Contribuição da insatisfação corporal e de variáveis demográficas e acadêmicas no comportamento alimentar de estudantes universitários brasileiros e portugueses
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Data
2016-09-23
Autores
Santana, Moema de Souza [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Objetivos: Construir uma versão em português do Questionário Alimentar de Três Fatores (TFEQ) utilizando o acordo ortográfico estabelecido entre países de língua portuguesa. Investigar as propriedades métricas das versões completa (TFEQ) e reduzida (TFEQ-18) do Questionário Alimentar de Três Fatores quando aplicadas a estudantes universitários brasileiros e portugueses. Identificar a contribuição da insatisfação com o tamanho do corpo e de variáveis demográficas e acadêmicas no comportamento alimentar. Métodos: O TFEQ foi traduzido para o português por três tradutores bilíngues nativos do Brasil. Essas versões foram conciliadas em versão única que foi enviada para a um pesquisador português e um moçambicano para obtenção de um instrumento culturalmente adequado para os três países. Em seguida, a versão adaptada transculturalmente foi enviada a dois retrotradutores. As retrotraduções foram confrontadas com a versão original do instrumento para avaliação de sua equivalência. Realizou-se estudo piloto para verificação do Índice de Incompreensão (II) e da praticabilidade do instrumento. Para avaliação da validade de conteúdo 8 profissionais da área de Nutrição/Psicologia com conhecimento sobre imagem corporal/desordens alimentares analisaram cada item do TFEQ segundo sua essencialidade. A Razão de Validade de Conteúdo (RVC) foi computada e considerada adequada se ≥0,75. A versão em português do TFEQ foi preenchida por 1.335 estudantes universitários brasileiros e 1.216 portugueses. Realizou-se Análise Fatorial Confirmatória (AFC) utilizando como índices de ajustamento a Razão de qui-quadrado pelos graus de liberdade (2/gl), o Comparative Fit Index (CFI), o Tucker-Lewis Index (TLI) e o Root Mean Square Error of Approximation (RMSEA). A validade convergente (VEM) e a validade discriminante (r2) foram estimadas. A confiabilidade foi avaliada pela confiabilidade composta (CC) e pela consistência interna (α). Estimou-se a invariância transnacional (Brasil vs. Portugal) e dentro de cada país (Amostra Teste vs. Validação) dos modelos do TFEQ utilizando análise multigrupos (2). Foram testadas a versão original (com 51 itens com correlação entre os fatores – TFEQ oblíquo), reduzida (TFEQ-18), unifatoriais (fatores do TFEQ avaliados separadamente) e a ortogonal (com 51 itens sem correlação entre os fatores). Definido o melhor modelo, confeccionou-se um modelo estrutural, para cada país separadamente, considerando como variáveis dependentes os fatores investigados pelo TFEQ-18 (Restrição Cognitiva – RC, Alimentação Emocional - AE e Descontrole Alimentar - DA) e como variáveis independentes a insatisfação com o tamanho do corpo e as características demográficas e acadêmicas. Utilizou-se teste z para estimar a significância das trajetórias (β) (α=5%). Resultados: Nenhum item do TFEQ apresentou Índice de Incompreensão (II) ≥ 20%, portanto, a compreensão da versão em português foi considerada adequada. A praticabilidade do instrumento foi adequada tanto no Brasil (96,1%) quanto em Portugal (91,1-95,6%). Trinta itens do TFEQ e onze do TFEQ-18 apresentaram RVC≥0,75 sendo considerados essenciais para avaliação do comportamento alimentar. O modelo oblíquo do TFEQ apresentou ajustamento sofrível às amostras mesmo após refinamento, enquanto, os modelos TFEQ-18 e unifatoriais refinados apresentaram ajustamento adequado às amostras. Observou-se validade convergente (VEM=0,50-0,76) e confiabilidade (CC=0,72-0,86 e α=0,72-0,89) adequadas para os modelos ajustados nas amostras. A validade discriminante esteve comprometida no modelo TFEQ oblíquo refinado entre os fatores Desinibição e Fome na amostra total (r²=0,56) e em Portugal (r²=0,60). Não foi verificada invariância transnacional do instrumento. A invariância em amostras independentes dentro de cada país foi atestada tanto no Brasil quanto em Portugal para todos os modelos ajustados às amostras. Os estudantes brasileiros apresentaram maiores escores de AE e DA (β=0,159-0,181; p<0,001). As variáveis sexo, desejo de diminuir o tamanho do corpo e uso de medicamentos para alterar a forma do corpo apresentaram contribuição significativa para os fatores RC e AE no Brasil e em Portugal assim como a idade, o ano do curso e o pensamento de desistir do curso para o fator DA. A significância da contribuição de variáveis como estrato socioeconômico, ano do curso, desempenho no curso, trabalho concomitante aos estudos e Índice de Massa Corporal (IMC) para os fatores do TFEQ-18 foi diferente entre os países. Conclusão: A versão transculturalmente adaptada para o português do TFEQ apresentou adequada validade de face e de conteúdo. Atestou-se que o TFEQ oblíquo refinado, o TFEQ-18 e os modelos unifatoriais apresentaram propriedades métricas adequadas e ausência de invariância transnacional (Brasil vs. Portugal) em amostra de estudantes universitários. Os estudantes brasileiros apresentaram escores mais elevados de AE e DA. A contribuição da insatisfação com o tamanho do corpo e das variáveis demográficas e acadêmicas no comportamento alimentar dos universitários foi distinta no Brasil e em Portugal.
Aims: To translate The Three Factor Eating Questionnaire (TFEQ) to Portuguese language and to adapt it according to The Portuguese Language Orthographic Agreement. To evaluate the psychometric properties of complete and 18-item version of TFEQ in Brazilian and Portuguese students. To identify the contribution of the dissatisfaction with body size and of variables demographic and academic to the eating behavior. Methods: TFEQ was translated into Portuguese language by three bilingual native speakers from Brazil. These three versions were combined into a single version and submitted to adaptation by Portuguese and Mozambican researchers to obtain a culturally appropriate instrument for the three countries. The final version was back-translated to English by another two translators and compared with the original version to examine their equivalence. Further, a pilot study was conducted to verify the Incomprehension Index (II) and Feasibility of the instrument. To assess the validity of content, 8 experts in psychology and in eating behavior evaluated each item of TFEQ according to its essentiality. The Content Validity Ratio (CVR) was calculated and considered adequate if ≥ 0.75. The adapted Portuguese version of TFEQ was completed by 1,335 Brazilian and 1,216 Portuguese students. Additionally, it was conducted a Confirmatory Factor Analysis (CFA) using the indexes Chi-Square by Degrees of Freedom Ratio ( 2 /df), Comparative Fit Index (CFI), Tucker-Lewis Index (TLI) and Root Mean Square Error of Approximation (RMSEA). A convergent validity (AVE) and discriminant validity (r 2 ) were also estimated. The reliability was evaluated by composite reliability (CR) and internal consistency (α) analyses. The invariance of independent and cross-cultural (between countries) samples was evaluated ( 2 ). The original complete (TFEQ with 51 items oblique - with factors correlated), short (TFEQ-18 - with factors correlated), unifactorial (TFEQ with 51 items – with factors assessed separately) and orthogonal versions (TFEQ with 51 items – with uncorrelated factors) were tested. After the best model was defined, it was made a structural model for each country separately, and the TFEQ-18 factors (Cognitive Restraint - CR, Emotional Eating - EE and Uncontrolled Eating - UE) were considered as dependent variables, while the dissatisfaction with body size and the variables demographics and academics were considered as independent variables. Finally, the Z-test was used to estimate the significance of trajectories (β) (α=5%). Results: As none of TFEQ item showed II ≥ 20%, the adapted Portuguese version was considered adequate. The Feasibility of the instrument was adequate in both Brazil (96.1%) and Portugal (91.1 to 95.6%), and either 30 items of the TFEQ and 11 of the TFEQ-18 were considered essential to assess eating behavior (CVR≥0.75). The TFEQ version obtained with oblique rotation presented a poor fit to the study samples while the TFEQ-18 and unifactorial models presented good fits. The instrument presented adequate convergent validity (AVE=0.50-0.76) and adequate reliability (CR=0.72-0.86 and α=0.72-0.89) for the fitted models in all samples. Among Portugueses and in the total sample, the discriminant validity in the TFEQ-51 oblique model was compromised by the factors Disinhibition and Hunger. The cross-national invariance was not verified. It was found a strong invariance in independent samples of the TFEQ models (Δχ2>0.05). Brazilian students had higher scores of EE and UE (β=0.159-0.181; p<0.001). The 12 variables gender, desire to reduce body size and use of medication to change body shape had a significant contribution to the CR and EE factors in Brazil and Portugal as well as the variables age, year of the course and the thought of giving up course for the UE factor. Significance of contribution of variables such as Social Economic Stratum, year of the course, performance in course and labour activity together with studies and Body Mass Index (BMI) for the factors of TFEQ- 18 differed between the studied countries. Conclusion: The cross-culturally adapted Portuguese version of TFEQ showed adequate face validity and content. The TFEQ models evaluated (oblique 51-item TFEQ, TFEQ-18 and unifactorial) showed adequate validity and reliability when applied to Brazilian and Portuguese students, and, it was not observed invariance among the countries. Furthermore, the Brazilian students had higher scores of EE and EU, and it was found a different contribution of the dissatisfaction with body size and of variables demographic, academic to the eating behavior of Brazilian and Portuguese students.
Aims: To translate The Three Factor Eating Questionnaire (TFEQ) to Portuguese language and to adapt it according to The Portuguese Language Orthographic Agreement. To evaluate the psychometric properties of complete and 18-item version of TFEQ in Brazilian and Portuguese students. To identify the contribution of the dissatisfaction with body size and of variables demographic and academic to the eating behavior. Methods: TFEQ was translated into Portuguese language by three bilingual native speakers from Brazil. These three versions were combined into a single version and submitted to adaptation by Portuguese and Mozambican researchers to obtain a culturally appropriate instrument for the three countries. The final version was back-translated to English by another two translators and compared with the original version to examine their equivalence. Further, a pilot study was conducted to verify the Incomprehension Index (II) and Feasibility of the instrument. To assess the validity of content, 8 experts in psychology and in eating behavior evaluated each item of TFEQ according to its essentiality. The Content Validity Ratio (CVR) was calculated and considered adequate if ≥ 0.75. The adapted Portuguese version of TFEQ was completed by 1,335 Brazilian and 1,216 Portuguese students. Additionally, it was conducted a Confirmatory Factor Analysis (CFA) using the indexes Chi-Square by Degrees of Freedom Ratio ( 2 /df), Comparative Fit Index (CFI), Tucker-Lewis Index (TLI) and Root Mean Square Error of Approximation (RMSEA). A convergent validity (AVE) and discriminant validity (r 2 ) were also estimated. The reliability was evaluated by composite reliability (CR) and internal consistency (α) analyses. The invariance of independent and cross-cultural (between countries) samples was evaluated ( 2 ). The original complete (TFEQ with 51 items oblique - with factors correlated), short (TFEQ-18 - with factors correlated), unifactorial (TFEQ with 51 items – with factors assessed separately) and orthogonal versions (TFEQ with 51 items – with uncorrelated factors) were tested. After the best model was defined, it was made a structural model for each country separately, and the TFEQ-18 factors (Cognitive Restraint - CR, Emotional Eating - EE and Uncontrolled Eating - UE) were considered as dependent variables, while the dissatisfaction with body size and the variables demographics and academics were considered as independent variables. Finally, the Z-test was used to estimate the significance of trajectories (β) (α=5%). Results: As none of TFEQ item showed II ≥ 20%, the adapted Portuguese version was considered adequate. The Feasibility of the instrument was adequate in both Brazil (96.1%) and Portugal (91.1 to 95.6%), and either 30 items of the TFEQ and 11 of the TFEQ-18 were considered essential to assess eating behavior (CVR≥0.75). The TFEQ version obtained with oblique rotation presented a poor fit to the study samples while the TFEQ-18 and unifactorial models presented good fits. The instrument presented adequate convergent validity (AVE=0.50-0.76) and adequate reliability (CR=0.72-0.86 and α=0.72-0.89) for the fitted models in all samples. Among Portugueses and in the total sample, the discriminant validity in the TFEQ-51 oblique model was compromised by the factors Disinhibition and Hunger. The cross-national invariance was not verified. It was found a strong invariance in independent samples of the TFEQ models (Δχ2>0.05). Brazilian students had higher scores of EE and UE (β=0.159-0.181; p<0.001). The 12 variables gender, desire to reduce body size and use of medication to change body shape had a significant contribution to the CR and EE factors in Brazil and Portugal as well as the variables age, year of the course and the thought of giving up course for the UE factor. Significance of contribution of variables such as Social Economic Stratum, year of the course, performance in course and labour activity together with studies and Body Mass Index (BMI) for the factors of TFEQ- 18 differed between the studied countries. Conclusion: The cross-culturally adapted Portuguese version of TFEQ showed adequate face validity and content. The TFEQ models evaluated (oblique 51-item TFEQ, TFEQ-18 and unifactorial) showed adequate validity and reliability when applied to Brazilian and Portuguese students, and, it was not observed invariance among the countries. Furthermore, the Brazilian students had higher scores of EE and EU, and it was found a different contribution of the dissatisfaction with body size and of variables demographic, academic to the eating behavior of Brazilian and Portuguese students.
Descrição
Palavras-chave
Comportamento alimentar, Cognição, Fome, Feeding behavior, Cognition, Hunger