Two validity evidences of the ESQUADA and Brazilians’ dietary quality levels

Santos, Thanise Sabrina Souza; Araújo, Pedro Henrique de Moura; Andrade, Dalton Francisco de; Louzada, Maria Laura da Costa; Assis, Maria Alice Altenburg de; Slater, Betzabeth

doi:10.11606/s1518-8787.2021055002397

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Original Article • Rev. Saúde Pública 55 • 2021 • https://doi.org/10.11606/s1518-8787.2021055002397 copy

Two validity evidences of the ESQUADA and Brazilians’ dietary quality levels

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

Assess two validity evidences of the diet quality scale (ESQUADA) for the selection of items with better discrimination of the Brazilians’ diet quality and propose a description in score levels.

METHODS

Brazilian adolescents and adults residing in the country (n = 2,059) answered an online questionnaire with 52 items, shared on social networks and email lists between March and April 2018. Statistical tests were applied to analyze the validity and reliability of the instrument’s evidence. Factor analysis was applied to study the dimensionality of the questionnaire items. Item response theory was applied to identify the discrimination and location of items on the continuum, construct the scale and assess the differential item functioning in terms of sex and age.

RESULTS

Among the 52 items of the questionnaire, 25 had greater measurement accuracy, with adequate adjustment and reliability. The item on the habit of eating ultra-processed foods at home showed the best discrimination of diet quality. No item showed differential functioning regarding sex and age. In the construction of the ESQUADA, five diet quality levels were identified: very poor, poor, good, very good and excellent. It was observed that while breakfast cereals and/or cereal bars are more frequently consumed by individuals with “very poor” diet quality; nuts and/or walnuts are most often consumed by those individuals with “excellent” diet quality.

CONCLUSION

The ESQUADA consists of 25 precise items with no differential functioning to assess the quality of Brazilians’ diet. The construction of the ESQUADA made it possible to recognize food consumption and dietary practices characteristic of each level of diet quality.

Adolescent; Adult; Young Adult; Validation Studies; Surveys and Questionnaires; Food Guide; Diet Surveys

Items	Communality	Factor Loading	a_i (SE)	b_i,2 (SE)	b_i,3 (SE)	b_i,4 (SE)
I-01-Do you usually have breakfast?	0.364	0.603	1.288 (0.154)	-0.637 (0.090)
I-02-What kind of foods do you usually eat at breakfast?	0.241	0.491	0.959 (0.125)	-1.673 (0.198)	-0.108 (0.098)
I-03-Do you usually have lunch?	0.264	0.514	1.021 (0.202)	-2.750 (0.427)
I-04-What kind of foods do you usually eat at lunch?	0.372	0.610	1.309 (0.343)	-3.457 (0.662)
I-08-Do you usually replace meals for snacks at lunch or dinner? (Consider examples of snacks: pizza, savory pastries, Hot Hit^®, Hot Pocket^®, Mc Donald’s^®, Bob’s^®, Subway^®, hamburger with salads or eggs, industrialized escondidinho, industrialized stroganoff or industrialized lasagna.).	0.264	0.514	1.020 (0.114)	-3.429 (0.356)	-1.937 (0.195)	0.521 (0.101)
I-09-Do you usually cook or help with the food preparation for meals such as lunch and dinner? (Consider helping with preparation: washing, chopping and/or cooking food.).	0.206	0.454	0.868 (0.132)	-0.245 (0.111)
I-11-Where do you or someone in your household usually buy fruits, legumes and/or vegetables?	0.176	0.419	0.786 (0.107)	0.304 (0.117)	2.305 (0.294)
I-13- “For another R$1.00, you take the largest portion of fries”. In situations like the example shown, do you usually choose the largest portion of food by paying a little more?	0.239	0.489	0.954 (0.127)	0.457 (0.108)
I-21-Do you usually eat whole-grain rice and/or whole-grain pasta?	0.261	0.511	1.011 (0.110)	-0.029 (0.095)	1.278 (0.145)	2.932 (0.298)
I-22-Do you usually eat oats, quinoa and/or rye?	0.476	0.690	1.624 (0.163)	-0.027 (0.068)	1.291 (0.106)	2.494 (0.196)
I-24-Do you usually eat raw and/or cooked legumes or vegetables? (Do not consider the consumption of cassava, potatoes and yams.).	0.414	0.643	1.429 (0.147)	-2.069 (0.176)	-0.771 (0.089)	0.599 (0.087)
I-25-Do you usually eat fruit? (Do not consider the consumption of juices.).	0.295	0.544	1.102 (0.118)	-2.622 (0.254)	-0.768 (0.105)	0.888 (0.117)
I-31-Do you usually eat Brazil nuts, cashew nuts and/or walnuts?	0.362	0.601	1.281 (0.139)	-0.409 (0.084)	1.075 (0.114)	3.080 (0.291)
I-32-What do you usually drink when you are thirsty?	0.200	0.448	0.852 (0.171)	-2.743 (0.475)
I-36-Do you usually eat industrialized cakes, biscuits or cookies (purchased ready-made)? (Consider also those made with ready-made dough.).	0.276	0.525	1.050 (0.117)	-0.863 (0.118)	1.601 (0.164)
I-40-Do you usually eat industrialized ketchup, mustard and/or mayonnaise (purchased ready-made)?	0.199	0.446	0.849 (0.117)	-2.249 (0.286)	1.759 (0.236)
I-41-Do you usually eat snacks such as fried or baked snacks, fast-food hamburgers, hot dogs and/or industrialized pizza (purchased ready-made)? (Consider as examples of fast-food hamburgers: hamburgers with salads or eggs, Hot Hit^®, Hot Pocket^®, Mc Donald’s^®, Bob’s^® or Subway^®.).	0.429	0.655	1.476 (0.153)	-2.853 (0.248)	-1.286 (0.111)	1.339 (0.118)
I-42-Do you usually eat industrialized breakfast cereal and/or cereal bars? (Consider as examples of breakfast cereals: Sucrilhos^®, Nescau Cereal^®, Corn Flakes^®, Crunch^® or All Bran^®.).	0.165	0.407	0.758 (0.127)	-3.738 (0.582)	-0.824 (0.164)
I-43- Do you usually eat chips or snacks such as: Ruffles^®, Cheetos^®, Elma Chips^®, Doritos^®, Pringles^® or microwave popcorn?	0.448	0.670	1.535 (0.158)	-3.117 (0.287)	-1.979 (0.164)	0.439 (0.073)
I-44-Do you usually drink sodas and/or juices in powder, in a box, can and/or bottle? (Consider as examples: Del Valle^®, Maguary^®, Tang^®, Sufresh^®, Mid^®, Taeq^®, Feel Good^®, H2O^®, Fresh^® or Aquarius^®.).	0.514	0.717	1.749 (0.162)	-0.430 (0.071)	0.863 (0.084)
I-46-Do you usually eat industrialized syrups/toppings for ice cream, industrialized jellies, dulce de leche, hazelnut cream like Nutella^® and/or condensed milk?	0.317	0.563	1.160 (0.133)	-1.891 (0.188)	1.118 (0.133)
I-48-Do you usually drink chocolate beverages such as Toddynho^®?	0.494	0.703	1.682 (0.187)	-1.608 (0.133)	-0.156 (0.068)
I-50-Do you usually eat industrialized mortadella, salami, pâtés/pastes with meat, turkey/chicken breast and/or ham flavor?	0.344	0.586	1.231 (0.123)	-1.607 (0.149)	0.906 (0.107)
I-51-Do you usually eat nuggets/steak (processed breaded chicken), sausage and/or industrialized hamburger (purchased ready-made)?	0.558	0.747	1.912 (0.199)	-2.471 (0.191)	-1.560 (0.113)	0.319 (0.066)
I-52-When you are at home, do you usually eat instant noodles, instant soups, industrialized frozen foods/meals and/or fast-food hamburgers? (Consider as examples: Nissin^®, Cup Noodles^®, Vono^®, industrialized lasagna, industrialized stroganoff, industrialized escondidinho, Hot Hit^®, Hot Pocket^®, Mc Donald’s^®, Bob’s^®, Subway^® or hamburgers with salads or eggs.).	0.633	0.796	2.237 (0.212)	-2.292 (0.158)	-1.473 (0.097)	0.134 (0.060)

Classification	Scale (0,1)	Scale (250,50)	Brief description
Very Poor	Less than or equal to -2	Less than or equal to 150	Individuals consume ultra-processed foods and replace meals for snacks on one or two days a week. Individuals consume fruits and vegetables on less than one day a week.
Poor	Greater than -2 and less than or equal to -1	Greater than 150 and less than or equal to 200	Individuals maintain their consumption of fruits and vegetables on less than one day a week. Individuals consume ultra-processed foods and replace meals for snacks on less than one day a week.
Good	Greater than -1 and less than or equal to 0.5	Greater than 200 and less than or equal to 275	Individuals maintain replacing meals for snacks on less than one day a week. Individuals do not consume some ultra-processed foods but consume sugary beverages on less than one day a week. Individuals consume fruits, legumes and vegetables on one to four days a week and oats, rye, quinoa, nuts, walnuts and whole-grain rice/past on less than one day a week. Individuals eat breakfast at least one day a week.
Very Good	Greater than 0.5 and less than or equal to 2.5	Greater than 275 and less than or equal to 375	Individuals do not replace meals for snacks. Individuals do not consume any ultra-processed foods. Individuals maintain eating breakfast on at least one day a week. Individuals consume fruits, legumes and vegetables on five or more days a week and oats, rye, quinoa, nuts, walnuts and whole-grain rice/pasta on one to four days a week.
Excellent	Greater than 2.5	Greater than 375	Individuals maintain not replacing meals for snacks and not consuming ultra-processed foods. Individuals maintain eating breakfast at least one day a week and consume fruits, legumes and vegetables on five or more days a week. Individuals consume oats, rye, quinoa, nuts, walnuts and whole-grain rice/pasta on five or more days a week.

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E-mail: revsp@usp.br

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[1] Correspondence: Thanise Sabrina Souza Santos Av. Dr. Arnaldo, 715. Cerqueira César 01246-904. São Paulo, SP, Brasil E-mail: thanisesouza@gmail.com