/0.5	1.25	1.25
Whole cereals, tubers and roots
Cereal and whole grains	140	2.0-3.0	(portion x 0.5)/2.0	0.50	≤ 6: 0.5 + (0.5 x (3-portion)/3)
Tubers and roots	120	2.0-3.0	(portion x 0.5)/2.0	0.50	> 6: 0.00
Fruits	65	1.5-3.0	(portion x 1.50)/1.5	1.50	≤ 6: 1.50 + (1.50 x (3-portion)/3)
Fruits	65	1.5-3.0	(portion x 1.50)/1.5	1.50	> 6: 0.00
Vegetables
Vegetables	20	2.0-3.0	(portion x 1.50)/2.0	1.50	1.50
Leafy vegetables	10	2.0-3.0	(portion x 1.50)/2.0	1.50	1.50
Legumes and oilseeds					1.50
Legumes	150	1.0-1.5	(portion x 1.5)	1.50
Oilseeds	50	1.0-1.5	(portion x 1.5)	1.50
Milk and dairy products
Milk and yogurts	120	1.0-1.5	portion	1.00	≤ 3: 0.5 + (0.5 x (1.5-portion)/1.5)
Cheeses	80	1.0-1.5	portion	1.00	> 3: 0.00
Oils and fats
Oils and fats	72	1.25-1.75	(portion x 0.75)/1.25	0.75	0.75
Cream	144

	SS	ME	RC	PF	PFE	WC	FR	VT	LO	MD	OF	TS	En
SS	1.00
ME	-0.04	1.00
RC	-0.13 *	-0.09 **	1.00
GF	0.00	-0.04	0.13 *	1.00
PFE	-0.03	0.40 *	-0.07	-0.02	1.00
WC	0.02	0.09 **	0.16 *	0.10 *	-0.06	1.00
FR	0.02	0.07 **	0.12 *	0.02	-0.06	0.15 *	1.00
VT	0.03	0.16 *	0.03	0.03	0.04	0.04	0.21 *	1.00
LO	0.20 *	-0.08 **	0.02	0.10 *	-0.06	-0.03	-0.12 *	-0.10 *	1.00
MD	-0.05	0.04	-0.06	0.03	0.07 **	0.11 *	0.04	0.03	-0.08 **	1.00
OF	0.28 *	0.05	-0.24 *	0.13 *	0.11 *	-0.07	-0.04	0.06	0.23 *	-0.04	1.00
TS	0.25 *	0.40 *	0.10 *	0.25 *	0.48 *	0.18 *	0.48 *	0.49 *	0.29 *	0.32 *	0.33 *	1.00
En	-0.10 *	-0.16 *	0.24 *	-0.11 *	-0.02	-0.07	-0.10 *	-0.22 *	-0.01	-0.02	-0.10 *	-0.19 *	1.00

Experts	Coefficient	Confidence interval
1	0.91	0.64	0.98
2	0.78	0.31	0.95
3	0.91	0.65	0.98
4	0.90	0.62	0.98
5	0.92	0.68	0.98
6	0.94	0.74	0.99
7	0.82	0.40	0.96
8	0.90	0.61	0.98
9	0.84	0.45	0.96
10	0.94	0.75	0.99
11	0.91	0.64	0.98
12	0.91	0.67	0.98
13	0.90	0.61	0.98
14	0.91	0.66	0.98
15	0.78	0.29	0.94
16	0.91	0.66	0.98
17	0.91	0.65	0.98
18	0.94	0.75	0.99
19	0.97	0.87	0.99
20	0.94	0.76	0.99
21	0.91	0.64	0.98
22	0.93	0.74	0.98
23	0.87	0.53	0.97
24	0.93	0.72	0.98
25	0.88	0.57	0.97
26	0.85	0.47	0.96

Evaluators	Average	SD	Minimum	Maximum	ICC			t	ST
Evaluators	Average	SD	Minimum	Maximum	R	95%CI		p-value	p-value
1	50.98	24.30	14.80	76.43	0.98	0.93	1.00	0.36	1.00
2	54.11	25.18	15.15	85.95	0.99	0.96	1.00	0.09	0.76
3	52.80	24.42	14.70	83.75	1.00	0.98	1.00	0.57	0.88
4	52.50	24.21	15.00	82.40	0.99	0.98	1.00	0.89	1.00
5	51.98	24.25	15.35	80.90	1.00	0.99	1.00	0.56	1.00
6	52.13	24.28	15.00	78.60	1.00	0.98	1.00	0.75	0.82
7	52.64	24.85	14.80	81.10	1.00	0.98	1.00	0.73	0.94
8	52.82	25.24	14.85	82.50	0.99	0.98	1.00	0.60	0.80
DQI-DFG-2019	52.38	24.15	14.60	83.20	-	-	-	-	-

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[1] S. Caivano Universidade Federal de São Paulo - Campus Baixada Santista. Av. Ana Costa 95, Santos, SP 11060-001, Brasil. simone.caivano@hotmail.com