Trends in the prevalence of obesity, overweight, and thinness among schoolchildren aged 7-14 years from southern Brazil (2002-2019).

OBJECTIVE: To analyze the obesity, overweight, and thinness trends among Brazilian schoolchildren by sex, age group, and type of school according to World Health Organization (WHO) and International Obesity Task Force (IOTF) criteria. METHODS: We conducted four surveys between 2002 and 2018/19 involving schoolchildren aged 7-14 years from a state capital in southern Brazil. Weight status was classified using both WHO and IOTF criteria. RESULTS: In the total sample, obesity prevalence based on the IOTF and the WHO criteria were 72% and 44% higher in 2018/19 compared with 2002, respectively. Over the whole period, the obesity prevalence increased among children (WHO: 10.1% vs. 14.1%; IOTF: 5.0% vs. 8.3%), and those from public schools (WHO: 10.5% vs. 16.4%; IOTF: 5.6% vs. 10.1%). There was no significant reduction in thinness prevalence over the analyzed period. CONCLUSION: Obesity prevalence remains on an upward trend in a state capital in southern Brazil, especially among children from public schools. A higher prevalence of overweight and obesity was observed using the WHO criteria compared with IOTF criteria.

The effect of oral dietary interventions on nutritional status and treatment tolerance in patients with hematologic neoplasms receiving chemotherapy: a systematic review.

CONTEXT: Adverse events from chemotherapy treatment affect food intake, nutritional status, and treatment tolerance in cancer patients. However, the effect of nutritional intervention in patients with hematologic neoplasms receiving chemotherapy remains unknown. OBJECTIVE: The aim of this systematic review was to evaluate the evidence on nutritional interventions on nutritional status, treatment tolerance, inflammatory markers, quality of life, and mortality in patients with hematologic neoplasms receiving chemotherapy. DATA SOURCES: The MEDLINE, LILACS, CINAHL, Web of Science, Embase, ICTRP, CENTRAL, and ClinicalTrials.gov databases were searched. Additional literature and the bibliographies of identified articles were also considered. DATA EXTRACTION: Randomized controlled trials in individuals with hematologic neoplasms receiving chemotherapy along with nutritional counseling and oral nutritional supplementation, and intake of supplementary food products, alone or in combination, were assessed as criteria of interest. The data were extracted independently by 2 researchers. The risk of bias was assessed through the Cochrane risk-of-bias tool (RoB 2). DATA ANALYSIS: Ten studies were included up to August 15, 2022 (updated in November of 2022). With regard to the outcomes, 4 studies assessed nutritional status and 2 studies showed a positive result of the intervention on some of the markers. Seven studies assessed certain markers of treatment tolerance and only 2 studies showed improvement in the outcome after the intervention. CONCLUSION: The studies that found positive results are quite different from each other in terms of intervention, study time, and design. More randomized controlled trials are needed to test different dietary interventions using placebo and blinding, when possible, and with reduced sample variability in individuals with hematologic neoplasms receiving chemotherapy. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42020196765.

Association between Sleep Timing, Being Overweight and Meal and Snack Consumption in Children and Adolescents in Southern Brazil.

Sleep timing is one of the dimensions of sleep that refers to the time of day when sleep occurs. It has been included in sleep-related research because of the potential associations between being overweight and the consumption of meals and snacks. This cross-sectional study aimed to investigate associations between sleep timing, meal and snack consumption and weight status in 1333 schoolchildren aged 7-14 years. The midpoint of sleep was used as a sleep timing measure obtained by the midpoint between bedtime and wake-up time, classified as Early, Intermediate, and Late. Schoolchildren in the Early group were less likely to be overweight (OR: 0.83, 95% CI 0.69; 0.99), and had higher odds of mid-morning snack consumption (OR: 1.95, 95% CI 1.56; 2.44) and lower probability to consume an evening snack (OR: 0.75, 95% CI 0.59; 0.94) compared with the Intermediate group. The Late group had lower odds of mid-morning snack consumption (OR: 0.67, 95% CI 0.55, 0.80) than the Intermediate group. The consumption of mid-morning and evening snacks was associated with the Early and Late midpoints of sleep. These results suggest that bedtime and wake-up time are relevant to consuming meals and snacks and may also be related to a greater probability of being overweight in children and adolescents.

How Brazilian Schoolchildren Identify, Classify, and Label Foods and Beverages-A Card Sorting Methodology.

This study examined how Brazilian schoolchildren identified, classified, and labeled foods and beverages. Semi-structured interviews were conducted with 133 schoolchildren aged 7 to 10 years old from a public school located in southern Brazil in 2015. A set of cards with pictures of 32 food and beverage items from the web-based Food Intake and Physical Activity of Schoolchildren tool (Web-CAAFE) were used. Participants identified each item, formed groups for them based on similarity, and assigned labels for those groups. Student's t-tests and analysis of variance (ANOVA) tests were used to verify the mean difference between the groups of items. K-means cluster analysis was applied to identify similar clusters. Schoolchildren made an average of 9.1 piles of foods and beverages that they thought were similar (±2.4) with 3.0 cards (±1.8) each. Five groups were identified: meats, snacks and pasta, sweets, milk and dairy products, and fruits and vegetables. The most frequently used nomenclature for labeling groups was taxonomic-professional (47.4%), followed by the specific food item name (16.4%), do not know/not sure (13.3%), and evaluative (health perception) (8.8%). The taxonomic-professional category could be applied to promote improvements in the identification process of food and beverage items by children in self-reported computerized dietary questionnaires.

Methodological aspects and characteristics of participants in the study on the prevalence of obesity in children and adolescents in Florianópolis, Southern Brazil, 2018-2019: EPOCA study.

PURPOSE: To describe the methodological aspects and characteristics of the participants of the EPOCA survey. METHODS: The study was conducted with schoolchildren aged between seven to 14 years old from 30 schools in Florianópolis, Southern Brazil. Body mass, height, girths, and skinfold thicknesses were measured. Food consumption and physical activity from the previous day were self-reported using the validated Web-CAAFE questionnaire. Adolescents completed a specific questionnaire about physical activity, meal consumption, and weight control behaviors. Parents/guardians responded to a sociodemographic and habits questionnaire. RESULTS: A total of 1671 schoolchildren participated in the study (response rate: 27.2%). About 63% of schoolchildren were enrolled in public schools. Most studied in the morning shift (54.2%), were female (53.1%) and aged between seven and 10 years (58.1%). The prevalence of overweight was 33.7% and obesity was 11.3%. CONCLUSIONS: The data obtained will allow us to assess the trend in the prevalence of overweight and obesity and associated factors when compared to other surveys performed. Descriptions of the logistics and protocols can help in the development and improvement of similar studies. It is hoped that the results of EPOCA 2018/2019 may help in the design of obesity prevention policies and programs for this population.

Is breakfast consumption among Brazilian schoolchildren associated with an ultra-processed food dietary pattern?

Omission of breakfast starts at school age and can be explained as a reflection of the independent behaviour acquired in this phase of life. Breakfast has been investigated for its association with healthier diet quality, but few studies have investigated this relationship in schoolchildren aged 7 to 13 years. The objective of this study was to assess breakfast consumption in schoolchildren aged 7 to 13 years and to examine associations with dietary patterns (DPs). It was a cross-sectional study carried out in 2017 with 1069 students in Florianopolis, southern Brazil. Previous-day food consumption, physical activity and screen activities were self-reported. Factor analysis was used to identify DPs. Associations between breakfast consumption and overall DPs were evaluated using multivariate linear regression. Breakfast consumption was reported by 85% of the children, with the highest proportion observed among students on the afternoon school shift. Five DPs were identified explaining 41% of the total variance in daily food consumption: Ultra-processed, Mixed, Traditional Brazilian Lunch, Healthy + Sweets and Traditional Brazilian Breakfast. Breakfast consumption was directly associated with a Traditional Brazilian Breakfast DP (ß = 0.335; 95% CI = 0.227, 0.442), a Mixed DP (ß = 0.241; 95% CI = 0.160, 0.323), and a Healthy + Sweets DP (ß = 0.160; 95% CI = 0.061, 0.260), and inversely associated with an Ultra-processed DP (ß = -0.116; 95% CI = -0.207, -0.026). Breakfast consumption was associated with overall DPs, suggesting the importance of eating this meal by schoolchildren. We emphasise the relevance of offering a healthy breakfast at public schools for students who do not take this meal at home, contributing to health promotion.

Most meal and snack patterns are stable over a 3-year period in schoolchildren in southern Brazil.

This study aimed to identify meal and snack patterns in Brazilian schoolchildren and assess their stability over 3 years. This is a repeated cross-sectional study carried out in 2013, 2014 and 2015 with 6353 schoolchildren aged 7-12 years from public schools in Florianópolis, Brazil. Previous-day food consumption data for six pre-defined meals (breakfast, mid-morning snack, lunch, mid-afternoon snack, dinner and evening snack) were collected using the validated Web-CAAFE (Food Consumption and Physical Activity of Schoolchildren) questionnaire. Latent class analysis was performed to derive meal and snack patterns. The stability of patterns was analysed using multinomial logistic regression, and the probability of belonging to a meal pattern was calculated for each year. Three patterns were identified for breakfast and four patterns for a mid-morning snack, lunch, mid-afternoon snack, dinner and evening snack. Most meal and snack patterns were stable over the 3-year evaluation period. In the total sample, for a mid-afternoon snack, there was an increase in the probability of the children belonging to the 'Fruits and porridge' pattern (14.5%, 95% CI 12%-17% in 2015 vs. 9.2%, 95% CI 6.8%-11.7% in 2013) and a reduction in the 'Ultra-processed' pattern (42.5%, 95% CI 39.4%-45.6% in 2015 vs. 51.3%, 95% CI 46.5%-56.1% in 2013). These results appear to be in line with the recommendations of the Brazilian Dietary Guidelines and regional policies to increase the intake of healthy foods and limit that of ultra-processed, high fat, sugar and salt foods.

Age at menarche and its association with overweight including obesity and socio-economic conditions of Brazilian schoolgirls: A time-trend analysis.

This study aims to describe the time trend of age at menarche in Brazilian schoolgirls evaluated in 2007, 2012/2013 and 2018/2019, and to assess its association with having overweight, including obesity and socio-economic conditions. Three cross-sectional studies were carried out in 2007, 2012/2013 and 2018/2019 in schoolchildren enrolled between the second and ninth years of elementary school and comprising 838, 688 and 326 schoolgirls, respectively. Body mass index Z scores were calculated and categorised as either without overweight or with overweight (including obesity). The type of school (a proxy of socio-economic condition) was categorised as either public or private. Menarche data were collected using the status quo and recall methods. The mean age at menarche was estimated by survival analysis. Differences in age at menarche according to the year of survey, weight status and type of school were verified by the Log-Rank test and Cox's univariate and multiple regression. There was an increase in the prevalence of overweight in girls throughout the surveys, with 21.4% in 2007, 27.2% in 2012 and 28.5% in 2018 (p = 0.007) having overweight. There was a decrease in the mean age at menarche between 2007 and 2018/2019 (12.3 vs. 11.9 years, respectively). The mean age at menarche in girls with overweight was lower in the three time periods when compared to girls without overweight (11.9, 11.8 and 11.5 vs. 12.4, 12.4 and 12.1, respectively). Girls with overweight were more likely to have had earlier age at menarche than girls without overweight (Hazard Ratio 1.57; 95% CI 1.36; 1.80). There were no differences in the age at menarche according to the type of school. The increase in the prevalence of girls with overweight (including obesity) may be associated with the age at menarche. Girls with overweight had a higher risk of earlier age at menarche than girls without overweight.

Association between lifestyle patterns and overweight and obesity in adolescents: a systematic review.

The purpose of this systematic review was to summarize the evidence from observational studies regarding the association between lifestyle patterns and overweight and obesity in adolescents. To our knowledge, no review study has analyzed this association in this age group. A systematic search was conducted in LILACS, Scopus, PubMed Central, and Web of Science databases, with no language or time restrictions. Studies that included adolescents (10-19 years old) were selected using data-driven methods that combined the diet domain with at least one of the following behavioral domains: physical activity, sedentary behavior, and sleep. Twenty-one articles met all eligibility criteria. Of these, 12 studies were used for synthesizing the results. Studies differed in many aspects, such as sample size, behavioral assessment tools, and lifestyle pattern and weight status indicators. Overall, cross-sectional studies found no association between lifestyle patterns and overweight and obesity, even when the data were stratified by sex. However, when analyzing the results stratified by risk of bias, a positive association between predominantly unhealthy and mixed lifestyle patterns with overweight/obesity was identified in cross-sectional studies with moderate risk of bias. A prospective study revealed an increase in body mass index over time associated with mixed and predominantly unhealthy lifestyle patterns. Current findings regarding the association between lifestyle patterns and overweight and obesity in adolescents are inconsistent. More studies are needed to clarify possible associations.

Meal and snack patterns of 7-13-year-old schoolchildren in southern Brazil.

OBJECTIVE: The aim of the current study was to identify and describe the meal and snack patterns (breakfast, mid-morning snack, lunch, mid-afternoon snack, dinner and evening snack) of public schoolchildren. DESIGN: Cross-sectional study. Information on the previous day's food intake was obtained through the Web-CAAFE (Food Intake and Physical Activity of Schoolchildren), an interactive questionnaire, which divides daily food consumption into three meals (breakfast, lunch and dinner) and three snacks (mid-morning, mid-afternoon and evening). Each meal contains thirty-one food items and the schoolchildren clicked on the food items consumed in each meal. Factor analysis was used to identify meal and snack patterns. The descriptions of the dietary patterns (DP) were based on food items with factor loads ≥ 0·30 that were considered representative of each DP. SETTING: Schoolchildren, Florianopolis, Brazil. PARTICIPANTS: Children (n 1074) aged 7-13 years. RESULTS: Lunch was the most consumed meal (96·0 %), followed by dinner (86·4 %), breakfast (85·3 %) and mid-afternoon snack (81·7 %). Four DP were identified for breakfast, mid-morning snack, lunch, dinner and evening snack, and three for mid-afternoon snack. Breakfast, lunch and dinner patterns included traditional Brazilian foods. DP consisting of fast foods and sugary beverages were also observed, mainly for the evening snack. CONCLUSIONS: The results of the current study provide important information regarding the meal and snack patterns of schoolchildren to guide the development of nutrition interventions in public health.

Association between sleep period time and dietary patterns in Brazilian schoolchildren aged 7-13 years.

OBJECTIVES: To assess the association between sleep period time and dietary patterns (DPs) in Brazilian schoolchildren aged 7-13 years. METHODS: Sleep data of 1019 children were obtained from a questionnaire completed by parents/guardians. Food consumption, physical activity, and screen-based activity were assessed through the validated Web-CAAFE questionnaire. Latent profile analysis was used to identify dietary patterns. Associations between sleep period time and dietary patterns were analyzed by multinomial logistic regression, and the average marginal effect of sleep period time on the probability of adherence to dietary patterns was determined. RESULTS: Overall, 11.4% of children had inadequate sleep period time (<9 h per day). Three mutually exclusive dietary patterns were identified: "Monotonous" characterized by high consumption of pasta, instant pasta, sweets, and hamburgers/hot dog/pizza/salty snacks; "Traditional" characterized by high consumption of rice, vegetables, green leaves, beans, manioc flour, maize/potatoes, and meats; and "Dairy, bread, green leaves, maize/potatoes and sausage". The likelihood of adherence to the "Dairy, bread, green leaves, maize/potatoes and sausages" DP decreased by 0.026 as sleep period time increased by 1 h per day. For a sleep period time of more than 10 h per day, the average marginal effect of sleep period time on the likelihood of adherence to the this dietary pattern was significant and negative. CONCLUSIONS: Sleep period time was inversely associated with adherence to the "Dairy, bread, green leaves, maize/potatoes and sausages" DP; children who slept more than 10 h per day were less likely to present this pattern.

Effect of the day and the number of days of application on reproducibility of a questionnaire to assess the food intake in schoolchildren. / Efeito do dia e do número de dias de aplicação na reprodutibilidade de um questionário de avaliação do consumo alimentar de escolares.

INTRODUCTION: The Food Intake and Physical Activity of School Children (Web-CAAFE) is an online questionnaire developed to monitor the diet and physical activity of Brazilian schoolchildren. The study aimed to evaluate the effect of the day of the week and the number of applications on Web-CAAFE reproducibility. METHODS: Schoolchildren in grades 2 to 5 of two municipal schools in Florianópolis (n = 197) filled out the Web-CAAFE twice in the same day, of which 113 filled out the instrument in three non-consecutive days. The analysis was performed using the intraclass correlation (ICC) and logistic regression was used to evaluate the factors associated with poor reproducibility. RESULTS: The reproducibility of the questionnaire was significantly lower for children who filled out their consumption mostly on weekends in relation to weekdays (OR = 2.93; p = 0.045), and was significantly better in girls in relation to boys (OR = 0.29; p< 0.001). Higher CCI was observed on the second and third day of Web-CAAFE application in relation to the first day. These results are relevant for planning future studies that use dietary assessment instruments in children, especially on evaluation of their validity and reproducibility. CONCLUSIONS: The results suggest that at least two days provides acceptable reproducibility results of the Web-CAAFE and that the weekend recall may reduce the reproducibility.

Efeito do dia e do número de dias de aplicação na reprodutibilidade de um questionário de avaliação do consumo alimentar de escolares / Effect of the day and the number of days of application on reproducibility of a questionnaire to assess the food intake in schoolchildren

RESUMO: Introdução: O questionário de Consumo Alimentar e Atividade Física de Escolares (Web-CAAFE) foi desenvolvido para o monitoramento da dieta e atividade física de escolares brasileiros. Este estudo buscou avaliar o efeito do dia da semana e do número de aplicações na reprodutibilidade do Web-CAAFE. Metodologia: Escolares do 2º ao 5º ano (n = 197) de Florianópolis preencheram o Web-CAAFE por duas vezes no mesmo dia, dos quais 113 o fizeram em três dias não consecutivos. Avaliou-se a reprodutibilidade por meio da correlação intraclasse (CCI) e da regressão logística, para avaliação dos fatores associados à pior reprodutibilidade. Resultados: Observaram-se piores resultados de reprodutibilidade para o preenchimento do consumo nos finais de semana em relação àqueles que responderam em dias da semana (odds ratio - OR = 2,93; p = 0,045) e melhores resultados em meninas em relação aos meninos (OR = 0,29; p < 0,001). O preenchimento do consumo realizado nos segundo e terceiro dias apresentou melhor reprodutibilidade que o realizado no primeiro. Esses resultados são relevantes para o planejamento de futuros estudos que utilizem instrumentos de consumo alimentar em crianças, em especial sobre avaliação de sua validade e reprodutibilidade. Conclusões: Os resultados sugerem que pelo menos dois dias de aplicação do Web-CAAFE fornecem resultados aceitáveis de reprodutibilidade, e que o preenchimento referente ao fim de semana pode reduzi-la.

ABSTRACT: Introduction: The Food Intake and Physical Activity of School Children (Web-CAAFE) is an online questionnaire developed to monitor the diet and physical activity of Brazilian schoolchildren. The study aimed to evaluate the effect of the day of the week and the number of applications on Web-CAAFE reproducibility. Methods: Schoolchildren in grades 2 to 5 of two municipal schools in Florianópolis (n = 197) filled out the Web-CAAFE twice in the same day, of which 113 filled out the instrument in three non-consecutive days. The analysis was performed using the intraclass correlation (ICC) and logistic regression was used to evaluate the factors associated with poor reproducibility. Results: The reproducibility of the questionnaire was significantly lower for children who filled out their consumption mostly on weekends in relation to weekdays (OR = 2.93; p = 0.045), and was significantly better in girls in relation to boys (OR = 0.29; p< 0.001). Higher CCI was observed on the second and third day of Web-CAAFE application in relation to the first day. These results are relevant for planning future studies that use dietary assessment instruments in children, especially on evaluation of their validity and reproducibility. Conclusions: The results suggest that at least two days provides acceptable reproducibility results of the Web-CAAFE and that the weekend recall may reduce the reproducibility.

Trends in food consumption of schoolchildren from 2nd to 5th grade: a panel data analysis / Tendências no consumo alimentar de escolares do 2º ao 5º ano: uma análise de dados em painel

ABSTRACT Objective To identify trends in food consumption among schoolchildren (2nd-5th grades) from public schools in the city of Florianópolis, Brazil, in a period of three years. Methods Three cross-sectional surveys were carried out in 2013 (n=1,942), 2014 (n=1,989) and 2015 (n=2,418). Dietary intake data were obtained using the Web-Based Food Intake and Physical Activity of Schoolchildren questionnaire. Food items were aggregated to eight food groups. Kruskal-Wallis heterogeneity and trend tests were used to analyze the differences and trends among the mean intake frequency of food groups. Results There were trends to decrease the mean intake frequency of sweets in the total sample (2013: 0.72±0.91; 2014: 0.68±0.87; 2015: 0.67±0.89, p=0.03) which was determined by children between 7-9 years old (2013: 0.69±0.88; 2014: 0.64±0.85; 2015: 0.62±0.87, p=0.02), and boys (2013: 0.75±0.90; 2014: 0.70±0.86; 2015: 0.68±0.88, p=0.03). Younger children also tended to increase the mean intake frequency of fruits and vegetables (2013: 1.03±1.35; 2014: 1.16±1.45; 2015: 1.17±1.41, p=0.03) and those aged ten-12 years decreased their intake of dairy products (2013: 1.32±1.25; 2014: 1.23±1.18; 2015: 1.20±1.20, p=0.05). Conclusion The results suggest positive trends for younger children, with an increased consumption of fruits and vegetables in both sexes and decreased consumption of sweets for boys. Older children reduced their consumption of dairy products over the three-year period of this study.

RESUMO Objetivo Este estudo buscou identificar tendências no consumo alimentar de escolares do 2º ao 5º ano de escolas públicas do município de Florianópolis durante três anos. Métodos Três pesquisas transversais foram conduzidas em 2013 (n=1.942), 2014 (n=1.989) e 2015 (n=2.418). Dados de consumo alimentar foram obtidos com a aplicação do questionário de avaliação de consumo alimentar e atividade física. Os itens alimentares foram classificados em oito grupos. Utilizaram-se os testes Kruskal-Wallis de heterogeneidade e de tendência para analisar as diferenças e tendências entre as médias de frequência de consumo dos grupos alimentares. Resultados Verificou-se uma tendência de redução da média de frequência de consumo de doces para a amostra total (2013: 0,72±0,91; 2014: 0,68±0,87; 2015: 0,67±0,89, p=0,03), que foi determinada pelos escolares de 7 a 9 anos (2013: 0,69±0,88; 2014: 0,64±0,85; 2015: 0,62±0,87, p=0,02) e do sexo masculino (2013: 0,75±0,90; 2014: 0,70±0,86; 2015: 0,68±0,88, p=0,03). Escolares mais novos também tenderam a aumentar o consumo de frutas, verduras e legumes (2013: 1,03±1,35; 2014: 1,16±1,45; 2015: 1,17±1,41, p=0,03), e os de 10 a 12 anos diminuíram laticínios (2013: 1,32±1,25; 2014: 1,23±1,18; 2015: 1,20±1,20, p=0,05). Conclusão Os resultados sugerem tendências positivas para escolares mais novos, com o aumento do consumo de frutas, verduras e legumes em ambos os sexos e redução de doces para os meninos. Escolares mais velhos reduziram laticínios nos três anos de seguimento.