Cross-cultural measurement equivalence of the Healthy Eating Index adapted version for children aged 1–2 years

Abstract

The objectives of this study were to evaluate the cross-cultural measurement equivalence of the Healthy Eating Index (HEI) for children aged 1 to 2 years and to analyse the quality of nutrition of preterm infants. This was a cross-sectional study with 106 premature infants attended in two specialized outpatient clinics of university hospitals. The quality of the diet was analysed through an adapted HEI to meet the dietary recommendations of Brazilian children aged 1 to 2 years. 24-hour recalls measured food consumption. The reliability of the instrument was evaluated by internal consistency analysis and inter-observer reliability using Conbrach’s alpha coefficient and Kappa with quadratic ponderation. The construct validity was evaluated by the Principal Component Analysis and by Spearman’s correlation coefficient with total energy and consumption of some groups’ food. The diet quality was considered adequate when the total HEI score was over 80 points. Cronbach’s alpha was 0.54. Regarding inter-observer reliability, ten items showed strong agreement (k>0.8). The items scores had low correlations with energy consumed (r ≤ 0.30), and positive and moderate correlation of fruit (r=0.67), meat (r=0.60) and variety of diet (r=0.57) with total scores. When analysing the overall quality of the diet, most patients need improvement (median 78.7 points), which can be attributed to low total vegetable intake and the presence of ultra-processed foods in the diet. The instrument showed auspicious psychometric properties, being promising to evaluate the quality of the diet in children aged 1 to 2 years.