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

Published online by Cambridge University Press:  25 November 2020

S. A. Ribas
Department of Nutrition in Public Health, Federal University of the State of Rio de Janeiro, Rio de Janeiro, 22290-240, Brazil
D. M. G. Santos
Nutrition Division, Pedro Ernesto University Hospital, Rio de Janeiro, 20551-030, Brazil
G. P. C. Rosa
School of Nutrition, Federal University of the State of Rio de Janeiro, Rio de Janeiro, 22290-240, Brazil
M. T. Teixeira
Department of Nutrition in Public Health, Federal University of the State of Rio de Janeiro, Rio de Janeiro, 22290-240, Brazil
L. G. Rodrigues
Department of Nutrition in Public Health, Federal University of the State of Rio de Janeiro, Rio de Janeiro, 22290-240, Brazil
E. S. Marques
Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, 20550-013, Brazil


The objectives of this study were to evaluate the cross-cultural measurement equivalence of the Healthy Eating Index (HEI) for children aged 1–2 years and to analyse the quality of nutrition of preterm infants. This was a cross-sectional study with 106 premature infants attended in two specialised 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 1–2 years. Food consumption was measured by 24-h recalls. The reliability of the instrument was evaluated by internal consistency analysis and inter-observer reliability using Cronbach’s α coefficient and κ with quadratic ponderation. The construct validity was evaluated by 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 α was 0·54. Regarding inter-observer reliability, ten items showed strong agreement (κ > 0·8). The item 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 ultraprocessed foods in the diet. The instrument showed auspicious psychometric properties, being promising to evaluate the quality of the diet in children aged 1–2 years.

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© The Author(s), 2020. Published by Cambridge University Press on behalf of The Nutrition Society

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