Sisvan food intake markers from six to 23 months: critical analysis and validation

Guedes, Bianca de Melo; Santos, Thanise Sabrina Souza; Leffa, Paula dos Santos; Silva, Sara Araújo da; Lourenço, Bárbara Hatzlhoffer

doi:10.11606/s1518-8787.2024058005811

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Original Article • Rev. Saúde Pública 58 • 2024 • https://doi.org/10.11606/s1518-8787.2024058005811 copy

Sisvan food intake markers from six to 23 months: critical analysis and validation

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To explore the internal structure and analyze evidence of measurement invariance of the Sisvan form of food intake markers of the Food and Nutrition Surveillance System (Sisvan) for children aged six to 23 months.

METHODS

Sisvan microdata from 2015 to 2019 were used. After analyzing sample adequacy, exploratory factor analysis was carried out considering factor loadings (≥ 0.30 and < 0.85), communality (> 0.20), model fit indices – Tucker-Lewis index (TLI) > 0.90, and root mean square error of approximation (RMSEA) < 0.08. A critical analysis of the form items was performed to adjust the parameters. Measurement stability was investigated between age groups, macro-regions and longitudinally by multi-group confirmatory factor analysis in configural, metric, and scalar invariance models. Configural invariance was accepted if RMSEA < 0.08 and TLI and comparative fit index (CFI) > 0.90. Metric and scalar invariances were accepted if ΔRMSEA < 0.015 and ΔCFI < 0.01, compared to the previous model.

RESULTS

After critical analysis, items were grouped (vegetables and leafy greens; meat or eggs and liver) and excluded (salty food; porridge with milk; rice, potatoes, yams, cassava, flour, or pasta). The exploratory model comprised three factors: healthy complementary feeding (fruit; vegetables; orange or dark green leafy vegetables or fruits; meat, offal, or egg; beans), ultra-processed (yogurt; hamburger and/or sausages; sweetened drinks; instant noodles, packet snacks, or salty cookies; sandwich cookies, sweets, or treats), and milk feeding (breast milk; other milk), with satisfactory factor loadings, communalities and fit (TLI: 0.918, RMSEA: 0.071). The reformulated instrument was stable in the invariance models tested.

CONCLUSIONS

With the incorporation of the modifications to the Sisvan form, the food intake markers subsidize a more adequate interpretation of the feeding situation of children aged six to 23 months.

Food and Nutrition Surveillance; Food Intake; Complementary Feeding; Infants; Validation Study

Food intake markers	Factor loading^b			h²

	Factor 1	Factor 2	Factor 3
Breast milk	-	-	0.80	0.58
Milk other than breast milk	-	-	0.59	0.34
Whole fruit	-	0.66	-	0.38
Vegetables (vegetables or leafy greens)	-	0.79	-	0.55
Orange or dark green leafy vegetables or fruits	-	0.79	-	0.54
Meat, offal, or egg	-	0.61	-	0.54
Beans	-	0.56	-	0.43
Yogurt	0.32	-	-	0.25
Hamburgers and/or sausages	0.72	-	-	0.50
Sweetened drinks	0.77	-	-	0.56
Instant noodles, packet snacks, or salty cookies	0.87	-	-	0.66
Sandwich cookies, sweets, or treats	0.82	-	-	0.64
Variance^a	0.22	0.20	0.08	-
Fit indices^b	-	-	-	-
RMSEA (90% CI)	0.071 (0.070;0.071)
TLI	0.918

Groups of interest	Fit indices^a

	RMSEA (90% CI)	TLI	CFI	Comparison	ΔRMSEA	ΔCFI
Age groups
A. Configural invariance	0.047 (0.047;0.047)	0.921	0.939	-	-	-
B. Metric invariance	0.044 (0.044;0.045)	0.931	0.940	B vs A	-0.003	0.001
C. Scalar invariance	0.047 (0.047;0.047)	0.922	0.935	C vs B	0.003	-0.005
Macro-regions
A. Configural invariance	0.053 (0.053;0.053)	0.909	0.930	-	-	-
B. Metric invariance	0.048 (0.048;0.048)	0.926	0.935	B vs A	-0.005	0.005
C. Scalar invariance	0.053 (0.053;0.054)	0.909	0.923	C vs B	0.005	-0.012
Years (2015 to 2019)
A. Configural invariance	0.053 (0.053;0.054)	0.913	0.933	-	-	-
B. Metric invariance	0.048 (0.048;0.048)	0.930	0.938	B vs A	-0.005	0.005
C. Scalar invariance	0.051 (0.051;0.052)	0.919	0.932	C vs B	0.003	-0.006

On the previous day, the child was fed:
Breast milk	○ Yes	○ No	○ Don’t know
Milk other than breast milk	○ Yes	○ No	○ Don’t know
Whole, chopped, or mashed fruit	○ Yes	○ No	○ Don’t know
Vegetables (vegetables or leafy greens)	○ Yes	○ No	○ Don’t know
Orange vegetables or fruits (pumpkin or jerimum, carrots, papaya, mango) or dark green leaves (cabbage, kale, purslane, Jerusalem artichoke, spinach, mustard greens)	○ Yes	○ No	○ Don’t know
Meat, offal, or egg	○ Yes	○ No	○ Don’t know
Beans	○ Yes	○ No	○ Don’t know
Yogurt	○ Yes	○ No	○ Don’t know
Hamburger and/or sausages (ham, mortadella, salami, sausage)	○ Yes	○ No	○ Don’t know
Sweetened beverages (soda, boxed juice, powdered juice, boxed coconut water, guarana/ginger syrups, fruit juice with added sugar)	○ Yes	○ No	○ Don’t know
Instant noodles, packet snacks, or salty cookies	○ Yes	○ No	○ Don’t know
Sandwich cookies, sweets, or treats (candies, lollipops, chewing gum, caramel, jelly)	○ Yes	○ No	○ Don’t know
Rice, potatoes, yams, cassava, flour, or pasta (not instant noodles)*	○ Yes	○ No	○ Don’t know

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[1] Correspondence: Bárbara Hatzlhoffer Lourenço Universidade de São Paulo Faculdade de Saúde Pública Departamento de Nutrição Avenida Doutor Arnaldo, 715 - 2º andar 01246-904 São Paulo, SP, Brasil E-mail: barbaralourenco@usp.br