Association between the Consumption of Ultra-Processed Foods and Asthma in Adults from Ribeirão Preto, São Paulo, Brazil.

BACKGROUND: Ultra-processed Food (UPF) consumption can play a role in the pathogenesis and progression of asthma. The aim of this study was to evaluate the association between the consumption of UPF and asthma. METHODS: This cross-sectional study included 1857 adults aged 23-25 years from the Ribeirão Preto-SP birth cohort (1978/1979). The exposure variable was the consumption of UPF (expressed as their percentage contribution to energy intake-% total caloric value [%TCV] and their percentage contribution to the amount of food ingested-%grams), which was assessed with a food frequency questionnaire. Asthma was the outcome and was defined based on a positive methacholine challenge test and the presence of wheezing, chest tightness, or shortness of breath over the last 12 months. Poisson regression with robust variance was used to estimate the association between these variables. Unadjusted analyses and analyses adjusted for sex, age, household income, smoking, and physical activity level were performed. RESULTS: The prevalence of asthma in the sample was 13.2%. The mean total consumption of UPF was 37.9 ± 11.2% TCV (corresponding to 35.1 ± 15.1% grams). There was no association between the consumption of UPF and asthma in adults. CONCLUSION: This study provides no evidence for an association between the consumption of UPF and asthma in young adults.

Performance of Body Fat Percentage, Fat Mass Index and Body Mass Index for Detecting Cardiometabolic Outcomes in Brazilian Adults.

Obesity is a recognized risk factor for the development of cardiometabolic outcomes. Therefore, it is essential to evaluate anthropometric and body composition indicators used for its diagnosis. This study aimed to assess the diagnostic performance of body fat percentage (BF%), fat mass index (FMI) and body mass index (BMI) for detecting cardiometabolic outcomes in adults. A cross-sectional study was conducted involving adults at 30 years of age from Pelotas, RS (n = 3517) and at 37-39 years from Ribeirão Preto, SP (n = 1696). Receiver operating characteristic (ROC) curves were used to determine the cut-off points for predicting cardiometabolic risk factors, including altered blood pressure, blood glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDDL-c), C-reactive protein and glycated hemoglobin. The cut-off points of BF% ranged from 25.2 to 27.8 in men and from 37.4 to 39.7 in women at 30 years, and from 26.1 to 27.8 in men and from 38.5 to 42.2 in women at 37-39 years. For FMI (kg/m2), the cut-off points ranged from 6.3 to 7.5 in men and from 9.5 to 10.8 in women at 30 years, and from 7.3 to 7.8 in men and from 10.2 to 12.2 in women at 37-39 years. The BMI cut-off points (kg/m2) ranged from 26.3 to 27.3 in men and from 25.4 to 27.2 in women at 30 years, and from 28.3 to 29.0 in men and from 27.2 to 29.6 in women at 37-39 years. The areas under the curve were similar for the three indicators, ranging from 0.523 to 0.746. BMI showed a performance similar to that of the body fat-based indicators in identifying cardiometabolic outcomes. The cut-off points of the three indicators showed acceptable discriminatory power in subjects with cardiometabolic risk factors.

High Consumption of Sugar-Sweetened Beverages Is Associated with Low Bone Mineral Density in Young People: The Brazilian Birth Cohort Consortium.

Sugar-sweetened beverages (SSB) consumption may be associated with a reduction in bone mineral density (BMD). The aim of this study was to evaluate the association between the consumption of SSB and BMD among young people. We performed a cross-sectional study that evaluated 6620 young people (18-23 years of age) from three Brazilian birth cohorts (Ribeirão Preto, Pelotas, and São Luís). We analyzed the daily frequency and the amount and energy contribution of the SSB, which were obtained through a food frequency questionnaire. Total body and lumbar spine BMD (g/cm2), measured by dual-energy X-ray absorptiometry, were the outcomes. Unadjusted linear regression models, adjusted for sex, socioeconomic class, physical activity, smoking, alcohol consumption, and body mass index were used. The highest tertile of SSB consumption frequency (2.1-16.7 times/day) was associated with a lower lumbar spine BMD (ß = -0.009; 95% CI: -0.017; -0.001; standardized ß = -0.03). This association persisted after adjustment for confounders (ß = -0.008; 95% CI: -0.016; -0.001; standardized ß = -0.03). No association was observed between SSB consumption frequency and total body BMD or between the amount and energy contribution of SSB and total body or lumbar spine BMD. A high frequency of SSB consumption was associated with a low lumbar spine BMD.

Impactos da pandemia do novo coronavírus no direito humano à alimentação e à nutrição adequadas e programas de segurança alimentar e nutricional: quais os desafios e o que propor? / Impacts of the new coronavirus pandemic on human rights to adequate food and nutrition and food and nutritional security programs: what are the challenges and solutions?

Resumo Introdução A pandemia do novo coronavírus intensificou a violação do direito humano à alimentação e nutrição adequadas e elevou a insegurança alimentar e nutricional na população brasileira. Objetivo Analisar as estratégias das políticas e programas de segurança alimentar e nutricional adotadas pelo governo brasileiro durante a pandemia (ano de 2020) para promoção da segurança alimentar e nutricional e combate à insegurança alimentar e nutricional no país. Método Realizou-se busca nos sites oficiais para análise das ações propostas. Resultados Apesar de algumas proposições pontuais, como a distribuição do auxílio emergencial, estratégias mais enérgicas, como o fortalecimento do Programa de Aquisição de Alimentos, encorajamento de pequenos agricultores, facilitação do transporte e da comercialização de alimentos e a garantia da continuidade de programas assistenciais que facilitem acesso à renda e à alimentação durante a pandemia, precisam ser urgentemente adotadas. Conclusão Essas estratégias requerem atuação das três esferas de governo em prol do combate dos impactos da pandemia do novo coronavírus nos índices de insegurança alimentar e nutricional no Brasil.

Abstract Background The new coronavirus pandemic increased the violation of human rights to adequate food and nutrition and increased food and nutritional insecurity in the Brazilian population. Objective to analyze the policies and programs adopted by the Brazilian Government to promote food and nutritional security during the pandemic (year 2020). Method Official websites were searched to identify proposed initiatives. Results Despite some specific measures, such as emergency financial aid, more effective strategies to strengthen the Food Acquisition Program, encourage small farmers, facilitate food transportation and sale and to guarantee that assistance programs that facilitate income and food access are continued throughout the whole pandemic, need to be urgently considered. Conclusion Initiatives from the three spheres of government are required to combat the impacts of the new coronavirus pandemic on indices of food and nutritional insecurity in Brazil.

Association between socioeconomic factors and fruit and vegetable consumption in Brazilians aged ≥ 50 years: ELSI-Brazil data / Associação entre consumo de frutas, legumes e verduras e fatores socioeconômicos em brasileiros com 50 anos ou mais: dados do ELSI-Brasil

OBJECTIVE: Daily fruit and vegetable consumption is a critical factor in health, especially aging. This study aimed to evaluate the association between socioeconomic factors and daily fruit and vegetable consumption in men and women aged ≥ 50 years. METHODS: This cross-sectional study used 2015-2016 data from the Brazilian longitudinal study of aging (ELSI-Brazil), which included 8665 individuals aged ≥ 50 years. Daily fruit and vegetable consumption was the dependent variable, and income, education, sex, age, and race were the independent variables. Associations between fruit and vegetable consumption and the independent variables were determined using Poisson regression. RESULTS: Individuals who had completed higher education (OR 2.40; 95% CI 2.07-2.78), whose income was > 3 times the minimum wage (OR 2.42; 95% CI 2.18-2.68), and those aged > 80 years (OR 1.44; 95% CI 1.27-1.63) were more likely to consume fruits and vegetables. However, men (OR 0.63; 95% CI 0.58-0.67), Blacks (OR 0.74; 95% CI 0.65-0.84), and people of mixed race (OR 0.68; 95% CI 0.63-0.73), were less likely to consume fruits and vegetables. CONCLUSIONS: The results show inequality in fruit and vegetable consumption among people aged ≥ 50 years, which was lower among men, people of Black or mixed race, people with low income and education, and those with younger age. Interventions are needed to promote fruit and vegetable consumption, and thus healthy aging, among these groups

OBJETIVO: O consumo diário de frutas, legumes e verduras (FLV) é um fator primordial à saúde, especialmente no envelhecimento. Este estudo teve o objetivo de avaliar a associação entre fatores socioeconômicos e o consumo diário de FLV em pessoas com idade de ≥ 50 anos, de ambos os sexos. METODOLOGIA: Trata-se de um estudo transversal, com dados do ELSI-Brasil 2015 - 2016, realizado com 8.665 indivíduos com idade acima de 50 anos. O consumo diário de FLV foi a variável dependente e renda, escolaridade, sexo, idade e cor de pele foram as variáveis independentes. A regressão de Poisson foi usada para verificar a associação entre o consumo de FVL e as variáveis independentes. RESULTADOS: Indivíduos que possuíam ensino superior (odds ratio ­ OR 2,40; intervalo de confiança ­ IC95% 2,07 - 2,78), que recebiam mais que três salários-mínimos (OR 2,42; IC95% 2,18 - 2,68) e com idade superior a 80 anos (OR 1,44; IC95% 1,27 - 1,63) tinham maior probabilidade de consumir FLV. Por outro lado, homens (OR 0,63; IC95% 0,58 - 0,67) de cor de pele parda (OR 0,68; IC95% 0,63 - 0,73) e preta (OR 0,74; IC95% 0,65 - 0,84) tiveram menor chance de consumo de FVL. CONCLUSÕES: Os resultados revelam desigualdades no consumo de FLV entre pessoas com idade acima de 50 anos, com maior magnitude entre os com baixa renda, baixa escolaridade, menor idade, sexo masculino e cor de pele parda e preta, demonstrando, assim, a necessidade de estratégias de intervenção para aumentar o consumo desses alimentos, buscando a promoção do envelhecimento saudável

The Frequency of Daily Consumption of Sugar-Sweetened Beverages Is Associated with Reduced Muscle Mass Index in Adolescents.

The consumption of sugar-sweetened beverages (SSBs) has increased in recent years and has become a cause of concern because these beverages pose a risk to human health. Thus, we evaluated the association between SSBs consumption and muscle mass index (MMI) in adolescents. This cross-sectional study evaluated 2393 adolescents (18/19-years-old). Consumption of SSBs was analyzed based on the frequency of daily consumption and energy contribution categorized into tertiles. MMI was examined using the ratio of muscle mass (kilograms) to height (meters squared). The highest tertile of the frequency of daily SSB intake was associated with a reduced MMI in men (ß = -0.31; 95%CI: -0.60, -0.01) and women (ß = -0.24; 95%CI: -0.45, -0.02). However, these associations were not observed after adjusting for sugar contained in SSBs in men (ß = -0.26; 95%CI: -0.69, 0.17) and for carbohydrate, lipid, and protein intake in women (ß = -0.19; 95%CI: -0.42, 0.04). The highest energy contribution tertile of SSBs was associated with a reduced MMI in male adolescents (ß = -0.34; 95%CI: -0.64, -0.04). This association was not observed after adjusting for intake of sugar in SSBs (ß = -0.38; 95%CI: -0.75, 0.01). The frequency of daily consumption of SSBs was considered a risk factor for decreased MMI in both sexes, and the energy contribution of these drinks was a risk factor for MMI reduced only in male adolescents.

The consumption of culinary preparations and ultra-processed food is associated with handgrip strength in teenagers.

BACKGROUND: A nutrient-poor and hypocaloric diet may be associated with lower handgrip strength (HGS), whereas a high-quality or balanced diet may be associated with higher HGS. However, no study has used the NOVA system for classifying food by their degree of processing. OBJECTIVE: To analyze the association between food consumption according to the degree of food processing and HGS in Brazilian teenagers. METHODS: This cross-sectional study included teenagers aged 18 and 19 years old from the 1997/98 São Luís' birth cohort, Maranhão, Brazil. HGS (kilogram-force) was measured via a Jamar Plus + dynamometer. Food consumption was assessed using a semiquantitative food frequency questionnaire. The energy intake of culinary preparations (unprocessed or minimally processed food and processed culinary ingredients), processed, and ultra-processed foods was evaluated in percentages and categorized in tertiles. The associations between each food group intake and HGS was estimated via crude and adjusted linear regression models. A directed acyclic graph was used to identify confounding factors. RESULTS: We evaluated 2,433 teenagers, 52.1% of which were girls. For boys, adjusted analysis showed an association between the highest HGS and the 3rd tertile of culinary preparation consumption (ß: 1.95; 95%CI: 0.80; 3.10) and between the lowest HGS and the 3rd tertile of ultra-processed food consumption (ß: -2.25; 95%CI: -3.40; -1.10). Among girls, the consumption of culinary preparations in the 3rd tertile was associated with higher HGS (ß: 0.76; 95%CI: 0.05; 1.46). CONCLUSIONS: Higher consumption of culinary preparations and lower consumption of ultra-processed foods can contribute to reduce the chance of lower HGS in adult life. Interventions to promote the development and preservation of muscle strength should include dietary recommendations.

Ultra-processed food consumption is associated with increase in fat mass and decrease in lean mass in Brazilian women: A cohort study.

Objective: To investigate the association between ultra-processed food consumption at 23-25 years of age and measurements of body composition-fat mass, fat mass distribution and lean mass at 37-39 years of age in Brazilian adults. Methods: 1978/1979 birth cohort study conducted with healthy adults from Ribeirão Preto, São Paulo, Brazil. A total of 1,021 individuals participated in the fat mass analysis (measured by air displacement plethysmography) and 815 in the lean mass analysis and fat mass distribution (assessed by dual energy X-ray absorptiometry). Food consumption was evaluated by a food frequency questionnaire. Food items were grouped according to the level of processing as per the NOVA classification. Ultra-processed food consumption was expressed as a percentage of total daily intake (g/day). Linear regression models were used to estimate the effect of ultra-processed food consumption (g/day) on body mass index, body fat percentage, fat mass index, android fat, gynoid fat, android-gynoid fat ratio, lean mass percentage, lean mass index and appendicular lean mass index. Marginal plots were produced to visualize interactions. Results: The mean daily ultra-processed food consumption in grams was 35.8% (813.3 g). There was an association between ultra-processed food consumption and increase in body mass index, body fat percentage, fat mass index, android fat and gynoid fat and decrease in lean mass percentage, only in women. Conclusion: A high ultra-processed food consumption is associated with a long-term increase in fat mass and a decrease in lean mass in adult women.

Sex-Dependent Effects of the Intake of NOVA Classified Ultra-Processed Foods on Syndrome Metabolic Components in Brazilian Adults.

Longitudinal studies evaluating the relationship between UPF consumption and the incidence of Metabolic Syndrome (MetS) and its components are still scarce. This study aimed to evaluate the effect of UPF consumption on the incidence of MetS and its components in adults. A prospective study was conducted with 896 participants from the 1978/79 Ribeirão Preto cohort, São Paulo, Brazil. UPF consumption was evaluated in %kcal and %g at ages 23-25 years. Incidence of MetS and its components were estimated at ages 37-39 years, according to the Joint Interim Statement criteria. Poisson regression was used to assess associations, and interactions with sex were investigated. UPF consumption had no association with MetS (%kcal Adjusted PR: 1.00; 95% CI: 0.99-1.01; %g Adjusted PR: 1.00; 95% CI: 0.99-1.01). However, women with higher UPF consumption, in %kcal and %g, had a higher risk of abdominal obesity (%kcal: p = 0.030; %g: p = 0.003); and women with higher UPF consumption, in %g, had a higher risk of low HDL-cholesterol (p = 0.041). For the other components of MetS, no significant associations were observed in either sex. These findings suggest evidence of no association between UPF consumption and MetS; however, consumption of UPF was associated with increased WC and low HDL-c, but only in women.

Are Fat Mass and Lean Mass Associated with Grip Strength in Adolescents?

Background: The interaction between lean body mass (LBM) and fat mass index (FMI) with grip strength (GS) has not been explored in the same analysis model in adolescents. This study thus aims to analyze the association between FMI and LBM with GS. Methods: This cross-sectional study was conducted with data from the 2016 follow-up of the 1997/98 Birth Cohort of São Luís. Grip strength was assessed by the Jamar Plus + dynamometer. The LBM and FMI indexes were assessed [ratio of the mass (lean or fat-kg) to height (m2)]. The confounding variables identified for the relationship between FMI and LBM with GS in the same analysis model, by directed acyclic graph (DAG), were sex, age, race, work, alcohol consumption, smoking, physical activity, and consumption of ultra-processed foods and culinary preparations, used in the adjusted analysis. Results: A total of 2339 adolescents (52.5% girls) were analyzed. The boys have a higher GS than the girls. In the adjusted analysis, with each increase of 1 kg/m2 in the FMI, GS was reduced by 0.72 kgf for boys and 0.35 kgf for girls. At each increase of 1 kg/m2 in the LBM, GS increased by 2.18 kgf for boys and 1.26 kgf for girls. Conclusions: FMI was associated with lower GS regardless of the LBM. LBM was associated with higher GS regardless of the FMI.

[Associations between sleep duration and fat mass, lean mass, and body mass index in adolescents in São Luís, Maranhão State, Brazil]. / Associações entre duração de sono e índices de massa gorda, muscular e corporal em adolescentes de São Luís, Maranhão, Brasil.

The study aimed to assess the association between sleep duration and body composition in adolescents. A cross-sectional study was performed with 1,269 adolescents from the 1997/1998 birth cohort in São Luís, Maranhão State, Brazil, 18 and 19 years of age. Sleep duration was assessed with accelerometry data. Body composition was assessed with fat mass index (FMI), lean mass index (LMI), and body mass index (BMI). Confounding factors were identified in a directed acyclic graph in DAGitty 3.0. Descriptive analyses were performed for all variables, followed by linear regression, with estimation of crude and adjusted regression coefficient with respective 95% confidence intervals (95%CI). In adolescent boys, each additional hour of sleep was associated with reductions of 0.30kg/m2 in LMI (95%CI: -0.45; -0.15), 0.26kg/m2 in FMI (95%CI: -0.48; -0.03), and 0.61kg/m2 in BMI (95%CI: -0.93; -0.30). In adolescent girls, each additional hour of sleep was associated with a reduction of 0.22kg/m2 in LMI (95%CI: -0.36; -0.07). Longer duration of sleep was associated with lower LMI in both sexes and lower FMI and BMI in boys, evidencing the importance of adequate hours of sleep for improving body composition indices.

O objetivo do estudo foi avaliar a associação entre duração de sono e composição corporal em adolescentes. Estudo transversal, com 1.269 adolescentes de 18 e 19 anos da coorte de nascimentos de 1997/1998 de São Luís, Maranhão, Brasil. A duração do sono foi avaliada a partir dos dados registrados por acelerometria. A composição corporal foi avaliada pelo o índice de massa gorda (IMG), índice de massa muscular (IMM) e índice de massa corporal (IMC). Os fatores de confusão foram identificados em gráfico acíclico direcionado no programa DAGitty 3.0. Foram realizadas análises descritivas para todas as variáveis e, posteriormente, regressão linear, com estimativa dos coeficientes de regressão brutos e ajustados, com os respectivos intervalos de 95% de confiança (IC95%). Nos adolescentes do sexo masculino, cada hora a mais de sono associou-se a reduções de 0,30kg/m2 do IMM (IC95%: -0,45; -0,15), de 0,26kg/m2 do IMG (IC95%: -0,48; -0,03) e 0,61kg/m2 do IMC (IC95%: -0,93; -0,30). Nas adolescentes, cada hora a mais de sono associou-se à redução de 0,22kg/m2 do IMM (IC95%: -0,36; -0,07). A maior duração do sono associou-se a menor IMM em ambos os sexos e menor IMG e IMC no sexo masculino, o que evidencia a importância de ter adequadas horas de sono para melhorar os índices de composição corporal.

El objetivo fue evaluar la asociación entre duración del sueño y composición corporal en adolescentes. Estudio transversal, con 1.269 adolescentes de 18 y 19 años de la cohorte de nacimientos de 1997/1998 de São Luís, Maranhão, Brasil. La duración del sueño se evaluó a partir de los datos registrados por acelerometría. La composición corporal se evaluó por el índice de masa grasa (IMG), índice de masa muscular (IMM) e índice de masa corporal (IMC). Los factores de confusión se identificaron en un gráfico acíclico dirigido en el programa DAGitty 3.0. Se realizaron análisis descriptivos para todas las variables y, posteriormente, regresión lineal, con estimación de los coeficientes de regresión brutos y ajustados, con los respectivos intervalos de 95% de confianza (IC95%). En los adolescentes del sexo masculino, cada hora más de sueño se asoció con reducciones de 0,30kg/m2 del IMM (IC95%: -0,45; -0,15), de 0,26kg/m2 del IMG (IC95%: -0,48; -0,03) y 0,61kg/m2 del IMC (IC95%: -0,93; -0,30). En las adolescentes, cada hora más de sueño se asoció a la reducción de 0,22kg/m2 del IMM (IC95%: -0,36; -0,07). La mayor duración del sueño se asoció a un menor IMM en ambos sexos y menor IMG e IMC en el sexo masculino, lo que evidencia la importancia de tener adecuadas horas de sueño para mejorar los índices de composición corporal.

Associações entre duração de sono e índices de massa gorda, muscular e corporal em adolescentes de São Luís, Maranhão, Brasil / Associations between sleep duration and fat mass, lean mass, and body mass index in adolescents in São Luís, Maranhão State, Brazil / Asociaciones entre duración del sueño e índices de masa grasa, muscular y corporal en adolescentes de São Luís, Maranhão, Brasil

O objetivo do estudo foi avaliar a associação entre duração de sono e composição corporal em adolescentes. Estudo transversal, com 1.269 adolescentes de 18 e 19 anos da coorte de nascimentos de 1997/1998 de São Luís, Maranhão, Brasil. A duração do sono foi avaliada a partir dos dados registrados por acelerometria. A composição corporal foi avaliada pelo o índice de massa gorda (IMG), índice de massa muscular (IMM) e índice de massa corporal (IMC). Os fatores de confusão foram identificados em gráfico acíclico direcionado no programa DAGitty 3.0. Foram realizadas análises descritivas para todas as variáveis e, posteriormente, regressão linear, com estimativa dos coeficientes de regressão brutos e ajustados, com os respectivos intervalos de 95% de confiança (IC95%). Nos adolescentes do sexo masculino, cada hora a mais de sono associou-se a reduções de 0,30kg/m2 do IMM (IC95%: -0,45; -0,15), de 0,26kg/m2 do IMG (IC95%: -0,48; -0,03) e 0,61kg/m2 do IMC (IC95%: -0,93; -0,30). Nas adolescentes, cada hora a mais de sono associou-se à redução de 0,22kg/m2 do IMM (IC95%: -0,36; -0,07). A maior duração do sono associou-se a menor IMM em ambos os sexos e menor IMG e IMC no sexo masculino, o que evidencia a importância de ter adequadas horas de sono para melhorar os índices de composição corporal.

The study aimed to assess the association between sleep duration and body composition in adolescents. A cross-sectional study was performed with 1,269 adolescents from the 1997/1998 birth cohort in São Luís, Maranhão State, Brazil, 18 and 19 years of age. Sleep duration was assessed with accelerometry data. Body composition was assessed with fat mass index (FMI), lean mass index (LMI), and body mass index (BMI). Confounding factors were identified in a directed acyclic graph in DAGitty 3.0. Descriptive analyses were performed for all variables, followed by linear regression, with estimation of crude and adjusted regression coefficient with respective 95% confidence intervals (95%CI). In adolescent boys, each additional hour of sleep was associated with reductions of 0.30kg/m2 in LMI (95%CI: -0.45; -0.15), 0.26kg/m2 in FMI (95%CI: -0.48; -0.03), and 0.61kg/m2 in BMI (95%CI: -0.93; -0.30). In adolescent girls, each additional hour of sleep was associated with a reduction of 0.22kg/m2 in LMI (95%CI: -0.36; -0.07). Longer duration of sleep was associated with lower LMI in both sexes and lower FMI and BMI in boys, evidencing the importance of adequate hours of sleep for improving body composition indices.

El objetivo fue evaluar la asociación entre duración del sueño y composición corporal en adolescentes. Estudio transversal, con 1.269 adolescentes de 18 y 19 años de la cohorte de nacimientos de 1997/1998 de São Luís, Maranhão, Brasil. La duración del sueño se evaluó a partir de los datos registrados por acelerometría. La composición corporal se evaluó por el índice de masa grasa (IMG), índice de masa muscular (IMM) e índice de masa corporal (IMC). Los factores de confusión se identificaron en un gráfico acíclico dirigido en el programa DAGitty 3.0. Se realizaron análisis descriptivos para todas las variables y, posteriormente, regresión lineal, con estimación de los coeficientes de regresión brutos y ajustados, con los respectivos intervalos de 95% de confianza (IC95%). En los adolescentes del sexo masculino, cada hora más de sueño se asoció con reducciones de 0,30kg/m2 del IMM (IC95%: -0,45; -0,15), de 0,26kg/m2 del IMG (IC95%: -0,48; -0,03) y 0,61kg/m2 del IMC (IC95%: -0,93; -0,30). En las adolescentes, cada hora más de sueño se asoció a la reducción de 0,22kg/m2 del IMM (IC95%: -0,36; -0,07). La mayor duración del sueño se asoció a un menor IMM en ambos sexos y menor IMG e IMC en el sexo masculino, lo que evidencia la importancia de tener adecuadas horas de sueño para mejorar los índices de composición corporal.

[Sociodemographic, dietary, and lifestyle factors associated with increased body fat in adolescents of São Luís, Maranhão State, Brazil]. / Fatores sociodemográficos, alimentares e hábitos de vida associados à maior adiposidade corporal em adolescentes de São Luís, Maranhão, Brasil.

The study aimed to verify factors associated with increased body fat in adolescents. This was a cross-sectional study in which the data source was a birth cohort launched in São Luís, Maranhão State, Brazil, in 1997/1998 and revisited in 2016. Body fat was measured with air displacement plethysmography. Sociodemographic, lifestyle, and dietary variables were included as possible factors associated with elevated body fat, stratified by sex. Body fat was considered elevated when ≥ 25% for males and ≥ 30% for females. The highest prevalence rates of high body fat were associated with female gender and age 19 years (PR = 1.17; 95%CI: 1.02-1.35), alcohol consumption (PR = 1.14; 95%CI: 1.00-1.30), and never eating breakfast (PR = 1.46; 95%CI: 1.17-1.81) or lunch (PR = 1.51; 95%CI: 1.18-1.93). Male adolescents with the highest prevalence of high body fat were physically active (PR = 1.49; 95%CI: 1.07-2.09). Lower prevalence of high body fat was found in male adolescents belonging to economic class D/E (PR = 0.38; 95%CI: 0.16-0.90). In conclusion, female adolescents 19 years of age that consumed alcohol and that did not eat breakfast or lunch had higher body fat, as did physically active male adolescents. Meanwhile, male adolescents in socioeconomic class D/E had less body fat.

O objetivo do estudo foi verificar os fatores associados à elevada adiposidade corporal em adolescentes. Trata-se de um estudo transversal tendo como fonte de dados uma coorte de nascimentos iniciada em São Luís, Maranhão, Brasil, em 1997/1998 e reentrevistada em 2016. A adiposidade corporal foi mensurada por meio de pletismografia por deslocamento de ar. Variáveis sociodemográficas, hábitos de vida e alimentares foram incluídos como possíveis fatores associados à elevada adiposidade corporal, sendo estratificada por sexo. A adiposidade corporal foi considerada elevada quando ≥ 25% para o sexo masculino e ≥ 30% para o sexo feminino. Verificaram-se maiores prevalências de alta adiposidade corporal nas adolescentes do sexo feminino que tinham 19 anos (RP = 1,17; IC95%: 1,02-1,35), que consumiam bebida alcoólica (RP = 1,14; IC95%: 1,00-1,30), as que nunca faziam o desjejum (RP = 1,46; IC95%: 1,17-1,81) ou o almoço (RP = 1,51; IC95%: 1,18-1,93). Os adolescentes do sexo masculino que tinham maior prevalência de elevada adiposidade corporal eram ativos fisicamente (RP = 1,49; IC95%: 1,07-2,09). Menor prevalência de elevada adiposidade corporal foi encontrada nos adolescentes do sexo masculino pertencentes à classe econômica D/E (RP = 0,38; IC95%: 0,16-0,90). Conclui-se que adolescentes do sexo feminino de 19 anos, que consumiam bebida alcoólica, e as que não costumavam fazer o desjejum e o almoço tinham maior adiposidade corporal, assim como os adolescentes do sexo masculino ativos fisicamente. Enquanto adolescentes do sexo masculino pertencentes à classe socioeconômica D/E tinham menor adiposidade corporal.

El objetivo del estudio fue verificar los factores asociados a la elevada adiposidad corporal en adolescentes. Se trata de un estudio transversal, teniendo como fuente de datos una cohorte de nacimientos iniciada en São Luís, Maranhão, Brasil, en 1997/1998 y reentrevistada en 2016. La adiposidad corporal se midió mediante pletismografía por desplazamiento de aire. Las variables sociodemográficas, hábitos de vida y alimentarios fueron incluidos como posibles factores asociados a la elevada adiposidad corporal, siendo estratificada por sexo. La adiposidad corporal se consideró elevada cuando ≥ 25% para el sexo masculino y ≥ 30% para el sexo femenino. Se verificaron mayores prevalencias de alta adiposidad corporal en las adolescentes del sexo femenino que tenían 19 años (RP = 1,17; IC95%: 1,02-1,35), que consumían bebida alcohólica (RP = 1,14; IC95%: 1,00-1,30), quienes nunca tomaban el desayuno (RP = 1,46; IC95%: 1,17-1,81) o la comida (RP = 1,51; IC95%: 1,18-1,93). Los adolescentes del sexo masculino que tenían una mayor prevalencia de elevada adiposidad corporal eran activos físicamente (RP = 1,49; IC95%: 1,07-2,09). Menor prevalencia de elevada adiposidad corporal se encontró en los adolescentes del sexo masculino, pertenecientes a la clase económica D/E (RP = 0,38; IC95%: 0,16-0,90). Se concluye que las adolescentes del sexo femenino de 19 años, que consumían bebida alcohólica y las que no estaban acostumbradas a desayunar y comer tenían mayor adiposidad corporal, así como los adolescentes del sexo masculino activos físicamente. Mientras que los adolescentes del sexo masculino pertenecientes a la clase socioeconómica D/E tenían menor adiposidad corporal.

Incidence of metabolic syndrome in adults with healthy weight, normal weight obesity, and overweight/obesity.

OBJECTIVES: The aim of this study was to estimate the incidence of metabolic syndrome (MetS) in individuals with a healthy weight (HWI), normal weight obesity (NWO), or overweight/obesity (OWO). METHODS: In all, 787 adults belonging to a 1978/1979 birth cohort from Ribeirão Preto were placed into one of three groups: HWI (body mass index [BMI] ≥18.5 and <25 kg/m2 + ∑skinfolds ≤90th percentile); NWO (BMI ≥18.5 and <25 kg/m2 +∑skinfolds >90th percentile); and OWO (BMI ≥25 kg/m2 +∑skinfolds >90th percentile). Those diagnosed with MetS at the 23 to 25 y of age were excluded according to Joint Interim Statement criteria. The incidence of MetS and its components in individuals 37 to 39 y of age was evaluated by Poisson regression with robust estimation of variance, which was adjusted for family income; physical activity level; and daily intake of calories, lipids, and added sugar. RESULTS: MetS was detected in 279 adults at 37 to 39 y of age. NWO and OWO individuals showed higher risk ratios (RRs) for the development of MetS (RR,1.87; 95% confidence interval [CI], 1.36-2.57; RR, 1.61; 95% CI, 1.29-2.03), increased blood glucose levels (RR, 1.77; 95% CI, 1.12-2.79; RR, 1.51; 95% CI, 1.12-2.04), and increased waist circumferences (RR, 1.46; 95% CI, 1.32-1.61; RR, 1.50; 95% CI, 1.38-1.62). There was a higher risk for increased blood pressure (RR, 1.72; 95% CI, 1.35-2.19) among OWO individuals, but not among those with NWO. CONCLUSION: Individuals with NWO have a risk ratio for MetS similar to individuals with OWO. This demonstrates the need to assess body fat percentages, even in BMI-designated normal weight individuals, both for prevention and management of obesity.

Birth by cesarean delivery and central adiposity in adolescents from a birth cohort.

The aim of this study was to analyze the association between birth by cesarean section and central adiposity in adolescents in São Luís, Maranhão State, Brazil. This was a cohort study that included 601 participants evaluated at birth and at 18-19 years. At birth we assessed type of delivery, maternal education, family income, maternal marital status, maternal body mass index before pregnancy, prenatal care, maternal smoking habit, gestational age at delivery and intrauterine growth restriction. In the adolescents, we evaluated central adiposity using the dual X-ray energy absorptiometry method. The indicators of central fat used were the trunk-to-total fat mass ratio (T/T), the android-to-gynoid fat mass ratio (A/G), the trunk-to-limb fat mass ratio (T/Lb), and the trunk-to-leg fat mass ratio (T/Lg). A theoretical model for the study of associations was developed using directed acyclic graphs, which allowed selecting the variables that required minimum adjustment for inclusion in the predictive model of exposure to cesarean delivery. The data were analyzed with marginal structural models weighted by the inverse of the probability of selection. A total of 38.6% of the adolescents studied were delivered by cesarean section. There was no significant difference in the central adiposity of adolescents delivered by cesarean section according to the indicators used: T/T ( coefficient = -0.003; 95%CI: -0.013; 0.007), A/G (coefficient = 0.001; 95%CI: -0.015; 0.018); T/Lb (coefficient = -0.016; 95%CI: -0.048; 0.016); T/Lg (coefficient = 0.014; 95%CI: -0.060; 0.030). In conclusion, there was no association between cesarean section delivery and greater central adiposity in the studied adolescents.

Fatores sociodemográficos, alimentares e hábitos de vida associados à maior adiposidade corporal em adolescentes de São Luís, Maranhão, Brasil / Sociodemographic, dietary, and lifestyle factors associated with increased body fat in adolescents of São Luís, Maranhão State, Brazil / Factores sociodemográficos, alimentarios y hábitos de vida asociados a una mayor adiposidad corporal en adolescentes de São Luís, Maranhão, Brasil

Resumo: O objetivo do estudo foi verificar os fatores associados à elevada adiposidade corporal em adolescentes. Trata-se de um estudo transversal tendo como fonte de dados uma coorte de nascimentos iniciada em São Luís, Maranhão, Brasil, em 1997/1998 e reentrevistada em 2016. A adiposidade corporal foi mensurada por meio de pletismografia por deslocamento de ar. Variáveis sociodemográficas, hábitos de vida e alimentares foram incluídos como possíveis fatores associados à elevada adiposidade corporal, sendo estratificada por sexo. A adiposidade corporal foi considerada elevada quando ≥ 25% para o sexo masculino e ≥ 30% para o sexo feminino. Verificaram-se maiores prevalências de alta adiposidade corporal nas adolescentes do sexo feminino que tinham 19 anos (RP = 1,17; IC95%: 1,02-1,35), que consumiam bebida alcoólica (RP = 1,14; IC95%: 1,00-1,30), as que nunca faziam o desjejum (RP = 1,46; IC95%: 1,17-1,81) ou o almoço (RP = 1,51; IC95%: 1,18-1,93). Os adolescentes do sexo masculino que tinham maior prevalência de elevada adiposidade corporal eram ativos fisicamente (RP = 1,49; IC95%: 1,07-2,09). Menor prevalência de elevada adiposidade corporal foi encontrada nos adolescentes do sexo masculino pertencentes à classe econômica D/E (RP = 0,38; IC95%: 0,16-0,90). Conclui-se que adolescentes do sexo feminino de 19 anos, que consumiam bebida alcoólica, e as que não costumavam fazer o desjejum e o almoço tinham maior adiposidade corporal, assim como os adolescentes do sexo masculino ativos fisicamente. Enquanto adolescentes do sexo masculino pertencentes à classe socioeconômica D/E tinham menor adiposidade corporal.

Abstract: The study aimed to verify factors associated with increased body fat in adolescents. This was a cross-sectional study in which the data source was a birth cohort launched in São Luís, Maranhão State, Brazil, in 1997/1998 and revisited in 2016. Body fat was measured with air displacement plethysmography. Sociodemographic, lifestyle, and dietary variables were included as possible factors associated with elevated body fat, stratified by sex. Body fat was considered elevated when ≥ 25% for males and ≥ 30% for females. The highest prevalence rates of high body fat were associated with female gender and age 19 years (PR = 1.17; 95%CI: 1.02-1.35), alcohol consumption (PR = 1.14; 95%CI: 1.00-1.30), and never eating breakfast (PR = 1.46; 95%CI: 1.17-1.81) or lunch (PR = 1.51; 95%CI: 1.18-1.93). Male adolescents with the highest prevalence of high body fat were physically active (PR = 1.49; 95%CI: 1.07-2.09). Lower prevalence of high body fat was found in male adolescents belonging to economic class D/E (PR = 0.38; 95%CI: 0.16-0.90). In conclusion, female adolescents 19 years of age that consumed alcohol and that did not eat breakfast or lunch had higher body fat, as did physically active male adolescents. Meanwhile, male adolescents in socioeconomic class D/E had less body fat.

Resumo: El objetivo del estudio fue verificar los factores asociados a la elevada adiposidad corporal en adolescentes. Se trata de un estudio transversal, teniendo como fuente de datos una cohorte de nacimientos iniciada en São Luís, Maranhão, Brasil, en 1997/1998 y reentrevistada en 2016. La adiposidad corporal se midió mediante pletismografía por desplazamiento de aire. Las variables sociodemográficas, hábitos de vida y alimentarios fueron incluidos como posibles factores asociados a la elevada adiposidad corporal, siendo estratificada por sexo. La adiposidad corporal se consideró elevada cuando ≥ 25% para el sexo masculino y ≥ 30% para el sexo femenino. Se verificaron mayores prevalencias de alta adiposidad corporal en las adolescentes del sexo femenino que tenían 19 años (RP = 1,17; IC95%: 1,02-1,35), que consumían bebida alcohólica (RP = 1,14; IC95%: 1,00-1,30), quienes nunca tomaban el desayuno (RP = 1,46; IC95%: 1,17-1,81) o la comida (RP = 1,51; IC95%: 1,18-1,93). Los adolescentes del sexo masculino que tenían una mayor prevalencia de elevada adiposidad corporal eran activos físicamente (RP = 1,49; IC95%: 1,07-2,09). Menor prevalencia de elevada adiposidad corporal se encontró en los adolescentes del sexo masculino, pertenecientes a la clase económica D/E (RP = 0,38; IC95%: 0,16-0,90). Se concluye que las adolescentes del sexo femenino de 19 años, que consumían bebida alcohólica y las que no estaban acostumbradas a desayunar y comer tenían mayor adiposidad corporal, así como los adolescentes del sexo masculino activos físicamente. Mientras que los adolescentes del sexo masculino pertenecientes a la clase socioeconómica D/E tenían menor adiposidad corporal.

Birth by cesarean delivery and central adiposity in adolescents from a birth cohort / Nascimento por parto cesáreo e adiposidade central em adolescentes de uma coorte de nascimentos / Nacimiento por parto con cesárea y adiposidad central en adolescentes de una cohorte de nacimientos

Abstract: The aim of this study was to analyze the association between birth by cesarean section and central adiposity in adolescents in São Luís, Maranhão State, Brazil. This was a cohort study that included 601 participants evaluated at birth and at 18-19 years. At birth we assessed type of delivery, maternal education, family income, maternal marital status, maternal body mass index before pregnancy, prenatal care, maternal smoking habit, gestational age at delivery and intrauterine growth restriction. In the adolescents, we evaluated central adiposity using the dual X-ray energy absorptiometry method. The indicators of central fat used were the trunk-to-total fat mass ratio (T/T), the android-to-gynoid fat mass ratio (A/G), the trunk-to-limb fat mass ratio (T/Lb), and the trunk-to-leg fat mass ratio (T/Lg). A theoretical model for the study of associations was developed using directed acyclic graphs, which allowed selecting the variables that required minimum adjustment for inclusion in the predictive model of exposure to cesarean delivery. The data were analyzed with marginal structural models weighted by the inverse of the probability of selection. A total of 38.6% of the adolescents studied were delivered by cesarean section. There was no significant difference in the central adiposity of adolescents delivered by cesarean section according to the indicators used: T/T ( coefficient = -0.003; 95%CI: -0.013; 0.007), A/G (coefficient = 0.001; 95%CI: -0.015; 0.018); T/Lb (coefficient = -0.016; 95%CI: -0.048; 0.016); T/Lg (coefficient = 0.014; 95%CI: -0.060; 0.030). In conclusion, there was no association between cesarean section delivery and greater central adiposity in the studied adolescents.

Resumo: O estudo teve como objetivo analisar a associação entre nascimento por parto cesáreo e adiposidade central em adolescentes em São Luís, Maranhão, Brasil. O estudo de coorte incluiu 601 participantes avaliados ao nascer e com 18-19 anos de idade. Ao nascer, foram avaliados o tipo de parto, escolaridade materna, renda familiar, estado civil materno, índice de massa corporal pré-gestacional, atendimento pré-natal, tabagismo materno, idade gestacional ao nascer e restrição do crescimento intrauterino. Nos adolescentes, a adiposidade central foi avaliada com o método da absorciometria de raios-X de dupla energia. Como indicadores da adiposidade central, foram usadas a razão gordura tronco/gordura total (T/T), razão gordura androide/gordura ginecoide (A/G), razão gordura tronco/gordura membros (T/Lb) e razão gordura tronco/gordura membros inferiores (T/Lg). Foi desenvolvido um modelo teórico para analisar as associações, usando gráficos acíclicos dirigidos, permitindo a seleção das variáveis que exigiam ajuste mínimo para inclusão no modelo preditivo de exposição ao parto cesáreo. Os dados foram analisados com modelos estruturais marginais, ponderados pelo inverso da probabilidade de seleção. Entre os adolescentes estudados, 38,6% nasceram de parto cesáreo. Não houve diferença significativa na adiposidade central nos adolescentes nascidos de parto cesáreo, de acordo com os indicadores utilizados: T/T (coeficiente = -0,003; IC95%: -0,013; 0,007), A/G (coeficiente = 0,001; IC95%: -0,015; 0,018); T/Lb (coeficiente = -0,016; IC95%: -0,048; 0,016); T/Lg (coeficiente = 0,014; IC95%: -0,060; 0,030), O estudo conclui que não havia associação entre história de parto cesáreo e aumento de adiposidade central nesse grupo de adolescentes.

Resumen: El objetivo de esta investigación fue estudiar la asociación entre el nacimiento por parto con cesárea y la adiposidad central en adolescentes en São Luís, Maranhão, Brasil. La cohorte de estudio incluyó a 601 participantes evaluados en su nacimiento y con 18-19 años de edad. En el momento del nacimiento se evaluó el tipo de parto, educación de la madre, ingresos familiares, estado civil de la madre, índice de masa corporal de la madre, cuidado prenatal, madre fumadora, edad gestacional en el parto y restricción del crecimiento intrauterino. En los adolescentes, la grasa central se evaluó usando el método de absorciometría con rayos X de energía dual. Los indicadores de grasa central utilizados fueron: el cociente de torso-grasa total (T/T por sus siglas en inglés), el de androide/ginecoide de grasa corporal (A/G), el cociente de masa adiposa torso-extremidades (T/Lb por sus siglas en inglés), y el cociente de masa adiposa torso-pierna (T/Lg por sus siglas en inglés). Se desarrolló un modelo teórico para el estudio de asociaciones, usando grafos acíclicos dirigidos, lo que permitió seleccionar las variables que requerían un mínimo ajuste para su inclusión en el modelo predictivo de exposición al parto por cesárea. Los datos se analizaron con modelos estructurales marginales ponderados por el inverso de la probabilidad de selección. De los adolescentes estudiados, un 38,6% fueron partos por cesárea. No hubo una diferencia significativa en la adiposidad central de los adolescentes que nacieron por cesárea, según los indicadores usados: T/T (coeficiente = -0,003; 95%CI: -0,013; 0,007), A/G (coeficiente = 0,001; 95%CI: -0,015; 0,018); T/Lb (coeficiente = -0,016; 95%CI: -0,048; 0,016); T/Lg (coeficiente = 0,014; 95%CI: -0,060; 0,030). A modo de conclusión, no hubo asociación entre los partos por cesárea y una mayor adiposidad central en los adolescentes estudiados.

Population-based seroprevalence of SARS-CoV-2 and the herd immunity threshold in Maranhão.

OBJECTIVE: To estimate the seroprevalence of SARS-CoV-2 in the state of Maranhão, Brazil. METHODS: A population-based household survey was performed, from July 27, 2020 to August 8, 2020. The estimates considered clustering, stratification and non-response. Qualitative detection of IgM and IgG antibodies was performed in a fully-automated Elecsys® Anti-SARS-CoV-2 electrochemiluminescence immunoassay on the Cobas® e601 analyzer (Roche Diagnostics). RESULTS: In total, 3,156 individuals were interviewed. Seroprevalence of total antibodies against SARS-CoV-2 was 40.4% (95%CI 35.6-45.3). Population adherence to non-pharmaceutical interventions was higher at the beginning of the pandemic than in the last month. SARS-CoV-2 infection rates were significantly lower among mask wearers and among those who maintained social and physical distancing in the last month compared to their counterparts. Among the infected, 26.0% were asymptomatic. The infection fatality rate (IFR) was 0.14%, higher for men and older adults. The IFR based on excess deaths was 0.28%. The ratio of estimated infections to reported cases was 22.2. CONCLUSIONS: To the best of our knowledge, the seroprevalence of SARS-CoV-2 estimated in this population-based survey is one of the highest reported. The local herd immunity threshold may have been reached or might be reached soon.

High consumption of ultra-processed foods is associated with lower muscle mass in Brazilian adolescents in the RPS birth cohort.

OBJECTIVE: The aim of this study was to investigate the association between percent contribution of ultra-processed foods to total dietary energy intake and measurements of body composition obtained using high-validity methods. METHODS: This was a cross-sectional study with 1525 adolescents 18 to 19 y of age from the second follow-up of the 1997/98 São Luís birth cohort, Brazil. To evaluate nutritional status and body composition, the body mass index (BMI)-for-age was used, along with waist circumference, total and android body fat percentage, muscle mass, and the lean mass index (LMI). Food consumption was evaluated by a food frequency questionnaire. Food items were grouped according to the level of processing as per the NOVA classification. Through semi-structured questionnaires, sociodemographic and lifestyle data were abstracted. Adjusted linear regression models were used to evaluate the associations between consumption of ultra-processed foods and body composition measurements. RESULTS: Total average energy consumption was 2919.7 kcal, with 58% (1634.9 kcal) derived from natural or minimally processed foods and 37% (1136.5 kcal) from ultra-processed products. In the adjusted analyses, BMI, muscle mass, and LMI were inversely associated with consumption of ultra-processed foods. A 1% increase in the percent contribution of ultra-processed items to total dietary energy intake was associated with a 0.04 kg decrease in muscle mass (ß = -0.04; 95% confidence interval [CI], -0.06 to -0.02; P < 0.001) and a 0.01 kg/m2 decrease in lean body mass (ß = -0.01; 95% CI, -0.02 to -0.01; P < 0.001). CONCLUSION: The contribution of ultra-processed foods to total dietary energy intake of Brazilian adolescents was associated with body composition, especially with decreasing lean body mass.

Diagnostic performance of body mass index in detection of obesity using different cutoff points for excess body fat.

OBJECTIVES: The aim of this study was to assess the diagnostic sensitivity of body mass index (BMI) in detecting obesity according to different cutoff points in order to classify a high body fat percentage (%BF) in adolescents and young adults. METHODS: This was a cross-sectional study conducted with 2447 adolescents 18 and 19 y of age residing in São Luís, Brazil and 951 young adults 21 to 23 y of age residing in Ribeirão Preto, Brazil. Three references were used to define a high %BF (i.e., those of Williams et al., Ramírez-Vélez et al., and Macias et al.). The area under the receiver operating characteristic area under the curve (AUC) was used to assess the performance of BMI. RESULTS: Sensitivity ranged from 38.3% to 54.1% among boys and from 12.7% to 72.7% among girls. Among young adults, it ranged from 52.3% to 67.1% in men and from 33.7% to 86.6% in women. The AUC ranged from 0.69 to 0.76 among boys, from 0.56 from 0.85 among girls, from 0.75 to 0.80 among men, and from 0.67 to 0.88 among women. The best cutoff points for the BMI were 24.79 to 25.10 kg/m2 for boys, 21.89 to 27.04 kg/m2 for girls, 26.43 to 28.22 kg/m2 for men, and 23.34 to 29.28 kg/m2 for women. CONCLUSION: The use of different references for the classification of a high %BF implied a difference in the diagnostic sensitivity of the BMI. Higher cutoff points resulted in greater sensitivity and ability to differentiate individuals with and without obesity.