Folate and vitamin B12 status: temporal evaluation after mandatory fortification in Brazil.

OBJECTIVES: To perform temporal evaluation of folate and vitamin B12 status and their associated factors in a Brazilian population exposed to mandatory fortification. METHODS: Data from the cross-sectional population-based studies 2008 and 2015 Health Surveys of São Paulo, including individuals ≥ 20 years, both sexes, N = 549 in 2008 and N = 610 in 2015. Folate and vitamin B12 biomarkers status, B-complex supplements and medications use, and dietary intake were assessed. RESULTS: Serum folate concentrations increased in the entire population, adults and older adults in 2015 compared to 2008, while serum vitamin B12 concentration increased only in older adults. B-complex supplement use raised in 2015, reflecting in serum vitamins status. Overall serum vitamin B12 deficiencies (<200 pg/mL) were 23.2% and 21.2%, while serum folate deficiencies (<4 ng/mL) were 4.1% and 1.5% in 2008 and 2015, respectively. The lowest quintile of serum folate (≤8.7 ng/mL) was positively associated with smoking and oral contraceptive use, while the highest quintile (≥17.8 ng/mL) was inversely associated with smoking and positively with B-complex supplement use. The odds of having vitamin B12 deficiency was inversely associated with B-complex supplement use, higher serum folate median, higher dietary vitamin B12 intake and positively associated with using oral contraceptive. CONCLUSION: Overall deficiency of folate has decreased in 2015, being almost non-existent. Low vitamin B12 status presented similar proportions in the overall population comparing both periods, except for older adults. Different predictive variables were identified to better understand vitamins status outcomes in the most recent period of the study.

[Quality of diet is associated with water intake among residents in São Paulo, Brazil]. / A qualidade da dieta está associada com a ingestão de água em residentes de São Paulo, Brasil.

The scope of the study was to evaluate the probability of the adequacy of water intake among residents of São Paulo, and to investigate if the quality of diet differs according to the adequacy of water intake. Data were extracted from the Health Survey of São Paulo, a cross-sectional, population-based study. Water intake (drinking water beverages and food) was evaluated using two 24-hours dietary recalls and a supplementary dietary intake questionnaire. Adequacy and classification of water intake was assessed using the corresponding Adequate Intake for sex and age of the individual. Dietary quality was evaluated using the revised Brazilian Healthy Eating Index (BHEI). The associations were tested using the Theil-Sen median test and logistic regression models. A low probability of adequate water intake was observed, and this decreased with advancing age. Except among the elderly, among whom no association was observed, a positive association between water intake and the BHEI was observed, and for the total and integral fruit components, which was maintained after confusion adjustments. Among adults, it was observed that those who ingested less water had even lower scores for saturated fats. The residents of São Paulo have low water intake, and the quality of diet is worse among those who drink less water.

O objetivo foi avaliar se a qualidade da dieta varia de acordo com a adequação da ingestão de água em residentes de São Paulo. Trata-se do Inquérito de Saúde de São Paulo, estudo transversal de base populacional. A ingestão de água total (potável, de bebidas e de alimentos) foi avaliada por meio de dois recordatórios alimentares de 24h e questionário complementar sobre a dieta, e a qualidade da dieta foi avaliada por meio do índice de qualidade da dieta revisado (IQDR) para a população brasileira. A Adequate Intake foi usada para estratificar os indivíduos. As associações foram testadas pelo teste Theil-Sen e pelo modelo de regressão logística. Observou-se ingestão de água de 2,20 L/d, e que a qualidade da dieta "necessita de modificações". Exceto nos idosos em que não foi observada nenhuma associação, nos demais grupos mostrou-se que há associação positiva da ingestão de água com o IQDR, bem como com os componentes frutas totais e integrais. Estas associações foram mantidas mesmo após ajustes para variáveis de confusão. Nos adultos, observou-se que aqueles que ingeriram menos água tiveram menores pontuações para gorduras saturadas. A qualidade da dieta dos residentes de São Paulo é pior entre os que ingerem menos água.

Food Sources of Shortfall Nutrients among Latin Americans: Results from the Latin American Study of Health and Nutrition (ELANS).

Increased consumption of energy-dense, nutrient-poor foods can lead to inadequate intakes of shortfall nutrients, including vitamin A, D, C, and E, dietary folate, calcium, iron, magnesium, potassium, and fiber. The objective was to examine the prevalence of inadequate intake of shortfall nutrients and identify food sources of shortfall nutrients in eight Latin American countries. Data from ELANS, a multi-country, population-based study of 9218 adolescents and adults were used. Dietary intake was collected through two 24 h Recalls from participants living in urban areas of Argentina, Brazil, Chile, Colombia, Ecuador, Peru, and Venezuela. Foods and beverages were classified using the adapted version of the NHANES "What We Eat in America" system. Nutrients inadequacy was estimated using the Institute of Medicine recommendations and descriptive statistics were calculated. Prevalence of inadequacy was above 50% for most of the nutrients, which the exception of vitamin C with a prevalence of inadequacy of 39%. Milk, cheese, seafoods, breads, and fruit juices/drinks were among the top 5 sources for each of the 10 shortfall nutrients examined. Many food categories were top contributors to more than one dietary component examined. Understanding the nutrient intake and food sources can help inform dietary guidance and intervention approaches.

Prevalence and Factors Associated with Iron Deficiency and Anemia among Residents of Urban Areas of São Paulo, Brazil.

Anemia is a worldwide concern. This cross-sectional population-based study examined the prevalence of iron-deficiency anemia (IDA) among residents of São Paulo (n = 898; 12-93 years), considering sociodemographic factors, dietary iron inadequacy, and food contributors to iron intake. Blood cell count and iron biomarkers were quantified. Dietary iron intake was measured using two 24-h dietary recalls. Iron intake inadequacy was estimated using a probabilistic approach. The prevalence of anemia was 6.7%, depleted iron stores 5.1%, and IDA 1.1%. Women of all age groups, older adults, and those who were underweight or obese had the highest prevalence of anemia, and female adolescents had the highest prevalence of depleted iron stores. Female adolescents and adults were more vulnerable to depleted iron stores. Male adults and older adults had a considerable prevalence of iron overload. Except for female adolescents and adults, all groups had mild probabilities of inadequate iron intake. The main food iron contributor was wheat flour. Hemoglobin concentrations were directly associated with being an adult, having a higher income, and inversely associated with being female. Serum ferritin concentrations were directly associated with age and inversely correlated with female sex. Residents of São Paulo had a low prevalence of anemia, iron deficiency, and IDA, and sociodemographic factors interfered with these parameters.

Opportunities for diet quality improvement: the potential role of staple grain foods.

OBJECTIVE: Given the high disease burden associated with the low intake of whole grains, modelling studies that estimate the impact of dietary strategies to increase more healthful grain foods consumption are essential to inform evidence-based and culturally specific policies. The current study investigated the potential nutritional impact of replacing staple grain foods with more healthful options. DESIGN: Based on the 2015 Health Survey of São Paulo, a cross-sectional, population-based study, we modelled the substitution of white rice and white bread with brown rice and whole-wheat bread. Outcomes included changes in more healthful grain foods, energy and nutrient intakes. SETTING: Urban area of São Paulo, Brazil. PARTICIPANTS: Participants aged over 12 years who completed a semi-structured questionnaire and one 24-h recall (n 1741). RESULTS: The substitution of all white rice and white bread with brown rice and whole-wheat bread, respectively, would result in more than 5 % increases in Zn (+9·1 %), Ca (+9·3 %), vitamin E (+18·8 %), dietary fibre (+27·0 %) and Mg (+52·9 %) intake, while more than a 5 % decrease would be seen for total carbohydrate (-6·1 %), folate (-6·6 %), available carbohydrate (-8·5 %), Fe (-8·6 %), vitamin B6 (-12·5 %), vitamin B2 (-17·4 %), and vitamin B1 (-20·7 %). A substantial increase in the amount of more healthful grain foods consumed would be seen (10 g/d to 220 g/d, or from 4 % to 69 % of total grain intake). CONCLUSIONS: Replacing white rice and white bread with their whole-grain versions has the potential to improve diet quality, suggesting they are prime targets for policy actions aiming at increasing intake of more healthful grain foods.

Application of the ≤ 10:1 carbohydrate to fiber ratio to identify healthy grain foods and its association with cardiometabolic risk factors.

PURPOSE: Optimal metrics to assess healthfulness of carbohydrate-rich products are not well established. We investigated how the content per 10 g of carbohydrate of at least 1 g of fiber (≤ 10:1-ratio) related to nutritional quality in grain foods as well as cardiometabolic risk factors in São Paulo, Brazil. METHODS: Data were from the cross-sectional population-based study 2015 Health Survey of São Paulo, including a probabilistic sample of urban residents in the city. Participants (n = 1188) aged 20 + years completed a 24-h dietary recall and a subsample of 603 participants had blood samples, anthropometrics, and blood pressure measurements collected, and answered a second 24-h recall. Energy and nutrient contents of grain foods meeting or not meeting the ≤ 10:1-ratio were evaluated using linear regression models. The association between consumption (percent energy, %E) of grain foods meeting the ≤ 10:1-ratio and cardiometabolic risk factors were investigated using linear regression models. RESULTS: Foods meeting the ≤ 10:1-ratio had less available carbohydrate (- 3.0 g/serving), total sugar (- 7.4 g/serving), added sugar (- 7.2 g/serving) and saturated fat (- 0.7 g/serving), and more dietary fiber (+ 3.5 g/serving), protein (+ 2.1 g/serving), potassium (+ 100.1 mg/serving), iron (+ 0.9 mg/serving), selenium (+ 4.2 µg/serving), magnesium (+ 38.7 mg/serving), and zinc (+ 1.1 mg/serving). Each increase in 1%E consumption of grain foods meeting the ≤ 10:1-ratio was associated with lower levels of blood triacylglycerol (- 10.7%), the triacylglycerol/high-density lipoprotein cholesterol ratio (- 14.9%), fasting insulin (- 13.6%), and homeostasis model assessment for insulin resistance (- 14.0%). CONCLUSION: The ≤ 10:1-ratio identified grain foods with higher nutritional quality and higher intakes of these foods were associated with cardiometabolic risk factors related to atherogenic dyslipidemia and insulin resistance.

The Human Milk Microbiota is Modulated by Maternal Diet.

Human milk microorganisms contribute not only to the healthy development of the immune system in infants, but also in shaping the gut microbiota. We evaluated the effect of the maternal diet during pregnancy and during the first month of lactation on the human milk microbiota in a cross-sectional study including 94 healthy lactating women. Microbiota composition was determined by 16S rDNA profiling and nutrient intake assessed through food questionnaires. Thirteen genera were present in at least 90% of all samples, with three genera present in all samples: Streptococcus, Staphylococcus, and Corynebacterium. Cluster analysis indicated two distinct compositions: one marked by a high abundance of Streptococcus (cluster 1), and other by a high abundance of Staphylococcus (cluster 2). A global association with milk microbiota diversity was observed for vitamin C intake during pregnancy (p = 0.029), which was higher for cluster 2 individuals (cluster 2 median = 232 mg/d; cluster 1 = 175 mg/d; p = 0.02). Positive correlations were found between Bifidobacterium in the milk and intake of polyunsaturated and linoleic fatty acids during the lactation period (p < 0.01). We show that maternal diet influences the human milk microbiota, especially during pregnancy, which may contribute in shaping the gut microbiota.

[Validity of self-reported high cholesterol in the city of São Paulo, Brazil, and factors associated with this information's sensitivity]. / Validade da autorreferência de colesterol elevado na cidade de São Paulo, Brasil, e fatores associados à sensibilidade dessa informação.

The study aimed to validate self-report of high cholesterol in São Paulo, Brazil, and verify factors associated with this information's sensitivity. Data were used from the Health Survey of the City of São Paulo 2015, a cross-sectional population-based study with a probabilistic sample of the city's residents. The sample included 886 individuals with information from the structured questionnaire, blood measurements of total cholesterol and fractions or who reported being on medication for high cholesterol. The validity of self-reported information on high cholesterol was measured according to sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa index, considering total cholesterol and LDL-c and pharmacological treatment as the gold standard. Logistic regression models were developed to investigate factors associated with the sensitivity of this information. The sensitivity of information on high cholesterol using total cholesterol as the reference was 50.6%, specificity 90.19%, PPV 51.64%, NPV 89.82%, and kappa 0.41. Taking LDL-c as the gold standard, sensitivity was 53.52%, specificity 89.93%, PPV 49.22%, NPV 91.39%, and kappa 0.43. Using total cholesterol as the reference, age (OR = 1.69; 95%CI: 1.24-2.29) and having a private health plan (OR = 2.91; 95%CI: 1.06-7.99) were associated with the information's sensitivity. With LDL-c as the gold standard, age (OR = 1.71; 95%CI: 1.13-2.57), smoking (OR = 3.33; 95%CI: 1.08-10.27), and having a private health plan (OR = 3.64; 95%CI: 1.10-12.08) were associated with the information's sensitivity. The results suggest low sensitivity and low PPV of self-reported high cholesterol in residents of São Paulo.

O objetivo do presente estudo foi validar a autorreferência de colesterol elevado em residentes de São Paulo, Brasil, e verificar os fatores associados à sensibilidade dessa informação. Foram utilizados dados do Inquérito de Saúde de São Paulo de 2015, estudo transversal de base populacional com amostra probabilística de residentes do município. Foram incluídos 886 indivíduos com informações do questionário estruturado, dosagem de colesterol total e frações ou que referiram tratamento farmacológico do colesterol elevado. A validade da informação autorreferida de colesterol elevado foi determinada por meio da sensibilidade, especificidade, valores preditivos positivo (VPP) e negativo (VPN) e kappa, considerando as dosagens de colesterol total e LDL-c e o tratamento farmacológico como padrão-ouro. Modelos de regressão logística foram realizados a fim de investigar os fatores associados à sensibilidade dessa informação. A sensibilidade da informação de colesterol elevado tendo em conta o colesterol total como referência foi de 50,6%, a especificidade de 90,19%, VPP de 51,64%, VPN de 89,82% e kappa de 0,41. Considerando o LDL-c como padrão-ouro, a sensibilidade foi 53,52%, a especificidade 89,93%, o VPP 49,22%, o VPN 91,39% e kappa 0,43. Utilizando a dosagem de colesterol total como referência, a idade (OR = 1,69; IC95%: 1,24-2,29) e o plano de saúde (OR = 2,91; IC95%: 1,06-7,99) se associaram à sensibilidade dessa informação. Considerando a dosagem de LDL-c como padrão-ouro, a idade (OR = 1,71; IC95%: 1,13-2,57), o tabagismo (OR = 3,33; IC95%: 1,08-10,27) e o plano de saúde (OR = 3,64; IC95%: 1,10-12,08) foram associados à sensibilidade dessa informação. Os resultados indicam baixa sensibilidade e VPP da autorreferência do colesterol elevado em residentes de São Paulo.

El objetivo de este estudio fue validar el autoinforme de colesterol elevado en residentes de São Paulo, Brasil, y verificar los factores asociados a la sensibilidad de esta información. Se utilizaron datos de la Encuesta de Salud de São Paulo 2015, estudio transversal de base poblacional con una muestra probabilística de residentes del municipio. Se incluyeron 886 individuos con información del cuestionario estructurado, cantidad de colesterol total y fracciones o que informaron de un tratamiento farmacológico por colesterol elevado. La validez de la información autoinformada de colesterol elevado fue determinada por medio de la sensibilidad, especificidad, valores predictivos positivo (VPP) y negativo (VPN) y kappa, considerando las cantidades de colesterol total y LDL-c y el tratamiento farmacológico como parámetro de referencia. Se realizaron modelos de regresión logística, a fin de investigar los factores asociados a la sensibilidad de esa información. La sensibilidad de la información de colesterol elevado, teniendo en cuenta el colesterol total como referencia, fue de un 50,6%, la especificidad de 90,19%, VPP de 51,64%, VPN de 89,82% y kappa de 0,41. Considerando el LDL-c como parámetro de referencia, la sensibilidad fue 53,52%, la especificidad 89,93%, el VPP 49,22%, el VPN 91,39% y kappa 0,43. Utilizando la cantidad de colesterol total como referencia, la edad (OR = 1,69; IC95%: 1,24-2,29) y el plan de salud (OR = 2,91; IC95%: 1,06-7,99) se asociaron a la sensibilidad de esa información. Considerando la cantidad de LDL-c como parámetro de referencia, la edad (OR = 1,71; IC95%: 1,13-2,57), el tabaquismo (OR = 3,33; IC95%: 1,08-10,27) y el plan de salud (OR = 3,64; IC95%: 1,10-12,08) se asociaron a la sensibilidad de esa información. Los resultados indican baja sensibilidad y VPP del autoinforme de colesterol elevado en residentes de São Paulo.

Total and Added Sugar Intake: Assessment in Eight Latin American Countries.

Non-communicable diseases are growing at an alarming rate in Latin America. We assessed total and added sugar intake in Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela, to verify the adequacy of the World Health Organization's recommendations, considering gender, socioeconomic level (SEL) and age. A total of 9218 non-institutionalized individuals living in urban areas (age range 15-65 years) were assessed in the Latin American Study of Nutrition and Health (ELANS), a multicenter household population-based cross-sectional survey. Socio-demographic data were collected. Total and added sugar intakes were measured using two non-consecutive 24-h dietary recalls. The prevalence of excessive sugar intake was estimated. A large proportion of individuals showed high consumption of total and added sugar intake, which reflected in the high prevalence of excessive sugar intake. With minimal differences across countries, in general, women, individuals with high SEL, and younger people had higher percentages of total energy intake from total and added sugar intake, and of contribution of carbohydrates from total and added sugars. Thus, there is high consumption of total and added sugar intake in the Latin American countries with some peculiarities considering socio-demographic variables, which should be considered in each country's health intervention proposals.

2015 Health Survey of São Paulo with Focus in Nutrition: Rationale, Design, and Procedures.

This paper describes the design, sampling methods, and data collection procedures, with particular focus on dietary data, used for the 2015 Health Survey of São Paulo (Inquérito de Saúde de São Paulo, 2015 ISA-Capital) with Focus in Nutrition Study (2015 ISA-Nutrition). The ISA is a household cross-sectional, population-based survey that uses complex, stratified, multistage sampling to create a representative sample of residents from urban São Paulo, Brazil. The 2015 ISA-Nutrition comprised a sub-sample of the 2015 ISA-Capital and intended to include 300 adolescents (aged 12 to 19 years), 300 adults (aged 20 to 59 years), and 300 older adults (aged ≥60 years). From February 2015 to February 2016, 1737 individuals answered the first 24-h dietary recall (24HR), and 901 individuals consented to have their blood sample collected, to undergo anthropometric and blood pressure assessment, and to answer the second 24HR. The 2015 ISA-Nutrition aims to evaluate lifestyle-related modifiable factors in São Paulo's residents, as well as their association with biochemical and genetic markers, and environmental aspects related to cardiometabolic risk factors. This paper concludes that 2015 ISA-Nutrition may provide valuable insights into the cardiometabolic risk factors in a big city in an upper middle-income country and contribute to the formulation of health and nutritional policies.

The relationship between carbohydrate quality and the prevalence of metabolic syndrome: challenges of glycemic index and glycemic load.

PURPOSE: To estimate the prevalence of metabolic syndrome (MetS) and its components in adults and older adults residents of São Paulo, the association of MetS with the glycemic index (GI) and glycemic load (GL) and the foods that contribute to dietary GI and GL in this population. METHODS: Data from 591 adults and older adults participants in the Health Survey of São Paulo were used. This is a cross-sectional, population-based study with a complex multistage sample design of residents in the urban area of the municipality. Dietary consumption data, anthropometric measurements, blood pressure and blood samples were collected. The associations between GI, GL and MetS and its components were tested using logistic regression models, considering the sample design of the study. RESULTS: The prevalence of MetS in the adult and older adults residents of São Paulo was 30.3%. There was no association between GI, GL and MetS. GI and GL were positively associated with low high-density lipoprotein cholesterol (HDL-c), OR = 1.113 (95% CI 1.007-1.230) and OR = 1.019 (95% CI 1.002-1.037), respectively. GL was inversely associated with high blood pressure and this association differed by age group (OR = 0.981; 95% CI 0.964-0.998). Foods that most contributed to dietary GI and GL were sugar, white rice and French bread. CONCLUSIONS: Considering the high prevalence of low HDL-c in the population of São Paulo, GI and GL may contribute to the nutritional therapy of this dyslipidemia. However, findings should be treated with caution, considering several conflicting results between studies.

Validade da autorreferência de colesterol elevado na cidade de São Paulo, Brasil, e fatores associados à sensibilidade dessa informação / Validity of self-reported high cholesterol in the city of São Paulo, Brazil, and factors associated with this information's sensitivity / Validez del autoinforme de colesterol elevado en la ciudad de São Paulo, Brasil, y factores asociados con la sensibilidad de esta información

O objetivo do presente estudo foi validar a autorreferência de colesterol elevado em residentes de São Paulo, Brasil, e verificar os fatores associados à sensibilidade dessa informação. Foram utilizados dados do Inquérito de Saúde de São Paulo de 2015, estudo transversal de base populacional com amostra probabilística de residentes do município. Foram incluídos 886 indivíduos com informações do questionário estruturado, dosagem de colesterol total e frações ou que referiram tratamento farmacológico do colesterol elevado. A validade da informação autorreferida de colesterol elevado foi determinada por meio da sensibilidade, especificidade, valores preditivos positivo (VPP) e negativo (VPN) e kappa, considerando as dosagens de colesterol total e LDL-c e o tratamento farmacológico como padrão-ouro. Modelos de regressão logística foram realizados a fim de investigar os fatores associados à sensibilidade dessa informação. A sensibilidade da informação de colesterol elevado tendo em conta o colesterol total como referência foi de 50,6%, a especificidade de 90,19%, VPP de 51,64%, VPN de 89,82% e kappa de 0,41. Considerando o LDL-c como padrão-ouro, a sensibilidade foi 53,52%, a especificidade 89,93%, o VPP 49,22%, o VPN 91,39% e kappa 0,43. Utilizando a dosagem de colesterol total como referência, a idade (OR = 1,69; IC95%: 1,24-2,29) e o plano de saúde (OR = 2,91; IC95%: 1,06-7,99) se associaram à sensibilidade dessa informação. Considerando a dosagem de LDL-c como padrão-ouro, a idade (OR = 1,71; IC95%: 1,13-2,57), o tabagismo (OR = 3,33; IC95%: 1,08-10,27) e o plano de saúde (OR = 3,64; IC95%: 1,10-12,08) foram associados à sensibilidade dessa informação. Os resultados indicam baixa sensibilidade e VPP da autorreferência do colesterol elevado em residentes de São Paulo.

The study aimed to validate self-report of high cholesterol in São Paulo, Brazil, and verify factors associated with this information's sensitivity. Data were used from the Health Survey of the City of São Paulo 2015, a cross-sectional population-based study with a probabilistic sample of the city's residents. The sample included 886 individuals with information from the structured questionnaire, blood measurements of total cholesterol and fractions or who reported being on medication for high cholesterol. The validity of self-reported information on high cholesterol was measured according to sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa index, considering total cholesterol and LDL-c and pharmacological treatment as the gold standard. Logistic regression models were developed to investigate factors associated with the sensitivity of this information. The sensitivity of information on high cholesterol using total cholesterol as the reference was 50.6%, specificity 90.19%, PPV 51.64%, NPV 89.82%, and kappa 0.41. Taking LDL-c as the gold standard, sensitivity was 53.52%, specificity 89.93%, PPV 49.22%, NPV 91.39%, and kappa 0.43. Using total cholesterol as the reference, age (OR = 1.69; 95%CI: 1.24-2.29) and having a private health plan (OR = 2.91; 95%CI: 1.06-7.99) were associated with the information's sensitivity. With LDL-c as the gold standard, age (OR = 1.71; 95%CI: 1.13-2.57), smoking (OR = 3.33; 95%CI: 1.08-10.27), and having a private health plan (OR = 3.64; 95%CI: 1.10-12.08) were associated with the information's sensitivity. The results suggest low sensitivity and low PPV of self-reported high cholesterol in residents of São Paulo.

El objetivo de este estudio fue validar el autoinforme de colesterol elevado en residentes de São Paulo, Brasil, y verificar los factores asociados a la sensibilidad de esta información. Se utilizaron datos de la Encuesta de Salud de São Paulo 2015, estudio transversal de base poblacional con una muestra probabilística de residentes del municipio. Se incluyeron 886 individuos con información del cuestionario estructurado, cantidad de colesterol total y fracciones o que informaron de un tratamiento farmacológico por colesterol elevado. La validez de la información autoinformada de colesterol elevado fue determinada por medio de la sensibilidad, especificidad, valores predictivos positivo (VPP) y negativo (VPN) y kappa, considerando las cantidades de colesterol total y LDL-c y el tratamiento farmacológico como parámetro de referencia. Se realizaron modelos de regresión logística, a fin de investigar los factores asociados a la sensibilidad de esa información. La sensibilidad de la información de colesterol elevado, teniendo en cuenta el colesterol total como referencia, fue de un 50,6%, la especificidad de 90,19%, VPP de 51,64%, VPN de 89,82% y kappa de 0,41. Considerando el LDL-c como parámetro de referencia, la sensibilidad fue 53,52%, la especificidad 89,93%, el VPP 49,22%, el VPN 91,39% y kappa 0,43. Utilizando la cantidad de colesterol total como referencia, la edad (OR = 1,69; IC95%: 1,24-2,29) y el plan de salud (OR = 2,91; IC95%: 1,06-7,99) se asociaron a la sensibilidad de esa información. Considerando la cantidad de LDL-c como parámetro de referencia, la edad (OR = 1,71; IC95%: 1,13-2,57), el tabaquismo (OR = 3,33; IC95%: 1,08-10,27) y el plan de salud (OR = 3,64; IC95%: 1,10-12,08) se asociaron a la sensibilidad de esa información. Los resultados indican baja sensibilidad y VPP del autoinforme de colesterol elevado en residentes de São Paulo.

2015 Health Survey of São Paulo with Focus in Nutrition: Rationale, Design, and Procedures

This paper describes the design, sampling methods, and data collection procedures, with particular focus on dietary data, used for the 2015 Health Survey of São Paulo (Inquérito de Saúde de São Paulo, 2015 ISA-Capital) with Focus in Nutrition Study (2015 ISA-Nutrition). The ISA is a household cross-sectional, population-based survey that uses complex, stratified, multistage sampling to create a representative sample of residents from urban São Paulo, Brazil. The 2015 ISA-Nutrition comprised a sub-sample of the 2015 ISA-Capital and intended to include 300 adolescents (aged 12 to 19 years), 300 adults (aged 20 to 59 years), and 300 older adults (aged ≥60 years). From February 2015 to February 2016, 1737 individuals answered the first 24-h dietary recall (24HR), and 901 individuals consented to have their blood sample collected, to undergo anthropometric and blood pressure assessment, and to answer the second 24HR. The 2015 ISA-Nutrition aims to evaluate lifestyle-related modifiable factors in São Paulo's residents, as well as their association with biochemical and genetic markers, and environmental aspects related to cardiometabolic risk factors. This paper concludes that 2015 ISA-Nutrition may provide valuable insights into the cardiometabolic risk factors in a big city in an upper middle-income country and contribute to the formulation of health and nutritional policies.

Dietary BCAA Intake Is Associated with Demographic, Socioeconomic and Lifestyle Factors in Residents of São Paulo, Brazil.

BACKGROUND: Identifying which risk groups have a higher intake of branched chain amino acids (BCAA) is important for the planning of public policies. This study was undertaken to investigate BCAA consumption, the foods contributing to that consumption and their association with demographic, socioeconomic and lifestyle factors. METHODS: Data from the Health Survey of São Paulo, a cross-sectional population-based survey (n = 1662; age range 12-97 years), were used. Dietary intake was measured using 24-h dietary recalls. Baseline characteristics were collected. Associations between BCAA intake and demographic, socioeconomic and lifestyle factors were determined using linear regression. RESULTS: Total BCAA intake was 217.14 mg/kg·day (Leu: 97.16 mg/kg·day; Ile: 56.44 mg/kg·day; Val: 63.54 mg/kg·day). BCAA intake was negatively associated with female sex in adolescents and adult groups, with no white race in adolescents, and with former smoker status in adults. Conversely, BCAA was positively associated with household per capita income in adolescents and adults. No associations were observed in the older adults group. Main food contributors to BCAA were unprocessed red meat, unprocessed poultry, bread and toast, beans and rice. CONCLUSIONS: Adolescents and adults were the most vulnerable to having their BCCA intake influenced by demographic, socioeconomic and lifestyle factors.

Validation of self-reported diabetes in a representative sample of São Paulo city.

OBJECTIVE To validate the self-reported diabetes mellitus in adults and older adults living in the city of São Paulo, Brazil. METHODS We have used data of 569 subjects (284 adults and 285 older adults), participants of the population-based cross-sectional study Inquérito de Saúde do Município de São Paulo (Health Survey of São Paulo). Fasting glucose ≥ 7.0 mmol/L (126 mg/dL) and/or use of drugs (oral hypoglycemic and/or insulin) defined the diagnosis of diabetes mellitus. We have validated the self-reported diabetes mellitus by calculating the sensitivity, specificity, positive predictive values, and negative predictive values. We have used Poisson regression with robust variance to verify the factors associated with the sensitivity of the self-reported datum. For all analyses, we have considered the sample design of the study. RESULTS The sensitivity of self-reported diabetes mellitus was 63.8% (95%CI 49.2-76.3), specificity was 99.7% (95%CI 99.1-99.9), positive predictive value was 95.5% (95%CI 84.4-98.8), and negative predictive value was 96.9% (95%CI 94.9-98.2). The correct reporting of diabetes mellitus was more prevalent among older adults (PR = 2.0; 95%CI 1.2-3.5) than among adults. CONCLUSIONS The use of the datum of self-reported diabetes mellitus is valid, especially among older adults living in the city of São Paulo. The results highlight the need to track diabetes mellitus in asymptomatic subjects who have one or more risk factors for it, mainly in the adult population of this city.

Validation of self-reported diabetes in a representative sample of São Paulo city

ABSTRACT OBJECTIVE To validate the self-reported diabetes mellitus in adults and older adults living in the city of São Paulo, Brazil. METHODS We have used data of 569 subjects (284 adults and 285 older adults), participants of the population-based cross-sectional study Inquérito de Saúde do Município de São Paulo (Health Survey of São Paulo). Fasting glucose ≥ 7.0 mmol/L (126 mg/dL) and/or use of drugs (oral hypoglycemic and/or insulin) defined the diagnosis of diabetes mellitus. We have validated the self-reported diabetes mellitus by calculating the sensitivity, specificity, positive predictive values, and negative predictive values. We have used Poisson regression with robust variance to verify the factors associated with the sensitivity of the self-reported datum. For all analyses, we have considered the sample design of the study. RESULTS The sensitivity of self-reported diabetes mellitus was 63.8% (95%CI 49.2–76.3), specificity was 99.7% (95%CI 99.1–99.9), positive predictive value was 95.5% (95%CI 84.4–98.8), and negative predictive value was 96.9% (95%CI 94.9–98.2). The correct reporting of diabetes mellitus was more prevalent among older adults (PR = 2.0; 95%CI 1.2–3.5) than among adults. CONCLUSIONS The use of the datum of self-reported diabetes mellitus is valid, especially among older adults living in the city of São Paulo. The results highlight the need to track diabetes mellitus in asymptomatic subjects who have one or more risk factors for it, mainly in the adult population of this city.

Inadequacies in the habitual nutrient intakes of patients with metabolic syndrome: a cross-sectional study.

BACKGROUND: Dietary factors are important environmental factors associated with the prevalence of metabolic syndrome (MS). The objective of this study was to assess the habitual nutrient intakes of patients with MS. METHODS: A cross-sectional study included 103 patients (82 % women) with MS seen at the endocrinology outpatient clinic of Hospital Universitario Onofre Lopes. Habitual nutrient intake data were collected at two 24-h dietary recalls. Macronutrient intake adequacies were classified according to the I Brazilian guidelines for the diagnosis and treatment of metabolic syndrome. The prevalence of inadequate micronutrient intake was estimated using the estimated average requirements (EAR) cut-point method after adjusting for intra- and interpersonal variances and energy. RESULTS: The mean energy intake of the included patients was 1523.0 ± 592.2 kcal/d, higher in men (1884.0 vs. 1441.5 kcal/d in women; p = 0.003). The recommended percentage protein intake was exceeded in both women and men (18 % in women and 19 % in men). Although men consumed more fiber (18.8 vs. 13.3 g/d in women; p = 0.011), their intake was still inadequate. Women consumed more fat (47.6 vs. 41.3 g/d in men; p = 0.007). The prevalence of inadequate vitamin D and calcium intakes exceeded 80 % in both men and women and across all age groups. The same was observed for magnesium in men and women aged more than 30 years. The prevalence of inadequate vitamin E, riboflavin, and zinc intakes in men ranged from 50 to 75 %. The prevalence of inadequate vitamin A, vitamin C, thiamin, vitamin B6, copper, and selenium intakes in men and women was less than 50 %. CONCLUSIONS: Patients with MS had high protein intake, low fiber intake, and high a prevalence of inadequate vitamin D, magnesium, and calcium intakes.

Family income per capita, age, and smoking status are predictors of low fiber intake in residents of São Paulo, Brazil.

We hypothesized that dietary total fiber intake may be less than recommendations and that the intake of total, soluble, and insoluble fiber may be associated with demographic, lifestyle, and socioeconomic factors. Data were drawn from the Health Survey of São Paulo, a cross-sectional population-based study. Adolescents, adults, and elderly persons living in São Paulo city were included. Demographic, lifestyle, and anthropometric data were collected from households. Dietary intake was measured using two 24-hour dietary recalls. All analyses were conducted based on the sample design of the study. The proportion of individuals who met the adequate intake (AI) for total fiber intake was examined, and foods that contributed to the intake of fiber and fractions were evaluated. The relationship of total, soluble, and insoluble fiber intake with demographic, socioeconomic, and lifestyle characteristics was determined using multiple linear regression models. A low proportion of individuals met the AI for dietary fiber. The foods that most contributed to total fiber intake were beans, French bread, and rice. Total fiber intake was negatively associated with former and current smokers and positively associated with family income per capita and age. Soluble fiber intake was negatively associated with current smokers and positively associated with female sex, age, and family income per capita. Insoluble fiber intake was negatively associated with former or current smokers and positively associated with age. In summary, residents in the city of São Paulo had a low fiber intake, and demographic, socioeconomic, and lifestyle factors were associated with dietary fiber and intake of its fractions.

Magnesium-deficient high-fat diet: effects on adiposity, lipid profile and insulin sensitivity in growing rats.

BACKGROUND & AIMS: To determine if magnesium deficiency aggravates the effects of a high-fat diet in growing rats in terms of obesity, lipid profile and insulin resistance. METHODS: The study population comprised 48 newly weaned male Wistar Hannover rats distributed into four groups according to diet, namely, control group (CT; n = 8), control diet provided ad libitum; pair-feeding control group (PF; n = 16), control diet but in the same controlled amount as animals that received high-fat diets; high-fat diet group (HF; n = 12), and magnesium-deficient high-fat diet group (HFMg(-); n = 12). The parameters investigated were adiposity index, lipid profile, magnesium status, insulin sensitivity and the phosphorylation of proteins involved in the insulin-signaling pathway, i.e. insulin receptor ß-subunit, insulin receptor substrate 1 and protein kinase B. RESULTS: The HF and HFMg(-) groups were similar regarding gain in body mass, adiposity index and lipid profile, but were significantly different from the PF group. The HFMg(-) group exhibited alterations in magnesium homeostasis as revealed by the reduction in urinary and bone concentrations of the mineral. No inter-group differences were observed regarding glucose homeostasis. Protein phosphorylation in the insulin-signaling pathway was significantly reduced in the high-fat groups compared with the control groups, demonstrating that the intake of fat-rich diets increased insulin resistance, a syndrome that was aggravated by magnesium deficiency. CONCLUSIONS: Under the experimental conditions tested, the intake of a magnesium-deficient high-fat diet led to alterations in the insulin-signaling pathway and, consequently, increased insulin resistance.

Magnesium status and the physical performance of volleyball players: effects of magnesium supplementation.

The aim of this study was to test the hypothesis that magnesium supplementation influences the physical performance of volleyball players, as the efficacy of this approach remains questionable. Twenty-five professional male volleyball players were assigned randomly to experimental (350 mg Mg · d(-1), 4 weeks) and control groups (500 mg maltodextrin · d(-1), 4 weeks) maintaining inter-group homogeneity of urinary magnesium. Erythrocyte, plasma and urinary magnesium levels, plasma creatine kinase activity, lactate production, maximal oxygen uptake (VO2 max) and plyometric (squat jump, countermovement jump, countermovement jump with arm swing) and isokinetic (peak torque, potency and total work) performances were evaluated before (T0) and after (T1) supplementation. Levels of erythrocyte and urinary magnesium and creatine kinase activity and VO2 max remained within normal ranges in both groups. Plasma magnesium decreased significantly only within the experimental group. Significant decreases in lactate production and significant increases (of up to 3 cm) in countermovement jump and countermovement jump with arm swing values were detected in the experimental group following magnesium supplementation, but not in the control group at T1. It is concluded that magnesium supplementation improved alactic anaerobic metabolism, even though the players were not magnesium-deficient.