Letramento alimentar entre pessoas com Diabetes Mellitus: validando um constructo e analisando o efeito no consumo de ultraprocessados

Abstract

Objective: This study aimed to evaluate the validity and reliability of a construct called Food Literacy in people with Diabetes (FL-D) and to analyze the effect of this instrument, Social Support Satisfaction (SSS), and Empowerment (E) on the caloric intake of Ultra-Processed Foods (UPFs). Methods: This is a cross-sectional methodological study conducted between 2016 and 2018 in Montes Claros, Brazil. The sample size was calculated to ensure the evaluation of the reliability and validity of the FL-D scale, as well as to estimate the effect of SSS, mediated by FL-D and empowerment, on UPF consumption. The FL-D scale was developed with 17 items distributed across three dimensions: Access, Evaluation, and Application. UPF consumption was measured using a semi-structured food frequency questionnaire, and caloric intake was subsequently calculated. Statistical Analyses: Analyses were performed using SPSS 22.0 and JASP 1.8.2. The validity and reliability of the instrument were assessed through Confirmatory Factor Analysis (CFA). The fit indices used included χ², χ²/df, Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Standardized Root Mean Residual (SRMR), and Root Mean Square Error of Approximation (RMSEA). Internal consistency was verified using McDonald’s ω method. Results: The FL-D was found to be a valid and reliable instrument for measuring food literacy in people with diabetes. Gender and ethnicity/race did not influence FL-D, whereas education and age had a small effect. A hypothetical theoretical model was developed to analyze the effects, using Structural Equation Modeling to estimate relationships among the latent variables SSS, FL-D, and empowerment, as well as their impact on UPF consumption. A path analysis was also conducted, including Bartlett’s test and the Kaiser-Meyer-Olkin measure to verify model plausibility. The sample had a mean age of 62.25 ± 12.11 years, with 68.1% being women. The results indicated that SSS has an effect on UPF consumption mediated by FL-D and empowerment. Higher levels of SSS, FL-D, and empowerment were associated with reduced UPF consumption, contributing to improved quality of life among people with diabetes. Conclusions: The FL-D can be used in future research, and the results derived from this scale have the potential to support public health policies and educational actions. These actions should consider SSS and empowerment levels to promote effective interventions.