Could the Wheel of Cardiovascular Health Diet Be a Tool for Diet Quality in Nutritional Counseling? Comparison with Healthy Eating Index-2020.

OBJECTIVE: The Wheel of Cardiovascular Health Diet was recently elaborated based on current nutritional recommendations for healthy eating and was made for person-centered nutritional counseling, thus it may be an interesting tool to improve food awareness. However, its validity is yet to be tested. We hypothesized that the self-perception of patients diagnosed with chronic diseases, evaluated by the Wheel of Cardiovascular Health Diet, is satisfactory in assessing the quality of their diets, compared with the Healthy Eating Index-2020. METHODS: This is a cross-sectional analysis of adults with uncontrolled hypertension or type 2 diabetes. The patients answered the Wheel of Cardiovascular Health Diet, and then, based on the food frequency questionnaire, we analyzed the Healthy Eating Index-2020. RESULTS: A total of 330 patients were included in the study: 91.5% had hypertension, 58.5% had type 2 diabetes, and the median age was 58 (50-65) years. The mean difference observed between the percentage of the graphic area assessed by the patients' self-perception from the Wheel of Cardiovascular Health Diet and Healthy Eating Index-2020 was -10.0% (95%CI -35.3 to 15.3), and a moderate correlation was observed. Linear Regression models showed that a 10-point increase in patients' self-perception in the Wheel of Cardiovascular Health Diet is associated with a 2.9% increase (95%CI 2.08 to 3.70) in the diet quality by the Healthy Eating Index-2020 and is associated with lower BMI values: ß = -0.42 kg/m2 (95%CI -0.83 to -0.01). CONCLUSION: The Wheel of Cardiovascular Health Diet performed satisfactorily regarding validity and reliability by BMI and was associated with higher overall dietary quality, with the Healthy Eating Index-2020 as a relative reference.

Association of Eating Patterns and Diabetic Kidney Disease in Type 2 Diabetes: A Cross-Sectional Study.

OBJECTIVE: The aim of this cross-sectional study was to evaluate the relationship between eating patterns and diabetic kidney disease in patients with type 2 diabetes. METHODS: Outpatients underwent clinical and nutritional evaluation. Dietary information was obtained through a validated quantitative food frequency questionnaire, and eating patterns were identified by cluster analysis. Diabetic kidney disease was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 and/or persistently elevated urinary albumin concentration (albuminuria ≥ 14 mg/L). Procedures involving patients were approved by the Hospital's Ethics Committee. Patients with type 2 diabetes treated at university hospital and tertiary referral center, southern Brazil. RESULTS: A total of 329 patients were evaluated: mean age 62 ± 10 years, body mass index 30.9 ± 4.2 kg/m2, glycated hemoglobin 8.7% ± 2.0, and 10 (5 to 19) years of diabetes duration. Four eating patterns were identified based on cluster analysis: healthy= dairy products, fruits, and vegetables; snacks= dairy products, whole breads, vegetables, and low-calorie products; processed foods= refined carbohydrates and processed meat, and red meat= red meat. Poisson regression models confirmed that snack eaters (PR = 1.48, 95% CI 1.10, 1.99; P = .010) and red meat eaters (PR = 1.93, 95% CI 1.29, 2.89; P = .001) were associated with diabetic kidney disease. CONCLUSION: In this sample of outpatients with type 2 diabetes, the patterns of snacks and red meat were associated with diabetic kidney disease as compared to a healthy pattern.

Risks of dietary acrylamide exposure: a systematic review.

Acrylamide (AA) is a probable human carcinogen found in carbohydrate-rich foods that have been heated to high temperatures. AA dietary exposure has been associated to development of health problems. We perform a systematic review to elucidate the association of dietary AA exposure and human health problems. Articles were screened by reading titles and abstracts before the full text of eligible articles was read (κ=0.824). Data were harvested by two reviewers and checked by a third. Forty-one articles were analyzed and assessment of dietary exposure proved to be far from uniform and suffered from limitations that possibly impact on the validity of outcomes with relation to human health. Risk assessment of dietary acrylamide exposure is in need of high quality methods for evaluating dietary exposure and validated acrylamide content databases.

Reproducibility and validity of a quantitative FFQ designed for patients with type 2 diabetes mellitus from southern Brazil.

OBJECTIVE: To evaluate the reproducibility and validity of a previously constructed FFQ to assess the usual diet of patients with type 2 diabetes mellitus (T2DM). DESIGN: Cross-sectional survey using two quantitative FFQ (1-month interval) supported by a food photograph portfolio, a 3 d weighed diet record (WDR) and urinary N output measurement (as a biomarker of protein intake). SETTING: Group of Nutrition in Endocrinology, southern Brazil. SUBJECTS: Out-patients with T2DM. RESULTS: From a total of 104 eligible T2DM patients, eighty-eight were included in the evaluation of FFQ reproducibility and seventy-two provided data for the validity study. The intakes estimated from the two FFQ did not differ (P > 0·05) and the correlation coefficients were significant (P < 0·01) for energy and nutrients, ranging from 0·451 (soluble fibre) to 0·936 (PUFA). Regarding the validity evaluation, data from the FFQ were higher than those from the WDR for total (28·3%), soluble (27·4%) and insoluble fibres (29·1%), and SFA (13·5%), MUFA (11·1 %) and total lipids (9·2%; all P < 0·05). There were significant correlation coefficients between the FFQ and WDR for most nutrients, when adjusted for energy intake and de-attenuated. Also, the Bland-Altman plots between the FFQ and WDR for energy and macronutrient intakes showed that the FFQ may be used as alternative method to the WDR. The validity coefficient (using the method of triads) for the FFQ protein intake was 0·522 (95% CI 0·414, 0·597). CONCLUSIONS: This quantitative FFQ was valid and precise to assess the usual diet of patients with T2DM, according to its validity and reproducibility.

Development of a quantitative food frequency questionnaire for Brazilian patients with type 2 diabetes.

BACKGROUND: To investigate the association between dietary components and development of chronic diabetic complications, the dietary evaluation should include a long period, months or years. The present manuscript aims to develop a quantitative food frequency questionnaire (FFQ) and a portfolio with food photos to assess the usual intake pattern of Brazilian patients with type 2 diabetes to be used in future studies. METHODS: Dietary data using 3-day weighed diet records (WDR) from 188 outpatients with type 2 diabetes were used to construct the list of usually consumed foods. Foods were initially clustered into eight groups: "cereals, tubers, roots, and derivatives"; "vegetables and legumes"; "fruits"; "beans"; "meat and eggs"; "milk and dairy products"; "oils and fats", and "sugars and sweets". The frequency of food intake and the relative contribution of each food item to the total energy and nutrient intakes were calculated. Portion sizes were determined according to the 25th, 50th, 75th, and 95th percentiles of intake for each food item. RESULTS: A total of 62 food items were selected based on the 3-day WDR and another 27 foods or how they are prepared and nine beverages were included after the expert examination. Also, a portfolio with food photos of each included food item and portion sizes was made to assist the patients in identifying the consumed portion. CONCLUSIONS: We developed a practical quantitative FFQ and portfolio with photos of 98 food items covering those most commonly consumed in the past 12 months, to assess the usual diet pattern of patients with type 2 diabetes in Southern Brazil.

Interferência do clima no consumo de opções alimentares em uma Unidade de Alimentação e Nutrição / Influence of seasons on people's food choices in a Food and Nutrition Unit

INTRODUÇÃO: O comportamento alimentar é dividido em determinantes biológicos, socioculturais, antropológicos, econômicos, psicológicos e é também influenciado por fatores de sazonalidade dos alimentos. OBJETIVO: Avaliar a diferença nos hábitos de consumo quanto às opções de cardápios alternativos nos meses frios e quentes de uma Unidade de Alimentação e Nutrição (UAN) em Porto Alegre ­ RS. MÉTODOS: Foi realizado um estudo descritivo e quantitativo com dados secundários das opções de cardápios extras oferecidos no almoço da UAN: o prato do Chef e o Soft. Foram analisadas as diferenças de consumo no ano considerando dois meses frios (junho e julho) e dois meses quentes (outubro e novembro) em 2011. Os dados foram apresentados em frequência e porcentagem. A diferença entre os grupos foi avaliada por teste t de Student com nível de significância de 5%. RESULTADOS: Não foram encontradas diferenças de consumo do prato do Chef nos meses quentes e frios. Entretanto, houve diferença entre os meses de junho e outubro (p=0,0008). O consumo dos pratos Soft foi diferente entre os meses frios e quentes (p=0,001). A maior diferença de consumo entre eles foi constatada entre o mês de novembro e julho (p<0,0001). CONCLUSÃO: A identificação de hábitos no consumo alimentar por comensais de uma UAN em diferentes meses do ano, de acordo com as temperaturas de cada estação, é um importante instrumento de controle que permite o desenvolvimento e a avaliação geral dos cardápios a fim de proporcionar um melhor planejamento e gestão na preparação das refeições (AU)

BACKGROUND: Eating behavior is determined by biological, cultural, anthropological, economic, and psychological factors, and is also influenced by the seasonal availability of food items. AIM: To evaluate the differences, during warm and cold months, in people's consumption patterns of the alternative menus at a Food and Nutrition Unit (FNU) in Porto Alegre, RS, Brazil. METHODS: Descriptive and quantitative study using secondary data on the extra menus offered for lunch at the FNU: the "Chef" and "Soft" dishes. We compared the rates of consumptionof these dishes during two winter months (June and July) and two spring months (October and November) in 2011. Data are presented as frequency and percentage. Data were evaluated using Student's t test, with a significance level of 5%. RESULTS: There was no difference in consumption of the "Chef" dish either between the winter months or between the spring months. However, there was a difference in consumption between June and October (p = 0.0008). Consumption of the "Soft" dish was different between June and July, as well as between October and November (p = 0.001). The greatest difference in consumption of this dish was between November and July (p<0.0001). CONCLUSION: Identifying seasonal patterns of food consumption in a FNU is an important tool of control, which allows for the development and evaluation of the menus. Ultimately, this leads to an improvement in meal management (AU)

Associação entre aleitamento materno e estado nutricional atual de crianças e adolescentes atendidos em um hospital do sul do Brasil / Association between breastfeeding and current nutritional status of children and adolescents in a hospital in southern Brazil

Introdução: O leite materno é o alimento adequado para crianças nos primeiros meses de vida. O padrão de aleitamento materno pode estar relacionado ao estado nutricional de crianças e adolescentes. A escolaridade, a idade materna e a presença de filhos anteriores também podem estar relacionadas com a duração da amamentação. Objetivo: Avaliar a relação entre o tempo de aleitamento materno com o estado nutricional atual de crianças e adolescentes atendidos no Hospital de Clínicas de Porto Alegre (HCPA) - RS. Métodos: Estudo transversal realizado na unidade geral de internação pediátrica e no ambulatório geral de pediatria do HCPA com 106 crianças e adolescentes. Os participantes foram avaliados por meio da caderneta da criança, instrumento formulado para o estudo e avaliação antropométrica. Resultados: Não foram encontradas diferenças estatisticamente significativas em relação ao estado nutricional quando comparado com aleitamento materno, aleitamento materno exclusivo, tempo de amamentação exclusiva e tipo de leite utilizado após a interrupção do aleitamento materno exclusivo. Também não foram encontradas diferenças em relação ao tempo de aleitamento materno exclusivo quando comparado com idade da mãe no nascimento do bebê, escolaridade materna e filhos anteriores. Conclusão: Não foi encontrada associação estatisticamente significativa entre as variáveis analisadas. Entretanto, os dados percentuais sugerem que o aleitamento materno exclusivo pode influenciar positivamente no perfil nutricional das crianças, que mães com maior escolaridade e mães que possuem filhos anteriores amamentam exclusivamente por mais tempo.

Background: Human breast milk is the appropriate food for infants in the first months of life. The pattern of breastfeeding may be related to nutritional status of children and adolescents. Education, maternal age, and the presence of previous children may also be related to duration of breastfeeding. Aim: To evaluate the relationship between duration of breastfeeding and the current nutritional status of children and adolescents treated at the Hospital de Clínicas de Porto Alegre - RS. Methods: Cross-sectional study in a pediatric inpatient unit and an outpatient pediatric clinic with 106 children and adolescents. Participants were assessed by the Child Health Card, an instrument designed to study and anthropometric measurements. Results: There were no statistically significant differences in relation to nutritional status when compared with breastfeeding, exclusive breastfeeding, exclusive breastfeeding duration, and type of milk used after discontinuation of exclusive breastfeeding. We also found no differences in exclusive breastfeeding duration when compared with age of mother at birth, maternal education level, and the presence of previous children. Conclusion: There was no statistically significant association between the variables analyzed. However, the percentage data suggest that exclusive breastfeeding may positively affect the nutritional status of children. Mothers with higher education level or those with previous children are more likely to exclusively breastfeed longer.

Nutrição enteral artesanal, semiartesanal e industrializada em unidades hospitalares do Rio Grande do Sul: inquérito telefônico / Hospital-prepared, semi-industrialized and industrialized enteral nutrition in hospitals in Rio Grande do Sul: telephone survey

Introdução: estimativas apontam frequente utilização de formulações de nutrição enteral (NE) produzidas nas próprias unidades hospitalares (UHs) brasileiras por razões econômicas, culturais e logísticas. Objetivo: caracterizar o tipo de formulação de nutrição enteral utilizado, estabelecendo associações com o cadastramento das UHs para terapia nutricional enteral e com a equipe multidisciplinar de terapia nutricional. Métodos: foi realizado estudo transversal com UHs do Rio Grande do Sul (RS). Participaram do estudo UHs que utilizam terapia nutricional enteral para adultos internados, inseridas no Cadastro Nacional de Estabelecimentos de Saúde do Ministério da Saúde, como hospitais gerais, especializados, unidades mistas, pronto socorro geral, especializado e hospitais dia.Resultados: de um universo de 419 UHs do RS, foram incluídas 375 neste estudo. Considerando as perdas, recusas e a exclusão das UHs que não faziam uso de nutrição enteral, foram obtidos dados de 278 UHs de 220 municípios, por meio de entrevista telefônica com o profissional responsável pela terapia nutricional enteral. Das instituições participantes, 29,5% (82) relataram possuir equipes multidisciplinares de terapia nutricional enteral, sendo que, destas, 74,4% (61) possuíam equipe completa, 61,2% (170) utilizavam sistema aberto de infusão e 65,7% (182) usavam fórmula industrializada. Foi observada associação entre UHs cadastradas com o uso de fórmulas industrializadas, equipe multidisciplinar de terapia nutricional enteral completa, bomba de infusão (qui-quadrado; p < 0,001) e sistema fechado (qui-quadrado; p < 0,002), em contraposição às UHs não cadastradas. Conclusão: UHs cadastradas apresentam maiores conformidades quanto às recomendações do Ministério da Saúde.

Background: estimates indicate an increasing use of enteral formulas prepared in hospital kitchens in Brazil for economic, cultural and logistical reasons. Aim: to characterize the type of enteral nutrition used in hospitals, establishing an association with the hospital’s license for enteral nutrition therapy (ENT) and the multidisciplinary team of nutrition therapy (MTNT). Methods: this cross-sectional study was conducted in hospital units (HUs) located in the State of Rio Grande Sul, Brazil. HUs that used ENT for adult inpatients and were registered in the National Registry of Health Care Institutions of the Brazilian Ministry of Health, such as general and specialized hospitals, mixed units, general and specialized emergency departments, and day hospitals, participated in the study. Results: of a total of 419 HUs selected in the state, 375 were included in the study. Considering loss, refusal and exclusion of HUs that did not use enteral diets, we collected data from 278 HUs of 220 municipalities by telephone interview with the professional responsible for ENT. Of the participating institutions, 29.5% (82) reported having MTNTs, and of these, 74.4% (61) had a full team, 61.2% (170) used an open infusion system, and 65.7% (182) used industrially manufactured formulas. There was an association of registered HUs with use of industrially manufactured formulas, full MTNT, infusion pump (chi-square; p < 0.001), and closed systems (chi-square; p < 0.002), in contrast to non-registered HUs. Conclusion: Registered HUs show higher compliance with the recommendations of the Brazilian Ministry of Health.Conclusion: Further studies should be performed to confirm these findings.