Type and timing of ultra-processed foods consumption and its association with dietary intake and physical activity in women with obesity living in poverty.

BACKGROUND: The present study aimed to investigate the type and timing of ultra-processed foods (UPF) consumption and its association with dietary intake (DI) and physical activity (PA) in women with obesity living in poverty. METHODS: A cross-sectional study was employed. Obesity was defined by at least two criteria (body mass index, waist circumference or % fat mass). Poverty was defined as the three lowest classes of the Brazilian Economic Classification Criterion. PA was measured with triaxial accelerometers and DI was assessed with three 24-h dietary recalls. Foods were categorised according to the NOVA classification, with UPF classified into five subgroups, as well as the timing of consumption into six meals. RESULTS: In total, 56 adult women were included. Overall energy intake was 1653.21 (503.22) kcal/day. UPF intake was 21.62% (11.94%) kcal/day, being higher at breakfast (4.91% kcal/day), afternoon snack (5.39% kcal/day) and dinner (5.01% kcal/day). Only UPF subgroup 4 (sandwich biscuits, sweets, or treats) showed a positive association with energy intake (ß = 54.40 [27.6, 81.10] kcal/day) and a negative association with protein intake (ß = -0.31% [-0.48%, -0.14%] kcal/day). UPF consumption in morning (ß = -0.41% [-0.79%, -0.02%] kcal/day) and afternoon (ß = -0.18% [-0.33%, -0.04%] kcal/day) snacks was associated with lower protein intake. Furthermore, lunchtime UPF consumption was positively associated with walking time (ß = 0.16% [0.02%; 0.30%]) and steps/hour (ß = 8.72 [1.50; 15.94] steps/h). CONCLUSIONS: Women with obesity living in poverty consume more UPF during breakfast, afternoon snack and dinner. Physical activity is positively associated with UPF consumption at lunch. UPF, such as sandwich biscuits, sweets or treats, contribute to increasing energy intake and reducing protein intake.

Type 2 diabetes mellitus is associated with food addiction in Brazilian women living in poverty.

Food addiction (FA) has been widely investigated. For the first time, two studies reported its association with type 2 diabetes mellitus (DM2) in the general population and populations with mental disorders and undergoing bariatric surgery. However, the relationship between FA and DM2 needs to be better explored in different social contexts and population groups. Given this, the present study aims to evaluate whether DM2 diagnosis is associated with FA diagnosis in women living in poverty. This is a cross-sectional, population-based study conducted in a Brazilian capital city. FA was assessed by the modified Yale Food Addiction Scale (mYFAS) 2.0, and DM2 diagnosis was assessed by self-reporting of previous medical diagnosis. The association was assessed by multivariable Poisson regression with robust variance estimation adjusted for age, poverty situation, race/skin colour, physical activity and BMI. A total of 1878 women were included, of whom 15·1 % had FA and 3·2 % had a medical diagnosis of DM2. In the multivariable analysis, the medical diagnosis of DM2 was associated with FA (prevalence ratio, PR: 2·18; 95 % CI (1·26, 3·76)). The DM2 diagnosis was also identified to be associated with role interference (PR: 1·93; 95 % CI (1·01, 3·67)) symptom of FA. In conclusion, a positive association between FA and DM2 in women living in poverty was observed, information that adds to the current evidence already available in the literature, pointing to a new line of research and integrated care.

Longitudinal estimates of resting energy expenditure using predictive equations in individuals with excess weight after weight loss: A systematic review with meta-analysis.

BACKGROUND & AIMS: To determine which resting energy expenditure (REE) predictive equation has the lowest bias in the aggregate level in individuals with excess weight during weight loss interventions. METHODS: Searches were performed in MEDLINE, Web of Science, Scopus, CENTRAL and gray literature databases. Longitudinal studies on weight loss interventions which evaluated REE by predictive equations compared to that measured by indirect calorimetry in adults with excess weight at different follow-up times were included. Meta-analyses were performed with the differences between biases of predictive equations of the REE at the different follow-up times of weight loss. RESULTS: Of the total of 2178 occurrences found in the databases, only eight studies were included. The Harris-Benedict (1919) equation showed the smallest differences between bias up to the third month (MD = 103.33 kcal; 95%CI = -39.01; 245.67), in the sixth month (MD = 59.16 kcal; 95%CI = 8.74; 109.57) and at the 12th month (MD = -71.41 kcal; 95%CI = -150.38; 7.55) of weight loss follow-up. Weight loss does not seem to have an effect on bias at different follow-up times. CONCLUSION: Harris-Benedict (1919) equation seems to be the most adequate to assess the REE of individuals with excess weight during weight loss. However, the finding of large estimated predictive intervals may indicate that predictive equations may not be handy tools for individuals losing and regaining weight due to changes other than body weight.

Adequacy of the "pocket formulas" for measuring total energy expenditure in healthy women compared with the new DRI equation: A doubly labeled water study.

OBJECTIVES: "Pocket formulas" are practical alternatives for calculating an individual's total energy expenditure (TEE). Typically, more sophisticated predictive equations are used, such as the new equations proposed in the Dietary Reference Intakes (DRI). Nevertheless, these new equations necessitate estimating physical activity levels (PALs). The aim of this study was to compare the use of pocket formulas (kcal/kg of body weight) with the new predictive equations for energy expenditure proposed by the DRI (2023) in healthy women and with the doubly labeled water (DLW) method to predict TEE. METHODS: The TEEs of healthy adult women were measured by DLW and calculated using the pocket formulas (× 20, × 25, × 30, and × 35 kcal/kg of body weight) and the new DRI equation. PALs by triaxial accelerometers were also collected. RESULTS: The study included 55 women. For the entire sample, the × 30 pocket formula had the lowest bias (-6%; limits of agreement [LOAs]: -39.8; 27.5; root mean square error: 373.4) and the highest precision (42%). The pocket formulas showed reasonable agreement in the different body mass index categories compared with the results found by the 2023 DRI proposal. For individuals with normal weight, the agreement was × 35 kcal/kg: bias (%) = -4.8; LoA = -41.5; 31.8, with overweight, it was × 30 kcal/kg: bias (%) = -2.2; LoA = -25.1; 20.6, and with obesity, it was × 30 kcal/kg: bias (%) = 4.2; LoA = -21.1; 29.4. CONCLUSION: Pocket formulas provide a reasonable agreement with TEE in healthy, sedentary, or low-active adult women, which may be a more simplistic strategy when there is no PAL data for calculating the DRI equations.

Commentary on "Food addiction, orthorexia nervosa and dietary diversity among Bangladeshi university students: a large online survey during the COVID-19 pandemic".

The food addiction construct is receiving increasing attention from researchers and clinicians worldwide. Given its rise, scientific production on the subject is increasingly abundant. Conducting studies evaluating food addiction in emerging countries is of great importance, given that most scientific production comes from high-income countries. A recent study aimed to explore the prevalences of orthorexia nervosa and food addiction and their associations with dietary diversity in university students in Bangladesh during the COVID-19 pandemic. This correspondence presents questions about using the older version of the modified Yale Food Addiction Scale to assess food addiction. It also highlights issues related to the prevalence of food addiction observed in the study.

Association between food addiction with ultra-processed food consumption and eating patterns in a Brazilian sample.

The study objectives were to determine whether consumption of ultra-processed foods (UPF) and eating patterns are associated with food addiction (FA) in a Brazilian sample. This is a cross-sectional study. The Brazilian Food and Nutrition Surveillance System tool assessed food consumption markers and dietary patterns. The modified Yale Food Addiction Scale 2.0 was used to determine FA. 5946 participants were included with a mean age of 24 ± 6 years, and 4371 (73.5%) were female. After statistical adjustments for confounders, individuals with FA had lower consumption of fresh fruits (PR: 0.88; 95%CI: [0.79; 0.97]), vegetables (PR: 0.87; 95%CI: [0.79; 0.97]), and beans (PR: 0.85; 95%CI: [0.77; 0.95]). They also had higher consumption of UPF: hamburgers/sausages (PR: 1.15; 95%CI: [1.04; 1.27]), instant noodles, packaged snacks, and/or salty cookies (PR: 1.27; 95%CI: [1.13; 1.42]), and sandwich cookies, sweets, and/or treats (PR: 1.26; 95%CI: [1.14; 1.40]). Positive associations between FA and having meals in front of the screen (PR: 1.48; 95%CI: [1.28; 1.71]) and having a late-night snack (PR: 1.24; 95%CI: [1.11; 1.39]) remained. The negative association between FA and skipping breakfast (PR: 0.76; 95%CI: [0.68; 0.85]) also remained. These eating patterns may contribute to FA, which could be potential targets for clinical intervention.

Prevalence of food addiction determined by the Yale Food Addiction Scale in Latin America: A systematic review with meta-analysis.

OBJECTIVE: Food addiction (FA) has been extensively investigated worldwide; however, the prevalence of FA in the Latin American population has yet to be established and past work has largely neglected the specificities of this region, that includes the most significant economic disparities in the world. Thus, the objective of this study was to assess the prevalence of FA measured by the Yale Food Addiction Scale in Latin America. METHOD: The search was performed on MEDLINE, ScienceDirect, LILACS, IBECS, SciELO, PsycArticles, CENTRAL, and the gray literature. FA prevalence data were collected, and random effects meta-analyses were performed to calculate the overall weighted prevalence, the prevalence by country, and by clinical and non-clinical samples. RESULTS: A total of 10,082 occurrences were identified through database searches, and 23 studies were included (Mexico = 9; Brazil = 7; Chile = 4; Argentina = 1; Peru = 1; Uruguay = 1). The prevalence of FA found in clinical samples was 38% (95% CI: 16%-63%; I2  = 98.67%; 8 studies), while in non-clinical samples, it was 15% (95% CI: 10%-21%; I2  = 98.51%; 15 studies). DISCUSSION: The average prevalence of FA in the Latin American countries included here was in accordance with that reported in other regions worldwide. It is noteworthy that the studies were conducted only in six countries, which are among those with the highest income in the region and do not represent the situation in native populations or those with lower purchasing power. This gap in the data also reflects the effects of economic disparities on the availability of empirical data in the region. PUBLIC SIGNIFICANCE: The prevalence of food addiction in Latin America was similar to that reported in other regions. It was higher among individuals with overweight, whether or not undergoing bariatric surgery, than in non-clinical samples. These findings contribute to aggregate information about this condition that has drawn the attention of clinicians and researchers.

OBJETIVO: La adicción a la comida (FA, por sus siglas en inglés) ha sido ampliamente investigada en todo el mundo; sin embargo, la prevalencia de la FA en la población latinoamericana aún no se ha establecido y el trabajo previo ha descuidado en gran medida las especificidades de esta región, que incluye las disparidades económicas más significativas del mundo. Por lo tanto, el objetivo de este estudio fue evaluar la prevalencia de FA medida por la Escala de Adicción a la Comida de Yale en América Latina. MÉTODO: La búsqueda se realizó en MEDLINE, ScienceDirect, LILACS, IBECS, SciELO, PsycArticles, CENTRAL y la literatura gris. Se recopilaron datos de prevalencia de FA y se realizaron metanálisis de efectos aleatorios para calcular la prevalencia ponderada general, la prevalencia por país y por muestras clínicas y no clínicas. RESULTADO: Se identificaron 10 082 casos mediante búsquedas en bases de datos y se incluyeron 23 estudios (México = 9; Brasil = 7; Chile = 4; Argentina = 1; Perú = 1; Uruguay = 1). La prevalencia de FA encontrada en muestras clínicas fue del 38% (IC95%:16%; 63%; I2 = 98,67%; 8 estudios), mientras que en muestras no clínicas, fue del 15% (IC del 95%: 10%; 21%; I2 = 98,51%; 15 estudios). DISCUSIÓN: La prevalencia promedio de FA en los países latinoamericanos incluidos aquí estuvo de acuerdo con la reportada en otras regiones del mundo. Cabe destacar que los estudios se realizaron solamente en seis países, que se encuentran entre los de mayores ingresos de la región y no representan la situación de las poblaciones nativas o de menor poder adquisitivo. Esta brecha en los datos también refleja los efectos de las disparidades económicas en la disponibilidad de datos empíricos en la región.

Social and Racial Disparities in Food Consumption Among Brazilian College Students: a Nationwide Study.

This study aims to assess the association between economic class, race/skin color, and food consumption among Brazilian college students. A cross-sectional web-based survey was conducted with college students from all over Brazil. Demographic data, economic class, self-reported race/skin color, anthropometry, and food consumption markers from the Brazilian Food and Nutrition Surveillance System were collected. The final sample comprised 5843 participants with a mean age of 24.1 (SD: 6.3) years, 4292 (73.5%) were female, and 810 (13.9%) in the highest economic stratum. We observed a progressive decrease in the frequency of fresh fruits and vegetables consumption from higher to lower economic classes (p < 0.01 for both). Contrarily, there was a progressive increase in the frequency of consumption of beans from higher to lower economic classes (p < 0.01). The frequency consumption of vegetables was also associated with race/skin color (p < 0.01), being lower in brown (PR: 0.94; CI 95%: 0.90; 0.98), and black (PR: 0.91; 95% CI: 0.85; 0.98) individuals, compared to white individuals. Brown individuals showed higher frequency consumption of beans (PR: 1.10; 95% CI: 1.05; 1.15) than whites. When compared to individuals of white race/skin color, brown (PR: 1.07; 95% CI: 1.01; 1.13) and black (PR: 1.15; 95% CI: 1.07; 1.23) individuals showed higher frequency consumption of sweetened beverages. Economic class and race/skin color were independent factors associated with the food consumption of Brazilian college students.

Use of the activPAL® triaxial accelerometer to estimate total energy expenditure in low-income women: differences between body mass index classifications

ABSTRACT Objective: This study aimed to assess the agreement between the total energy expenditure (TEE) estimated by the activPAL® triaxial accelerometers (ACC) and the TEE measured by the doubly labeled water method (DLW), as well as to assess if these values differ between the classifications of body mass index (BMI). Materials and methods: This is a cross-sectional study. Low-income adult women (19-45y) with BMI ≥ 18.5 kg/m2 were included. Accelerometry data (activPAL®) were collected over 7 consecutive days, which were used to calculate TEE-ACC and compared with DLW data. The Bland-Altman method, concordance correlation coefficient and root mean square error were used to assess agreement between methods. Results: The sample consisted of 55 women with a mean age of 31 ± 5 years. The agreement between TEE-ACC and TEE-DLW showed a bias of -142.5 kcal (-7.1%). Among the BMI classifications, participants with normal weight show a bias of -417.1 kcal (-21.0%), participants with overweight, -87.5 kcal (-3.9%) and participants with obesity, 97.5 kcal (4.3%). Furthermore, the bias between the methods showed a significant and positive correlation with the body weight (r = 0.49; p < 0.01). Conclusion: The TEE-ACC estimates from activPAL® were reasonably accurate when compared to the TEE-DLW, especially in women with overweight and obesity, being much less accurate in individuals with normal weight.

Associação entre risco de sarcopenia e complicações clínicas da covid-19 em pessoas idosas hospitalizadas: estudo de coorte multicêntrico / Association between the risk of sarcopenia and clinical complications of covid-19 in hospitalized older adults: a multicenter cohort study

Resumo Objetivo Verificar se o risco de sarcopenia em pessoas idosas diagnosticadas com covid-19 associa-se com demanda por cuidados intensivos, ventilação mecânica e óbito. Método Estudo multicêntrico do tipo coorte, que incluiu pessoas idosas (≥65 anos) com diagnóstico laboratorial confirmado de covid-19. Foram coletados dados relacionados às características sociodemográficas, clínicas e nutricionais. O risco de sarcopenia foi avaliado pelo questionário Sarcopenia Risk Screening. As variáveis de desfecho foram: necessidade de terapia intensiva, ventilação mecânica e óbito. Foram realizadas regressões logísticas para verificar a associação dos desfechos clínicos e o risco de sarcopenia, com as seguintes variáveis de ajuste: idade, sexo, renda familiar, atividade física, hipertensão, diabetes, doença cardiovascular doença pulmonar obstrutiva crônica e índice de massa corporal. Resultados Foram incluídas no estudo 264 pessoas idosas com covid-19, com média de idade de 71,7 (±8,2) anos. Cento e quarenta e oito pessoas idosas (56,1%) tinham risco de sarcopenia. Hipertensão, diabetes e doença cardiovascular foram as principais comorbidades identificadas nas pessoas idosas, respectivamente, 75,4%, 45,5% e 28,4%. O risco de sarcopenia nas pessoas idosas hospitalizadas com covid-19 aumentou em mais de 2 vezes as chances de internamento na UTI (OR: 2,71 [1,57;4,68], p<0,001), em cerca de 5 vezes as chances de ventilação mecânica (OR: 5,19 [2,75;9,78], p<0,001) e em mais de 3 vezes as chances de óbito (OR: 4,05 [2,05;7,98], p<0,001). Conclusão Em pessoas idosas hospitalizadas com covid-19, a pré-existência do risco de sarcopenia foi preditor de desfechos clínicos desfavoráveis.

Abstract Objective To investigate whether the risk of sarcopenia in older adults diagnosed with covid-19 is associated with the need for intensive care, mechanical ventilation, and mortality. Method A multicenter cohort study was conducted, including older adults (≥65 years) with laboratory-confirmed covid-19 diagnosis. Data related to sociodemographic, clinical, and nutritional characteristics were collected. The risk of sarcopenia was assessed using the Sarcopenia Risk Screening questionnaire. Outcome variables included the need for intensive care, mechanical ventilation, and mortality. Logistic regressions were performed to assess the association between clinical outcomes and the risk of sarcopenia, adjusting for the following variables: age, gender, family income, physical activity, hypertension, diabetes, cardiovascular disease, chronic obstructive pulmonary disease, and body mass index. Results The study included 264 older adults with covid-19, with an average age of 71.7 (±8.2) years. One hundred and forty-eight older adults (56.1%) were at risk of sarcopenia. Hypertension, diabetes, and cardiovascular disease were the most common comorbidities identified in older adults, at 75.4%, 45.5%, and 28.4%, respectively. The presence of sarcopenia risk in hospitalized older adults with covid-19 increased the odds of ICU admission by more than 2-fold (OR: 2.71 [1.57; 4.68], p<0.001), nearly 5-fold for mechanical ventilation (OR: 5.19 [2.75; 9.78], p<0.001), and over 3-fold for mortality (OR: 4.05 [2.05; 7.98], p<0.001). Conclusion In hospitalized older adults with covid-19, pre-existing risk of sarcopenia was a predictor of unfavorable clinical outcomes.

Underreporting of energy intake is not associated with the reported consumption of NOVA-classified food groups in socially vulnerable women.

Few studies have investigated which types of food are least reported among underreporters of energy intake (EI). This study assessed the association between the underreporting of EI and the consumption report of food groups according to NOVA classification in women in social vulnerability. EI was measured through three 24-h dietary recalls administered by the research team. Total energy expenditure (TEE) was evaluated using the doubly labelled water method. The percentage of EI arising from each NOVA group food classification (unprocessed/minimally processed foods, culinary ingredients, processed foods and ultra-processed foods [UPF]) was calculated. The agreement between the EI and the TEE was assessed using the ratio EI:TEE. Associations were assessed with Pearson's correlation and multivariable linear regression, adjusted for age, education and body fat. The sample (63 women, age: 30.8 years, Body Mass Index: 27.6 kg/m2 ) reported an EI of 1849 kcal and a TEE of 2223 kcal, with a mean EI:TEE of 0.85. There were no significant correlations between the EI:TEE and the reported food intake according to NOVA classifications. Multivariable linear regression also did not show any significant associations (UPF: 8.47, 95% CI: [-3.65; 20.60] %kcal; Processed: -6.85, [-19.21; 7.71] %kcal; Culinary ingredients: 1.30 [-5.10; 7.71] %kcal; Unprocessed/minimally processed: -2.92 [-10.98; 5.13] %kcal). In conclusion, socially vulnerable women that underreport their EI do not report a lower intake of any specific group of foods according to NOVA classification.

Estimates of resting energy expenditure and total energy expenditure using predictive equations in adults with overweight and obesity: a systematic review with meta-analysis.

CONTEXT: Energy expenditure predictive equations can generate inaccurate estimates for overweight or obese individuals. OBJECTIVE: The objective of this review was to determine which predictive equations for resting energy expenditure (REE) and total energy expenditure (TEE) have the lowest bias and the highest precision in adults with overweight and obesity. DATA SOURCES: Searches were performed in January 2022 in MEDLINE, Web of Science, Scopus, CENTRAL, and the gray literature databases. DATA EXTRACTION: Meta-analyses were performed with equations included in more than 1 study. The DerSimonian and Laird random-effects model and the I2 statistic were used to quantify heterogeneity in the quantitative analyses. The Egger test was performed to assess potential publication biases, and metaregressions were conducted to explore the heterogeneity. Findings were presented separated by participants' body mass index classification (overweight and obesity). DATA ANALYSIS: Sixty-one studies were included. The FAO/WHO/UNU (1985) equation, which uses only body weight in its formula, showed the lowest bias in estimating REE (mean difference [MD] = 8.97 kcal; 95% CI = -26.99; 44.94). In the subgroup analysis for individuals with obesity, the Lazzer (2007) equation showed the lowest bias (MD = 4.70 kcal; 95% CI = -95.45; 104.86). The Harris-Benedict equation (1919) showed the highest precision values for individuals with overweight (60.65%) and for individuals with obesity (62.54%). Equations with body composition data showed the highest biases. The equation proposed by the Institute of Medicine (2005) showed the lowest bias (MD = -2.52 kcal; 95% CI = -125.94; 120.90) in estimating the TEE. Most analyses showed high heterogeneity (I2 > 90%). There was no evidence of publication bias. CONCLUSION: For individuals with overweight, the FAO/WHO/UNU (1985) and the Harris-Benedict equations (1919) showed the lowest bias and the highest precision in predicting the REE, respectively. For individuals with obesity, the Harris-Benedict equation (1919) showed the highest precision and the Lazzer equation (2007) showed the lowest bias. More studies are needed on predictive equations to estimate the TEE. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42021262969.