Evaluation of the Validity and Reliability of the Chinese Healthy Eating Index
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Evaluation Plan
2.3. Statistical Analyses
3. Results
3.1. Validity
3.2. Reliability
4. Discussion
5. Conclusions
Supplementary Materials
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Evaluation Item | Analysis Question | Analysis Strategy |
---|---|---|
Validity | ||
Content validity | Does the CHEI catch the various key aspects of diet quality specified in the Dietary Guidelines for Chinese (DGC)-2016? | Compared the CHEI components against the key recommendations of the DGC-2016. |
Construct validity | Does a higher CHEI score link with a lower exposure to confirmed dietary risk factors among the Chinese population? | Estimated the intakes of selected food groups by quintiles of the CHEI scores. |
Does the index give high scores to recommended menus for different gender and age groups? | Computed scores for exemplary menus developed for adult men, adult women, the healthy elderly, and young children. | |
Does the index distinguish between groups with known differences in diet quality? | Compared component and total scores of smokers and non-smokers, people with higher and lower education levels and people living in urban and rural areas. | |
Does the index assess diet quality independent of diet quantity? | Estimated the correlations between component scores and energy intake. | |
How many dimensions does the CHEI have? | Used a principal components analysis to estimate the underlying structure of the index. | |
What are the associations between the index and nutrient intakes? | Compared nutrient intakes across the quintiles of the CHEI score and examined the Pearson correlations between the index and each of the nutrients. | |
Reliability | ||
Internal consistency | How is the internal consistency of the index? | Estimated the Cronbach’s coefficient α. |
What are the correlations among the CHEI components? | Estimated Spearman correlations between each of the component scores. | |
Which component has the biggest impact on the total score? | Estimated Spearman correlations between each component and the sum of all others. |
Quintile of the CHEI | ||||||
---|---|---|---|---|---|---|
Selected Food Groups | Q1 (n = 2494) | Q2 (n = 2495) | Q3 (n = 2495) | Q4 (n = 2495) | Q5 (n = 2494) | P for Trend 1 |
CHEI score | 38.02 | 46.89 | 52.45 | 58.21 | 68.01 | |
Whole grains (g/1000 kcal per day) | 7.54 | 9.69 | 12.58 | 13.21 | 16.53 | <0.0001 |
Refine grains (g/1000 kcal per day) | 208.23 | 209.50 | 203.13 | 197.06 | 179.48 | <0.0001 |
Dairy products (g/1000 kcal per day) | 4.05 | 6.89 | 9.58 | 18.08 | 41.11 | <0.0001 |
Seed and nuts (g/1000 kcal per day) | 0.86 | 1.20 | 2.20 | 3.05 | 5.54 | <0.0001 |
Fruits (g/1000 kcal per day) | 7.81 | 15.08 | 27.30 | 44.75 | 79.07 | <0.0001 |
Vegetables (g/1000 kcal per day) | 145.48 | 154.22 | 156.78 | 159.96 | 167.43 | <0.0001 |
Fish and seafood (g/1000 kcal per day) | 7.70 | 9.85 | 11.58 | 14.64 | 21.98 | <0.0001 |
Red meat (g/1000 kcal per day) | 39.69 | 41.88 | 39.41 | 40.71 | 38.22 | 0.039 |
Exemplary Menus * | ||||
---|---|---|---|---|
CHEI Component (Maximum Score) | Adult Women 1 | Adult Men 2 | The Healthy Elderly 3 | Young Children 4 |
Total grains (5) | 5.0 | 5.0 | 5.0 | 2.8 |
Whole grains and mixed beans (5) | 5.0 | 5.0 | 5.0 | 3.3 |
Tubers (5) | 5.0 | 5.0 | 5.0 | 5.0 |
Total vegetables (5) | 5.0 | 5.0 | 5.0 | 5.0 |
Dark vegetables (5) | 5.0 | 5.0 | 5.0 | 5.0 |
Fruits (10) | 10.0 | 10.0 | 10.0 | 10.0 |
Dairy (5) | 5.0 | 5.0 | 5.0 | 5.0 |
Soybeans (5) | 5.0 | 5.0 | 5.0 | 5.0 |
Fish and seafood (5) | 5.0 | 5.0 | 5.0 | 3.3 |
Poultry (5) | 5.0 | 5.0 | 5.0 | 5.0 |
Eggs (5) | 5.0 | 5.0 | 5.0 | 5.0 |
Seeds and nuts (5) | 5.0 | 5.0 | 5.0 | 5.0 |
Red meat (5) | 5.0 | 4.8 | 5.0 | 3.7 |
Cooking oils (10) | 10.0 | 10.0 | 10.0 | 10.0 |
Sodium (10) | 9.7 | 10.0 | 9.1 | 8.1 |
Added sugars (5) | 5.0 | 5.0 | 5.0 | 5.0 |
Alcohol (5) | 5.0 | 5.0 | 5.0 | 5.0 |
Total score 5 (100) | 99.7 | 99.8 | 99.1 | 91.2 |
CHEI Component | Smokers (n = 2604) | Non-Smokers (n = 9869) | Education Year < 9 years (n = 8364) | Education Year ≥ 9 years (n = 4109) | Rural Area (n = 7347) | Urban Area (n = 5126) |
---|---|---|---|---|---|---|
Total grains | 4.55 ± 0.02 | 4.57 ± 0.01 | 4.64 ± 0.01 | 4.42 ± 0.01 ** | 4.72 ± 0.01 | 4.35 ± 0.01 ** |
Whole grains and mixed beans | 0.89 ± 0.03 | 1.00 ± 0.02 * | 0.95 ± 0.02 | 1.03 ± 0.02 ** | 0..95 ± 0.02 | 1.01 ± 0.02 ** |
Tubers | 2.23 ± 0.04 | 2.23 ± 0.02 | 2.22 ± 0.02 | 2.30 ± 0.03 * | 2.28 ± 0.03 | 2.19 ± 0.03 |
Total vegetables | 3.77 ± 0.03 | 3.89 ± 0.01 ** | 3.87 ± 0.01 | 3.85 ± 0.02 | 3.77 ± 0.02 | 4.01 ± 0.02 ** |
Dark vegetables | 2.47 ± 0.04 | 2.59 ± 0.02 * | 2.50 ± 0.02 | 2.68 ± 0.03 ** | 2.28 ± 0.02 | 2.96 ± 0.03 ** |
Fruits | 2.33 ± 0.06 | 2.99 ± 0.04 ** | 2.36 ± 0.04 | 3.86 ± 0.06 ** | 2.31 ± 0.04 | 3.61 ± 0.05 ** |
Dairy | 0.60 ± 0.03 | 0.72 ± 0.02 ** | 0.42 ± 0.01 | 1.25 ± 0.03 ** | 0.26 ± 0.01 | 1.30 ± 0.03 ** |
Soybeans | 2.38 ± 0.04 | 2.49 ± 0.02 | 2.36 ± 0.02 | 2.69 ± 0.03 ** | 2.31 ± 0.03 | 2.68 ± 0.03 ** |
Fish and seafood | 1.60 ± 0.04 | 1.57 ± 0.02 | 1.35 ± 0.02 | 2.04 ± 0.03 ** | 1.30 ± 0.02 | 1.97 ± 0.03 ** |
Poultry | 1.53 ± 0.04 | 1.54 ± 0.01 | 1.32 ± 0.02 | 1.98 ± 0.04 ** | 1.26 ± 0.02 | 1.92 ± 0.03 ** |
Eggs | 2.40 ± 0.04 | 2.41 ± 0.02 | 2.17 ± 0.02 | 2.87 ± 0.03 ** | 2.13 ± 0.02 | 2.77 ± 0.03 ** |
Seeds and nuts | 0.92 ± 0.04 | 1.02 ± 0.02 | 0.86 ± 0.02 | 1.28 ± 0.03 ** | 0.82 ± 0.02 | 1.24 ± 0.03 ** |
Red meat | 2.76 ± 0.03 | 2.97 ± 0.02 * | 3.11 ± 0.02 | 2.54 ± 0.03 ** | 3.16 ± 0.02 | 2.58 ± 0.02 ** |
Cooking oils | 7.67 ± 0.07 | 7.49 ± 0.04 * | 7.29 ± 0.04 | 8.01 ± 0.05 ** | 7.47 ± 0.04 | 7.62 ± 0.05 ** |
Sodium | 6.63 ± 0.06 | 6.35 ± 0.03 ** | 6.21 ± 0.02 | 6.82 ± 0.05 ** | 6.36 ± 0.04 | 6.47 ± 0.05 * |
Added sugars | 4.41 ± 0.03 | 4.35 ± 0.02 | 4.51 ± 0.02 | 4.07 ± 0.03 ** | 4.59 ± 0.01 | 4.03 ± 0.03 ** |
Alcohol | 4.61 ± 0.03 | 4.85 ± 0.01 ** | 4.77 ± 0.01 | 4.82 ± 0.01 | 4.75 ± 0.01 | 4.86 ± 0.01 ** |
Total score 2 | 51.74 ± 0.21 | 52.97 ± 0.01 ** | 50.88 ± 0.11 | 56.48 ± 0.17 ** | 50.74 ± 0.11 | 55.55 ± 0.16 ** |
CHEI Component | Total Grains | Whole Grains and Mixed Beans | Tubers | Total Vegetables | Dark Vegetables | Fruits | Dairy | Soybeans | Fish and Seafood | Poultry | Eggs | Seeds and Nuts | Red Meat | Cooking Oils | Sodium | Added Sugars | Alcohol | Total Score 1 | Energy |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Total grains | 1 | ||||||||||||||||||
Whole grains and mixed beans | 0.06 * | 1 | |||||||||||||||||
Tubers | −0.08 * | 0.12 * | 1 | ||||||||||||||||
Total vegetables | −0.13 * | −0.09 * | −0.05 * | 1 | |||||||||||||||
Dark vegetables | −0.18 * | −0.10 * | −0.16 * | 0.46 * | 1 | ||||||||||||||
Fruits | −0.17 * | 0.13 * | 0.08 * | 0.06 * | 0.05 * | 1 | |||||||||||||
Dairy | −0.30 * | 0.10 * | 0.04 * | −0.01 | 0.06 * | 0.29 * | 1 | ||||||||||||
Soybeans | −0.12 * | −0.02 | 0.07 * | 0.01 | −0.03 | 0.05 * | 0.07 * | 1 | |||||||||||
Fish and seafood | −0.22 * | −0.08 * | −0.05 * | 0.08 * | 0.13 * | 0.14 * | 0.18 * | 0.06 * | 1 | ||||||||||
Poultry | −0.13 * | −0.04 * | −0.08 * | 0.01 | 0.14 * | 0.10 * | 0.12 * | −0.02 | 0.18 * | 1 | |||||||||
Eggs | −0.17 * | −0.07 * | 0.12 * | 0.04 * | 0.05 * | 0.20 * | 0.26 * | 0.07 * | 0.12 * | 0.00 | 1 | ||||||||
Seeds and nuts | −0.17 * | 0.12 * | 0.05 * | −0.03 * | 0.02 | 0.20 * | 0.17 * | 0.03 * | 0.08 * | 0.06 * | 0.09 * | 1 | |||||||
Red meat | 0.33 * | 0.17 * | 0.14 * | −0.08 * | −0.20 * | −0.04 * | −0.10 * | −0.01 | −0.12 * | −0.12 * | 0.00 | 0.01 | 1 | ||||||
Cooking oils | 0.24 * | 0.05 * | 0.03 * | −0.02 | 0.00 | 0.14 * | 0.10 * | 0.04 * | 0.03 * | 0.12 * | 0.05 * | 0.07 * | −0.14 * | 1 | |||||
Sodium | 0.05 * | 0.02 | −0.04 * | −0.02 | 0.03 * | 0.08 * | 0.10 * | 0.04 * | 0.04 * | 0.06 * | −0.01 | 0.07 * | −0.13 * | 0.28 * | 1 | ||||
Added sugars | 0.21 * | −0.03 * | −0.02 | −0.01 | −0.05 * | −0.17 * | −0.33 * | −0.05 * | −0.15 * | −0.12 * | −0.15 * | −0.18 * | −0.02 | −0.04 | 0.03 * | 1 | |||
Alcohol | 0.09 * | 0.00 | −0.02 | 0.04 * | 0.07 * | 0.04 * | 0.05 * | −0.03 * | −0.02 | −0.03 | 0.02 | −0.05 * | −0.01 | −0.06 * | −0.07 * | −0.04 * | 1 | ||
Total score 1 | −0.10 * | 0.10 * | 0.04 | 0.08 * | 0.07 * | 0.27 * | 0.25 * | 0.06 * | 0.13 * | 0.10 * | 0.15 * | 0.15 * | −0.13 * | 0.22 * | 0.14 * | −0.20 * | −0.03 * | 1 | |
Energy | 0.10 * | 0.06 | −0.04 * | −0.13 * | −0.14 | −0.03 * | −0.04 * | 0.03 * | −0.03 * | 0.02 | −0.10 * | 0.12 * | −0.01 | 0.14 * | 0.34 * | 0.05 * | −0.18 * | 0.10 * | 1 |
Nutrients | Pearson Correlations Model 2 | |||
---|---|---|---|---|
Coefficent 1 | P | Coefficent 2 | P | |
Macronutrients | ||||
Protein | 0.354 | <0.0001 | 0.420 | <0.0001 |
Fat | −0.105 | <0.0001 | −0.243 | <0.0001 |
Carbohydrates | 0.164 | <0.0001 | 0.155 | <0.0001 |
Dietary fiber | 0.391 | <0.0001 | 0.408 | <0.0001 |
Micronutrients | ||||
Calcium | 0.423 | <0.0001 | 0.407 | <0.0001 |
Iron | 0.271 | <0.0001 | 0.269 | <0.0001 |
Phosphorus | 0.369 | <0.0001 | 0.489 | <0.0001 |
Magnesium | 0.322 | <0.0001 | 0.366 | <0.0001 |
Potassium | 0.431 | <0.001 | 0.492 | <0.001 |
Sodium | −0.305 | <0.001 | −0.360 | <0.001 |
Selenium | 0.349 | <0.0001 | 0.368 | <0.0001 |
Zinc | 0.244 | <0.0001 | 0.263 | <0.0001 |
Vitamin A | 0.284 | <0.0001 | 0.260 | <0.0001 |
Vitamin E | −0.054 | <0.0001 | −0.119 | <0.0001 |
Thiamine | 0.241 | <0.0001 | 0.248 | <0.0001 |
Riboflavin | 0.437 | <0.0001 | 0.455 | <0.0001 |
Niacin | 0.246 | <0.0001 | 0.221 | <0.0001 |
Vitamin B-6 | 0.281 | <0.0001 | 0.285 | <0.0001 |
Vitamin B-12 | 0.214 | <0.0001 | 0.199 | <0.0001 |
Vitamin C | 0.339 | <0.0001 | 0.313 | <0.0001 |
NRF 9.3 3 | 0.397 | <0.0001 |
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Yuan, Y.-Q.; Li, F.; Wu, H.; Wang, Y.-C.; Chen, J.-S.; He, G.-S.; Li, S.-G.; Chen, B. Evaluation of the Validity and Reliability of the Chinese Healthy Eating Index. Nutrients 2018, 10, 114. https://doi.org/10.3390/nu10020114
Yuan Y-Q, Li F, Wu H, Wang Y-C, Chen J-S, He G-S, Li S-G, Chen B. Evaluation of the Validity and Reliability of the Chinese Healthy Eating Index. Nutrients. 2018; 10(2):114. https://doi.org/10.3390/nu10020114
Chicago/Turabian StyleYuan, Ya-Qun, Fan Li, Han Wu, Ying-Chuan Wang, Jing-Si Chen, Geng-Sheng He, Shu-Guang Li, and Bo Chen. 2018. "Evaluation of the Validity and Reliability of the Chinese Healthy Eating Index" Nutrients 10, no. 2: 114. https://doi.org/10.3390/nu10020114