The Validation of the Persian Version of Sugar Addiction Questionnaire: Factor Structure, Item Analysis and Model Fit
-
Seyyed Salman Alavi
,
Faezeh Mokhtari
,
Zahra Molavi
,
Somayeh Nasiri Moghadam
,
Samira Yaseri
,
Fereshteh Jannatifard
,
Hamed Alaghemandan
,
Fatemeh Padrad
,
Ghazal Panahi Saeb
,
Lili Safdari
,
Mohammad Reza Mohammadi
Abstract
Objective: Excessive sugar consumption is a growing public health concern, with research suggesting it may function as an addictive substance. However, the lack of standardized tools to assess sugar addiction, particularly across cultures, remains a challenge. This study aims to validate the Persian version of the Sugar Addiction Questionnaire (SAQ) for use in Iran.
Method: In this cross-sectional psychometric validation study, 504 Persian-speaking adults (59.1% female, mean age = 29.8 ± 19.5 years) were recruited using convenience sampling from Tehran health centers. Participants completed the SAQ and Yale Food Addiction Scale (YFAS 2.0), and participated in DSM-5-based semi-structured interviews for sugar addiction. Factor analysis and reliability measures (Cronbach’s alpha, test-retest, split-half) were used to assess the SAQ's validity and reliability.
Results: The Persian SAQ demonstrated strong psychometric properties. Factor analysis revealed a five-factor structure explaining 45.08% of the variance. Concurrent validity was confirmed by significant correlations with the YFAS 2.0 (r = 0.51, P < 0.001) and BMI (r = 0.55, P < 0.001). The scale showed a good model fit (CFI = 0.91, RMSEA = 0.08), with acceptable reliability (Cronbach’s alpha = 0.79) and a test-retest correlation of 0.54. The optimal cutoff for diagnosing sugar addiction was 9, with the Area-Under-the-Curve (AUC) of 98%.
Conclusion: The Persian version of the SAQ is a reliable and valid tool for assessing sugar addiction in Iran. This validated instrument can improve the diagnosis and understanding of sugar-related behavioral issues, supporting better public health strategies for managing excessive sugar consumption.
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16. Rosa MACd, Gomes CMA, Rocha NSd, Kessler FHP, Slavutzky SMBd, Pechansky F. Dependence module of the MINI plus adapted for sugar dependence: psychometric properties. Psicologia: Reflexão e Crítica. 2013;26:77-86.
17. Fromm SP, Horstmann A. Psychometric Evaluation of the German Version of the Dietary Fat and Free Sugar-Short Questionnaire. Obes Facts. 2019;12(5):518-28.
18. Avena NM, Rada P, Hoebel BG. Evidence for sugar addiction: behavioral and neurochemical effects of intermittent, excessive sugar intake. Neurosci Biobehav Rev. 2008;32(1):20-39.
19. Kiwanuka SN, Astrøm AN, Trovik TA. Sugar snack consumption in Ugandan schoolchildren: Validity and reliability of a food frequency questionnaire. Community Dent Oral Epidemiol. 2006;34(5):372-80.
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21. Fawzy N, El-Deen DS. Assessment of Sugar Addiction among Non-Diabetic Patients. Novelty Journals. 2018;5(3).
22. Amerzadeh M, Takian A, Pouraram H, Akbari Sari A, Ostovar A. Economic barriers and gaps to reach the desirable consumption of salt, sugar, and fat in Iran: a qualitative study. J Health Popul Nutr. 2023;42(1):8.
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24. Gearhardt AN, Corbin WR, Brownell KD. Development of the Yale Food Addiction Scale Version 2.0. Psychol Addict Behav. 2016;30(1):113-21.
25. Haghighinejad H, Tarakemehzadeh M, Jafari P, Jafari M, Ramzi M, Hedayati A. Persian Version of the Yale Food Addiction Scale 2.0: Psychometric Analysis and Setting Cutoff Point for the Food Cravings Questionnaire-Trait-Reduced. Psychiatry Investig. 2021;18(3):179-86.
26. Niroumand Sarvandani M, Asadi M, Khosravi F, Gearhardt AN, Razmhosseini M, Soleimani M, et al. Validation and Psychological Properties of the Persian Version of DSM 5 Yale Food Addiction Scale 2.0 (PYFAS 2.0) in Non-clinical Population. Addict Health. 2022;14(3):175-84.
27. Peele S, Brodsky, A. Love and Addiction. New York: Taplinger; 1975. Available in: Love and Addiction: 4. "Love" as an Addiction
28. Alavi SS, Ferdosi M, Jannatifard F, Eslami M, Alaghemandan H, Setare M. Behavioral Addiction versus Substance Addiction: Correspondence of Psychiatric and Psychological Views. Int J Prev Med. 2012;3(4):290-4.
29. Sussman S. The Cambridge handbook of substance and behavioral addictions: Cambridge University Press; 2020.
30. Kim HY. Statistical notes for clinical researchers: assessing normal distribution (2) using skewness and kurtosis. Restor Dent Endod. 2013;38(1):52-4.
31. Ferguson E, Cox T. Exploratory factor analysis: A users’ guide. International journal of selection and assessment. 1993;1(2):84-94.
32. Lawshe C. A Quantitative Approach to Content Validity. Personnel psychology/Berrett-Koehler Publishers. 1975.
33. Cortina JM. What is coefficient alpha? An examination of theory and applications. Journal of applied psychology. 1993;78(1):98.
34. Polit DF. Getting serious about test-retest reliability: a critique of retest research and some recommendations. Qual Life Res. 2014;23(6):1713-20.
35. Bray GA, Nielsen SJ, Popkin BM. Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr. 2004;79(4):537-43.
36. Lustig RH, Schmidt LA, Brindis CD. Public health: The toxic truth about sugar. Nature. 2012;482(7383):27-9.
37. Bowen DJ, Grunberg NE. Variations in food preference and consumption across the menstrual cycle. Physiol Behav. 1990;47(2):287-91.
38. Farahmand M, Tehrani FR, Amiri P, Azizi F. Barriers to healthy nutrition: perceptions and experiences of Iranian women. BMC Public Health. 2012;12:1064.
39. Graves BS, Hall ME, Dias-Karch C, Haischer MH, Apter C. Gender differences in perceived stress and coping among college students. PLoS One. 2021;16(8):e0255634.
40. Orsini CA, Brown TE, Hodges TE, Alonso-Caraballo Y, Winstanley CA, Becker JB. Neural Mechanisms Mediating Sex Differences in Motivation for Reward: Cognitive Bias, Food, Gambling, and Drugs of Abuse. J Neurosci. 2022;42(45):8477-87.
41. Feraco A, Armani A, Amoah I, Guseva E, Camajani E, Gorini S, et al. Assessing gender differences in food preferences and physical activity: a population-based survey. Front Nutr. 2024;11:1348456.
42. Warren A. The relationship between gender differences in dietary habits, neuroinflammation, and Alzheimer's disease. Front Aging Neurosci. 2024;16:1395825.
2. WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Sugars Intake for Adults and Children. Geneva: World Health Organization Copyright © World Health Organization, 2015.; 2015.
3. Abdi F, ATARODI KZ, Mirmiran P, Esteki T. Surveying global and Iranian food consumption patterns: A review of the literature. 2015.
4. Huang Y, Chen Z, Chen B, Li J, Yuan X, Li J, et al. Dietary sugar consumption and health: umbrella review. Bmj. 2023;381:e071609.
5. Makarem N, Bandera EV, Lin Y, Jacques PF, Hayes RB, Parekh N. Consumption of Sugars, Sugary Foods, and Sugary Beverages in Relation to Adiposity-Related Cancer Risk in the Framingham Offspring Cohort (1991-2013). Cancer Prev Res (Phila). 2018;11(6):347-58.
6. Prada M, Saraiva M, Garrido MV, Sério A, Teixeira A, Lopes D, et al. Perceived Associations between Excessive Sugar Intake and Health Conditions. Nutrients. 2022;14(3):640.
7. Xiong J, Wang L, Huang H, Xiong S, Zhang S, Fu Q, et al. Association of sugar consumption with risk of depression and anxiety: a systematic review and meta-analysis. Front Nutr. 2024;11:1472612.
8. DiNicolantonio JJ, O'Keefe JH, Wilson WL. Sugar addiction: is it real? A narrative review. Br J Sports Med. 2018;52(14):910-3.
9. Avena NM, Rada P, Hoebel BG. Evidence for sugar addiction: behavioral and neurochemical effects of intermittent, excessive sugar intake. Neurosci Biobehav Rev. 2008;32(1):20-39.
10. Westwater ML, Fletcher PC, Ziauddeen H. Sugar addiction: the state of the science. Eur J Nutr. 2016;55(Suppl 2):55-69.
11. Wiss DA, Avena N, Rada P. Sugar Addiction: From Evolution to Revolution. Front Psychiatry. 2018;9:545.
12. Pursey KM, Yokum S, Brain K, Burrows T. Neural Responses in Addictive Eating: a Systematic Review. Current Addiction Reports. 2024;11(2):173-90.
14. Meule A, Gearhardt AN. Food addiction in the light of DSM-5. Nutrients. 2014;6(9):3653-71.
15. Falbe J, Thompson HR, Patel A, Madsen KA. Potentially addictive properties of sugar-sweetened beverages among adolescents. Appetite. 2019;133:130-7.
16. Rosa MACd, Gomes CMA, Rocha NSd, Kessler FHP, Slavutzky SMBd, Pechansky F. Dependence module of the MINI plus adapted for sugar dependence: psychometric properties. Psicologia: Reflexão e Crítica. 2013;26:77-86.
17. Fromm SP, Horstmann A. Psychometric Evaluation of the German Version of the Dietary Fat and Free Sugar-Short Questionnaire. Obes Facts. 2019;12(5):518-28.
18. Avena NM, Rada P, Hoebel BG. Evidence for sugar addiction: behavioral and neurochemical effects of intermittent, excessive sugar intake. Neurosci Biobehav Rev. 2008;32(1):20-39.
19. Kiwanuka SN, Astrøm AN, Trovik TA. Sugar snack consumption in Ugandan schoolchildren: Validity and reliability of a food frequency questionnaire. Community Dent Oral Epidemiol. 2006;34(5):372-80.
20. Gearhardt AN, Corbin WR, Brownell KD. Preliminary validation of the Yale Food Addiction Scale. Appetite. 2009;52(2):430-6.
21. Fawzy N, El-Deen DS. Assessment of Sugar Addiction among Non-Diabetic Patients. Novelty Journals. 2018;5(3).
22. Amerzadeh M, Takian A, Pouraram H, Akbari Sari A, Ostovar A. Economic barriers and gaps to reach the desirable consumption of salt, sugar, and fat in Iran: a qualitative study. J Health Popul Nutr. 2023;42(1):8.
23. Amerzadeh M, Takian A, Pouraram H, Sari AA, Ostovar A. Policy analysis of socio-cultural determinants of salt, sugar and fat consumption in Iran. BMC Nutr. 2022;8(1):26.
24. Gearhardt AN, Corbin WR, Brownell KD. Development of the Yale Food Addiction Scale Version 2.0. Psychol Addict Behav. 2016;30(1):113-21.
25. Haghighinejad H, Tarakemehzadeh M, Jafari P, Jafari M, Ramzi M, Hedayati A. Persian Version of the Yale Food Addiction Scale 2.0: Psychometric Analysis and Setting Cutoff Point for the Food Cravings Questionnaire-Trait-Reduced. Psychiatry Investig. 2021;18(3):179-86.
26. Niroumand Sarvandani M, Asadi M, Khosravi F, Gearhardt AN, Razmhosseini M, Soleimani M, et al. Validation and Psychological Properties of the Persian Version of DSM 5 Yale Food Addiction Scale 2.0 (PYFAS 2.0) in Non-clinical Population. Addict Health. 2022;14(3):175-84.
27. Peele S, Brodsky, A. Love and Addiction. New York: Taplinger; 1975. Available in: Love and Addiction: 4. "Love" as an Addiction
28. Alavi SS, Ferdosi M, Jannatifard F, Eslami M, Alaghemandan H, Setare M. Behavioral Addiction versus Substance Addiction: Correspondence of Psychiatric and Psychological Views. Int J Prev Med. 2012;3(4):290-4.
29. Sussman S. The Cambridge handbook of substance and behavioral addictions: Cambridge University Press; 2020.
30. Kim HY. Statistical notes for clinical researchers: assessing normal distribution (2) using skewness and kurtosis. Restor Dent Endod. 2013;38(1):52-4.
31. Ferguson E, Cox T. Exploratory factor analysis: A users’ guide. International journal of selection and assessment. 1993;1(2):84-94.
32. Lawshe C. A Quantitative Approach to Content Validity. Personnel psychology/Berrett-Koehler Publishers. 1975.
33. Cortina JM. What is coefficient alpha? An examination of theory and applications. Journal of applied psychology. 1993;78(1):98.
34. Polit DF. Getting serious about test-retest reliability: a critique of retest research and some recommendations. Qual Life Res. 2014;23(6):1713-20.
35. Bray GA, Nielsen SJ, Popkin BM. Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr. 2004;79(4):537-43.
36. Lustig RH, Schmidt LA, Brindis CD. Public health: The toxic truth about sugar. Nature. 2012;482(7383):27-9.
37. Bowen DJ, Grunberg NE. Variations in food preference and consumption across the menstrual cycle. Physiol Behav. 1990;47(2):287-91.
38. Farahmand M, Tehrani FR, Amiri P, Azizi F. Barriers to healthy nutrition: perceptions and experiences of Iranian women. BMC Public Health. 2012;12:1064.
39. Graves BS, Hall ME, Dias-Karch C, Haischer MH, Apter C. Gender differences in perceived stress and coping among college students. PLoS One. 2021;16(8):e0255634.
40. Orsini CA, Brown TE, Hodges TE, Alonso-Caraballo Y, Winstanley CA, Becker JB. Neural Mechanisms Mediating Sex Differences in Motivation for Reward: Cognitive Bias, Food, Gambling, and Drugs of Abuse. J Neurosci. 2022;42(45):8477-87.
41. Feraco A, Armani A, Amoah I, Guseva E, Camajani E, Gorini S, et al. Assessing gender differences in food preferences and physical activity: a population-based survey. Front Nutr. 2024;11:1348456.
42. Warren A. The relationship between gender differences in dietary habits, neuroinflammation, and Alzheimer's disease. Front Aging Neurosci. 2024;16:1395825.
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| Issue | Vol 20 No 2 (2025) | |
| Section | Original Article(s) | |
| Keywords | ||
| Addictive Behavioral Addiction Psychometrics Questionnaires Sugars Validation Study | ||
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How to Cite
1.
Alavi SS, Mokhtari F, Molavi Z, Nasiri Moghadam S, Yaseri S, Jannatifard F, Alaghemandan H, Padrad F, Panahi Saeb G, Safdari L, Mohammadi MR. The Validation of the Persian Version of Sugar Addiction Questionnaire: Factor Structure, Item Analysis and Model Fit. Iran J Psychiatry. 2025;20(2):186-199.
