Associations of the consumption of unprocessed red meat and processed meat with the incidence of cardiovascular disease and mortality, and the dose-response relationship: A systematic review and meta-analysis of cohort studies.

OBJECTIVES: The aim of this study was to examine the associations of unprocessed red meat and processed meat consumption with cardiovascular disease (CVD) incidence and mortality, and the dose-response relationship. METHODS: Published literature was retrieved through a structured search of 10 electronic databases: MEDLINE/PubMed, Scopus, SciELO, LILACS, ScienceDirect, Web of Science, Cochrane (CENTRAL), WHOLIS, PAHO and Embase, without language or year of publication restrictions. In addition, we searched the references of published studies. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes: The PRISMA Statement. RESULTS: Twenty-one prospective cohort studies were included in the systematic review. The CVDs evaluated in the inserted studies were stroke, heart failure (HF) and coronary heart disease (CHD). Considering the heterogeneity found in the studies, for the meta-analysis, 9 articles were included. The results presented in the meta-analysis of the association of consumption of unprocessed red meat and CVD indicated that there was a significant association with total stroke incidence (RR 1.10; 95%; CI 1.01 to 1.19; p = 0.02). There was no association with Ischemic stroke incidence, nor CHD Mortality with consumption of unprocessed red meat. However, for Hemorrhagic Stroke Mortality the assessment in the consumption of unprocessed red meat showed an association of protection for women (RR 0.64; 95%; CI 0.45 to 0.91; p = 0.01). As for the results of the meta-analysis of the association between consumption of processed meat and CVD, they indicated that there was a significant association with total stroke incidence (RR 1.17; 95%; CI 1.08 to 1.26; p < 0.0001). There was no association with Ischemic stroke, nor with CHD Mortality with consumption of processed meat. Some studies that showed no association of risk, presented a significant linear trend dose response for the association of the consumption of unprocessed red meat (Bernstein et al. 2010; Nagao et al. 2012) or processed meat (Bernstein et al. 2012) and CVD. CONCLUSION: According to the results found in the meta-analysis, the consumption of unprocessed red meat and processed meat are associated with the incidence of stroke, however, no positive association was observed in relation to mortality from CVD. This systematic review and meta-analysis protocol was registered on the PROSPERO (number: CRD42019100914).

Development and validation of protocols for photographed food record by visually impaired people.

OBJECTIVE: To develop and validate protocols for photographed food record directed to visually impaired people. DESIGN: Photographic techniques were established for capturing food images using a smartphone, and written protocols were defined. Thereafter, visually impaired people made photographic records of three standardised meals (breakfast, lunch/dinner, and snack) following the previously developed protocols. These photographs were then evaluated by a panel of experts (nutritionists and photographer) to indicate whether the framing, focus and angle were suitable to identify the food type, food amount and portion size. Agreement between the experts was assessed using Fleiss' Kappa. SETTING: Natal, the capital of Rio Grande do Norte, Brazil. PARTICIPANTS: Visually impaired people (n 40); nutritionists (n 2); professional photographer (n 1). RESULTS: Both protocols obtained a high proportion of satisfactory photos for all the items in the three dimensions investigated. When overall quality was assessed, the experts' agreement was a substantial that through the images it would be possible to identify the food type and portion size, both for Frontal Photos (k = 0·70 and k = 0·62, respectively) and Aerial Photos (k = 0·68 and k = 0·70, respectively). The degree of agreement that the photos presented a satisfactory global quality was moderate for the Frontal Photo (k = 0·43) and substantial for the Aerial Photo (k = 0·64). Participants who frequently used smartphone-type cell phones obtained better quality images for all these attributes for both protocols. CONCLUSIONS: The protocols for photographed food record developed for visually impaired people in this study are feasible and present themselves as an alternative strategy to qualitatively assess their dietary intake.

Quality of life assessment instruments for adults: a systematic review of population-based studies.

BACKGROUND: Against a backdrop of population aging and improving survival rates for chronic noncommunicable diseases (CNCD), researchers are placing growing emphasis on health-related quality of life (HRQoL). The aim of this study was to identify the QoL assessment instruments used in population-based studies with adults conducted around the world. METHODS: A systematic review of original research published in all languages between 2008 and 2018 was conducted. Systematic reviews and meta-analyses were excluded. RESULTS: Sixty-three articles (38.1% conducted in the Americas) fitted the eligibility criteria. Based on the AHRQ checklist for cross-sectional studies and the Newcastle-Ottawa scale for cohort studies, methodological quality was shown to be fair in the majority of studies (55.6%) and good in 44.4%. The country with the highest number of publications was Brazil (20.6%). Twelve types of generic instruments and 11 specific instruments were identified. The generic instrument SF-36 was the most frequently used measure (33.3% of studies). In-home interviewing was exclusively used by 47.6% of the studies, while 39 studies (61.9%) reported the use of self-administered questionnaires. Over two-thirds of the studies (34.9%) used questionnaires to investigate the association between chronic diseases and/or associated factors. CONCLUSIONS: It was concluded that the wide range of instruments and modes of questionnaire administration used by the studies may hinder comparisons between population groups with the same characteristics or needs. There is a lack of research on QoL and the factors affecting productive capacity. Studies of QoL in older persons should focus not only on the effects of disease and treatment, but also on the determinants of active aging and actions designed to promote it. Further research is recommended to determine which QoL instruments are best suited for population-based studies.

Systematic review of the association between dietary patterns and perinatal anxiety and depression.

BACKGROUND: Specific dietary factors contribute to greater risks of prenatal and postpartum anxiety and depression. This study aimed to systematically review and assess the evidence regarding the association between dietary patterns and perinatal anxiety and depression (PAAD). METHODS: A systematic search of the Latin American & Caribbean Health Sciences Literature (LILACS), PubMed, and Scopus databases for cross-sectional and cohort studies through April 2019 was conducted. The methodological quality of the studies was assessed using the Newcastle-Ottawa scale (NOS) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the quality of evidence. RESULTS: Ten studies (six cohort and four cross-sectional) were included. All studies had good methodological quality. In these studies, the Western (n = 10), healthy (n = 9), and traditional (n = 7) dietary patterns were examined. The healthy pattern was inversely associated with prenatal and postpartum anxiety and prenatal depression. The traditional Japanese dietary pattern, the traditional Indian-confinement dietary pattern, the United Kingdom traditional dietary and the traditional Brazilian dietary pattern were associated with a lower risk of prenatal depression, postpartum depression, prenatal anxiety and postpartum anxiety, respectively. There was no significant association between a Western dietary pattern and PAAD. The GRADE assessment suggested that the quality of the evidence was very low to low across all outcomes owing to the design, risk of bias, and small sample size. CONCLUSIONS: There is no definitive evidence about the relationship between Western dietary patterns and perinatal anxiety and depression. However, it found an inverse association among the healthy dietary pattern and PAAD. Future studies will be required to better evaluate associations between meal patterns and PAAD. Such studies may provide new insights and assist in the development of new prevention and treatment strategies.

Motivations for weight loss in adolescents with overweight and obesity: a systematic review.

BACKGROUND: Adolescents with overweight and obesity report various motivations for weight loss other than the desire for better health. However, there is little evidence regarding the main motivations for weight loss in adolescents. The present systematic review aimed to identify the motivations for weight loss in adolescents with overweight and obesity. METHODS: A systematic search for original articles published up to December 2016 was carried out in the PubMed, Scopus, LILACS, and ADOLEC databases. The terms used in the search were: motivation, motive, reason, "weight loss," "lose weight," and adolescent. RESULTS: Six studies (all cross-sectional) met the selection criteria and were included in the review. The instruments used to assess the participants' motivations for weight loss were interviews and questionnaires with open questions. Seventeen motivations for weight loss were identified, the main ones being better health, esthetic/cosmetic reasons, improvements in self-esteem, and avoidance of provocation/bullying. CONCLUSIONS: The results of the present review show the need for validated instruments to assess the motivations for weight loss in adolescents with overweight and obesity. Moreover, the high frequency of motivations for weight loss related to appearance and social acceptance evidences the need for multidisciplinary weight loss interventions that consider not only the biological factors, but also the psychological and social aspects.

The relationship of the oleic acid level and ECHDC3 mRNA expression with the extent of coronary lesion.

BACKGROUND: The fatty acid profile is associated with the risk and progression of several diseases, probably via mechanisms including its influence on gene expression. We previously reported a correlation between ECHDC3 upregulation and the severity of acute coronary syndrome. Here, we assessed the relationship of serum fatty acid profile and ECHDC3 expression with the extent of coronary lesion. METHODS: Fifty-nine individuals aged 30 to 74 years and undergoing elective cinecoronariography for the first time were enrolled in the present study. The extent of coronary lesion was assessed by the Friesinger index and patients were classified as without lesion (n = 18), low lesion (n = 17), intermediate lesion (n = 17) and major lesion (n = 7). Serum biochemistry, fatty acid concentration, and ECHDC3 mRNA expression in blood were evaluated. RESULTS: Elevated serum levels of oleic acid and total monounsaturated fatty acids were observed in patients with low and intermediate lesion, when compared to patients without lesion (p < 0.05). ECHDC3 mRNA expression was 1.2 fold higher in patients with low lesion than in patients without lesion (p = 0.020), and 1.8 fold lower in patients with major lesion patients than in patients with low lesion (p = 0.023). CONCLUSION: Increased levels of monounsaturated fatty acids, especially oleic acid, and ECHDC3 upregulation in patients with coronary artery lesion suggests that these are independent factors associated with the initial progression of cardiovascular disease.

Associations between Components of Metabolic Syndrome and Demographic, Nutritional, and Lifestyle Factors.

Objectives: To evaluate the associations between individuals with and without changes in components of metabolic syndrome (MetS) and demographic, nutritional, and lifestyle factors. Methods: A cross-sectional study was conducted with 224 individuals followed-up at a public hospital in Northeast Brazil. We used National Cholesterol Education Program-Adult Treatment Panel III (NCEP) criteria to diagnose MetS. We assessed components of MetS as dependent variables, while sex, age, food consumption, smoking, alcohol intake, physical activity, anthropometric parameters, and sleep hours were independent variables. Results: Comparing individuals with and without changes in components of MetS, the logistic regression models revealed that female sex was predictive of increased waist circumference and low HDL-c levels while advanced age was predictive of increased blood pressure and blood glucose levels. BMI emerged as a predictor for waist circumference and a protective factor for triglyceride levels. In addition, potassium intake, physical activity, and sleep duration were protective against decreased HDL-c, elevated triglyceride, and elevated blood pressure levels, respectively. Conclusion: This study demonstrated that sex, age, BMI, dietary potassium intake, physical activity, and hours of sleep are factors to be targeted in public health actions for prevention and treatment of MetS.

Plasma Levels of Magnesium, Calcium, Calcium to Magnesium Ratio, and Associations with Metabolic Syndrome and Cardiometabolic Risk Factors.

Magnesium and calcium are elements that have been associated with cardiometabolic risk factors related to metabolic syndrome (MetS). However, there are gaps in the knowledge regarding the impact of the calcium to magnesium (Ca/Mg) ratio in plasma. Thus, we aim to evaluate the associations between magnesium and calcium levels in plasma, and the Ca/Mg ratio in plasma with MetS components and other cardiometabolic risk factors. This cross-sectional study was carried out with 112 adults and older people, distributed into groups with (n = 60) and without MetS (n = 52). We evaluated sociodemographic, anthropometric, and biochemical data. Magnesium and calcium levels in plasma were measured by inductively coupled plasma mass spectrometry technique (ICP-MS). There was a high frequency of MetS, with no significant differences in magnesium and calcium levels and Ca/Mg ratio in plasma observed between groups. There were no associations between magnesium and MetS components or other cardiometabolic risk factors (all p > 0.05). Calcium levels were associated with total cholesterol (ß = - 0.020; p = 0.000) and high-density lipoprotein cholesterol (HDL-c) (ß = - 0.046; p = 0.005). The total cholesterol (ß = - 0.025; p = 0.000) and low-density lipoprotein cholesterol (LDL-c) (ß = 0.017; p = 0.020) were preditors of the Ca/Mg ratio. These results indicate important associations of calcium and the Ca/Mg ratio in plasma with cardiometabolic risk factors related to MetS.

Accuracy of dietary intake assessments using food records based on photographic images captured by visually impaired people.

Traditional methods to assess dietary intake have limited and questionable application in visually impaired people since the lack of vision and low leading role in their diet make it difficult to quantify and detail the food consumed throughout the day. Thus, this study investigated whether it is possible to accurately identify foods and estimate their quantities using food records based on photographic images captured by visually impaired people. A panel of experts composed of nutritionists (n = 20) assessed these records comprising three standardized meals (breakfast; lunch/dinner; snack) from visually impaired people (n = 40) using two different protocols (frontal photo; aerial photo). Each nutritionist reported an estimated food record for each photographic image, which was compared to its respective weighed food record. For both frontal and aerial photos, experts were frequently correct for the number of food items in the meal (95.0% or over for breakfast, 100% for lunch/dinner, and 100% for snacks). All experts identified at least 11 of the 13 food items, but the majority correctly estimated the food amount only for 23% of the items. Compared to the weighed food record, the photographic records underestimated the amount of 61.5% of food items based on frontal photos, and of 76.9% of food items based on aerial photos. While most foods could be identified by photographic images captured by visually impaired people enabling a qualitative assessment of the diet, they could not be quantified accurately by nutritionists.

Indices for measurement of sustainable diets: A scoping review.

INTRODUCTION: The current food system is associated with negative impacts on health, food insecurity and environmental harm. Sustainable diets have attracted increasing interest and novel proposals with a global scope have emerged. This scoping review aims to give an overview of the analysis of all the available evidence related to the sustainable diet indices that have been developed based on the EAT-Lancet Commission. METHODS: Searches were conducted in the PubMed, Embase, Web of Science, Scopus and Science Direct databases. This review was conducted following the PRISMA-ScR guidelines. The target population were studies addressed the use of an index or metric for assessing sustainable diets based on the EAT-Lancet Commission Summary Report were included. PCC acronym was used in the design of the study to describe eligibility criteria: P (Population)-Indexes; C (Concept)-Sustainable diets; C (Context)-Knowledge on the structure and applicability of measurement indices of sustainable diets based on EAT-Lancet recommendations available in the literature. Study eligibility criteria were restricted to papers published in English, from January 2019 through October 2022, with no population restriction. RESULTS: A total of 1,458 papers were retrieved, 14 of which were included in the review. Seven measures of sustainable diets were identified as follow: EAT-Lancet diet score (ELD-I), New EAT-Lancet diet score (EAT), Planetary Health Diet Index (PHDI), Sustainable Diet Index (SDI), Sustainable-HEalthy-Diet (SHED), novel Nutrient-Based EAT index (NB-EAT) and World Index for Sustainability and Health (WISH). Most studies were conducted in developed countries, where greater adherence to this type of diet was found. Estimated greenhouse gas emissions was the most reported indicator of sustainability, followed by diet quality and the benefits of sustainable diets with regards to health outcomes. DISCUSSION: We identified barriers that hinder progress towards sustainable diets, including the difficulty of comparing different indices and the tendency to neglect social aspects and the lack of common definitions and metrics. Despite being challenge, we highlight the importance of using indices that assess sustainable diets that harmonize various indicators, as recommended by the EAT-Lancet Commission, in order to promote positive changes towards a more sustainable future.

Plasma lipid metabolites as potential biomarkers for identifying individuals at risk of obesity-induced metabolic complications.

Lipidomics studies have indicated an association between obesity and lipid metabolism dysfunction. This study aimed to evaluate and compare cardiometabolic risk factors, and the lipidomic profile in adults and older people. A cross-sectional study was conducted with 72 individuals, divided into two sex and age-matched groups: obese (body mass index-BMI ≥ 30 kg/m2; n = 36) and non-obese (BMI < 30 kg/m2; n = 36). The lipidomic profiles were evaluated in plasma using 1H nuclear magnetic resonance (1H-NMR) spectroscopy. Obese individuals had higher waist circumference (p < 0.001), visceral adiposity index (p = 0.029), homeostatic model assessment insulin resistance (HOMA-IR) (p = 0.010), and triacylglycerols (TAG) levels (p = 0.018). 1H-NMR analysis identified higher amounts of saturated lipid metabolite fragments, lower levels of unsaturated lipids, and some phosphatidylcholine species in the obese group. Two powerful machine learning (ML) models-k-nearest neighbors (kNN) and XGBoost (XGB) were employed to characterize the lipidomic profile of obese individuals. The results revealed metabolic alterations associated with obesity in the NMR signals. The models achieved high accuracy of 86% and 81%, respectively. The feature importance analysis identified signal at 1.50-1.60 ppm (-CO-CH2-CH2-, Cholesterol and fatty acid in TAG, Phospholipids) to have the highest importance in the two models.

Prediction equations for fat and fat-free body mass in adolescents, based on body circumferences.

BACKGROUND: Fat mass (FM) and fat-free body mass (FFB) are important parameters for assessing nutritional status, since they are associated with higher prevalence of excess body fat and malnutrition worldwide. AIM: To develop prediction equations for fat and fat-free body mass in adolescents using body circumferences. SUBJECTS AND METHODS: This cross-sectional study included 218 adolescents (10-16 years) with normal weight as defined by body mass index. FM(Pred) and FFB(Pred) were estimated using stepwise multiple linear regression, considering age and body circumferences. Response variables, FM(BIA) and FFB(BIA) were estimated using bioelectric impedance analysis (BIA). The accuracy of the prediction equations was evaluated using the coefficient of determination (R(2)) and Akaike's Information Criterion (AIC). RESULTS: The best prediction equations for males were FM(Pred) = -7.114 - 0.592(age) - 0.958(wrist)+0.191(hip)+0.295(abdomen); R(2) = 0.552; AIC = 416.04 and FFB(Pred) = - 52.180+1.913(age)+1.954(wrist)+1.635(forearm); R(2) = 0.869; AIC = 578.24. For females, the best equations were FM(Pred) = -17.580 - 0.678(wrist)+0.221(abdomen)+0.241(hip)+0.202(proximal thigh) - 0.228(calf); R(2) = 0.838; AIC = 415.36 and FFB(Pred) = -31.066+0.90(age)+1.090(wrist) - 0.139(abdomen)+0.326(hip)+0.632(calf); R(2) = 0.878; AIC = 512.48. CONCLUSION: The equations developed to estimate fat body mass in females and fat-free body mass in both genders had high adjusted coefficients of determination and are therefore preferable to those derived using BIA.

The impact of essential and toxic elements on cardiometabolic risk factors in adults and older people.

BACKGROUND AND AIM: Evidence suggests an association between essential and toxic elements and the worsening of cardiometabolic risk factors. This study aimed to investigate the concentrations of zinc, copper, selenium, arsenic, cadmium, and mercury and their relationship with cardiometabolic risk factors in adults and older people. METHODS: This cross-sectional study was carried out with 112 adults with a mean age of 59 (sd 14) years old and a BMI of 29.30 (sd 5.11) Kg/m2. The subject's weight and height were measured for body mass index (BMI) calculation, classified according to the cut-off points recommended by the World Health Organization (WHO). We evaluated sociodemographic, clinical, lifestyle, waist circumference - WC, visceral adiposity index - VAI, glycemic lipid profile, blood pressure, and high-sensitive C-reactive protein (hs-CRP). Cardiovascular risk was defined by The Global Risk Score (GRS) score. Plasma zinc, selenium, copper levels, urinary arsenic, cadmium, and mercury levels were measured using the inductively coupled plasma mass spectrometry technique (ICP-MS). RESULTS: There was a negative association between urinary arsenic and VAI (ß - 0.03, p < 0.01), triglycerides (ß - 1.10, p < 0.01), and VLDL cholesterol (ß - 0.14, p = 0.02). Plasma copper and copper/zinc ratio were positively associated with fasting glucose and hs-CRP (ß 0.38, p < 0.01; ß 36.02, p = 0.01, ß 0.004, p < 0.01, ß 0.68, p < 0.001, respectively). Urinary arsenic (ß - 0.14, p = 0.04) and cadmium (ß - 36.42, p = 0.04) were negatively associated with systolic blood pressure. Also, urinary cadmium was negatively associated with diastolic blood pressure (ß - 21.55, p = 0.03), and urinary mercury showed an opposite behavior (ß 1.45, p = 0.03). CONCLUSION: Essential and toxic elements in urine and plasma could be potential biomarkers for cardiovascular risk factors. A healthy lifestyle should be adopted; in addition, government policies should be developed to guarantee sustainable production and a safe environment.

A methodological proposal for assessing food insecurity from a multidimensional perspective. / Proposta metodológica para avaliação da insegurança alimentar sob a ótica de suas múltiplas dimensões.

The aim of this study was to develop a methodological proposal for the assessment of food and nutritional insecurity (FNiS) in adults and older adults (Vigi-FNiS). The proposal was developed using data from the BRAZUCA Natal survey, a cross-sectional study with 411 people living in Natal in the state of Rio Grande do Norte, Brazil. The association between sociodemographic, health and nutrition variables and food insecurity (FI) was tested using Poisson multiple regression. Overall prevalence of FI was 42.1% (37.4%-46.9%) and was higher in women (47.5%), adults (48.2%) and black people (52.7%). The following variables were included in the Vigi-FNiS: people aged <18 years living in the household (A) (AdjPR=1.3; 1.1-1.6); family income (B) in quintiles (Q1: AdjPR=5, 4; 2.5-11.7; Q2: AdjPR=4.8; 2.2-10.5; Q3: AdjPR=3.8; 1.8-8.5; Q4 AdjPR=2.2; 1.0-5.1); inadequate treatment of drinking water (C) (AdjPR=1.3; 1.1-1.5); presence of chronic non-communicable diseases (D) (AdjPR=1.3; 1.1-1.7); not eating fruit for breakfast (E) (AdjPR=1.7; 1.3-2.5);eating meals on the couch or in bed (F) (AdjPR=1.3; 1.1-1.6); and skipping either lunch or dinner or dinner (G) (AdjPR=1.4; 1.2-1.7). A cutoff point for FNiS of 2.3 was adopted (Kappa=0.47; sensitivity=0.82; specificity=0.67; PPV=0.64; NPV=0.83).

O objetivo deste artigo é desenvolver uma proposta metodológica para avaliar a insegurança alimentar e nutricional (INSAN) em adultos e idosos. A proposta metodológica Vigi-INSAN foi elaborada com dados do Brazuca Natal, um estudo transversal com 411 residentes de Natal-RN. O modelo preditivo foi desenvolvido por regressão múltipla de Poisson, analisando-se as variáveis sociodemográficas, de saúde e nutrição, e a insegurança alimentar (IA). A prevalência de IA foi 42,1% (37,4%-46,9%), sendo maior em mulheres (47,5%), adultos (48,2%) e pessoas de cor/raça preta (52,7%). O Vigi-INSAN foi composto por: presença de <18 anos no domicílio (A) (RPaj=1,3; 1,1-1,6), renda familiar (B) (em quintis) (Q1: RPaj=5,4; 2,5-11,7; Q2: RPaj=4,8; 2,2-10,5; Q3: RPaj=3,8; 1,8-8,5; Q4 RPaj=2,2; 1,0-5,1), tratamento inadequado da água de beber (C) (RPaj=1,3; 1,1-1,5), presença de DCNT (D) (RPaj=1,3; 1,1-1,7), não comer frutas no café da manhã (E) (RPaj=1,7; 1,3-2,5), realizar refeições no sofá da sala ou na cama (F) (RPaj=1,3; 1,1-1,6) e pular pelo menos o almoço ou o jantar (G) (RPaj=1,4; 1,2-1,7). Foi adotado o ponto de corte 2,3 (Kappa=0,47; Sensibilidade=0,82; Especificidade=0,67; VPP=0,64; VPN=0,83).

Assessment of Biodiversity in Food Consumption Studies: A Systematic Review.

The assessment of food biodiversity has gained importance in nutrition due to the positive association between the diversity of foods consumed and the quality of diets. To date, however, we do not know systematically how food consumption studies address food biodiversity. Our objective with this paper was to characterize how food consumption studies address biodiverse foods, both in terms of (i) new methods capable of overcoming the limitations of existing methods, and (ii) indicators capable of measuring the contribution of biodiversity to nutrition. We conducted a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), using four databases: Web of Science, Medline/PubMed (via National Library of Medicine), Scopus, and Google Scholar. We selected papers focused on the consumption of biodiverse foods without time constraints. In addition, we assessed the methodological quality of the studies we selected. We reviewed a total of 22 studies, and summarized the methods and indicators most used. We found that some researchers used biodiversity mapping strategies based on ethnographic approaches before the dietary assessment. Regarding dietary assessment tools, retrospective direct methods were the most used by researchers. We list 23 indicators used by the authors, among them the Dietary Species Richness (DSR), used in 18% of the studies. Studies that used biodiversity mapping strategies based on ethnographic approaches before the dietary assessment portrayed the local availability of biodiverse foods more consistently, i.e., presented lists with local edible species satisfactorily identified. We believe researchers in the future can avoid many of the limitations of current methods by ensuring that teams are interprofessional. We emphasize that most of the indicators we summarized are not sensitive enough to biodiversity since they do not measure edible resources at the species level. In this sense, the DSR is promising, because it fills information gaps, especially in the case of wild or neglected species.

A Systematic Review on Processed/Ultra-Processed Foods and Arterial Hypertension in Adults and Older People.

The increase in the availability of processed and ultra-processed foods has altered the eating patterns of populations, and these foods constitute an exposure factor for the development of arterial hypertension. This systematic review analyzed evidence of the association between consumption of processed/ultra-processed foods and arterial hypertension in adults and older people. Electronic searches for relevant articles were performed in the PUBMED, EMBASE and LILACS databases. The review was conducted following the PRISMA guidelines and the Newcastle-Ottawa Scale. The search of the databases led to the retrieval of 2323 articles, eight of which were included in the review. A positive association was found between the consumption of ultra-processed foods and blood pressure/arterial hypertension, whereas insufficient evidence was found for the association between the consumption of processed foods and arterial hypertension. The results reveal the high consumption of ultra-processed foods in developed and middle-income countries, warning of the health risks of such foods, which have a high energy density and are rich in salt, sugar and fat. The findings underscore the urgent need for the adoption of measures that exert a positive impact on the quality of life of populations, especially those at greater risk, such as adults and older people.

Dietary Environmental Footprints and Their Association with Socioeconomic Factors and Food Purchase Practices: BRAZUCA Natal Study.

The analysis of dietary environmental impacts has proven to be an important tool for guiding the adoption of healthier and more sustainable diets. This study aimed to estimate the dietary carbon (CF), water (WF), and ecological (EF) footprints of residents in the city of Natal, Brazil; the study also aimed to verify their association with socioeconomic factors and food purchase practices. This is a cross-sectional study that used dietary data from 411 adults and elderlies, which was collected via a questionnaire that applied to the respondents. The results showed that the dietary CF was 1901.88 g CO2 eq/day/1000 kcal, the WF was 1834.03 L/day/1000 kcal, and the EF was 14.29 m2/day/1000 kcal. The highest environmental footprint values showed an association (p ≤ 0.05) with the factors of male sex, white ethnicity, and higher income and schooling, whereas the lowest environmental footprint values were associated with social vulnerability variables such as female sex, non-white ethnicity, and lower income and schooling (p ≤ 0.05). Moreover, people with lower environmental footprints consumed less fast food, had fewer meals at snack bars, and used food delivery services less often than those with higher footprints. The foods that most contributed to the CFs and WFs were beef and chicken, while fish and beef contribute the most to the EFs. The data in the present study show that a diet with a lower environmental impact is not always equal to a sustainable diet. This relationship is paradoxical and relates to food justice, as people with lower environmental footprint values are the same ones with worse socioeconomic conditions. In this sense, is it essential to consider the influence of the social context when assessing dietary environmental impacts and when assessing actions that promote healthier and more sustainable diets.

Environmental footprints of food consumption: Protocol for a systematic literature review.

Environmental footprints are indicators that can be used to estimate the impacts of diet on the environment. Since contemporary dietary practices are related to negative environmental impacts, this paper aims to describe a systematic review protocol to investigate the environmental footprints of food consumption by adults and elderly individuals worldwide. This protocol was developed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Search strategies and records of evidence searched in previously defined electronic databases will be defined. Original, population-based articles investigating the environmental footprints of food consumption by adults and the elderly will be included. Two independent reviewers will conduct the study selection and data extraction steps. Critical appraisal of the included studies will be based on the Newcastle-Ottawa Scale. For data synthesis, a narrative synthesis and, if possible, also a meta-analysis will be performed. The systematic review produced from this protocol will provide evidence for data synthesis of the environmental impact through environmental footprints of food consumption of the adult and elderly population from different territories and the footprint assessment tools used around the world. Therefore, it is a gap that needs to be filled because knowing these impacts will be important to inform the development of public policies that encourage healthy and sustainable food in the face of climate and epidemiological changes. PROSPERO registration number: CRD42021281488.

Biomarkers of Zinc and Copper Status and Associated Factors in Outpatients with Ischemic and Non-Ischemic Heart Failure.

Background: Few studies have explored the impact of ischemic and non-ischemic etiologies of heart failure and other factors associated with heart failure on zinc and copper status. This study examined zinc and copper status in 80 outpatients with ischemic (n = 36) and non-ischemic (n = 44) heart failure and associations with biodemographic, clinical, biochemical, and nutritional parameters.Materials: Biomarkers of plasma zinc and copper, copper-zinc ratio, 24-h urinary zinc excretion, ceruloplasmin, and dietary intake of zinc and copper were assessed. Plasma zinc and copper and urinary zinc were measured by inductively coupled plasma mass spectrometry (ICP-MS).Results: Patients with ischemic heart failure showed lower dietary zinc intake and higher dietary copper intake (both p = 0.02). Zinc and copper in plasma, copper-zinc ratio, ceruloplasmin, and 24-h urinary zinc excretion showed no statistical differences between the groups (all p ≥ 0.05). An inverse association was found between age (ß =-0.001; p = 0.005) and the use of diuretics (ß = -0.047; p = 0.013) and plasma zinc. Copper levels in plasma (ß = 0.001; p < 0.001), and albumin (ß = 0.090; p<0.001) were directly associated with plasma zinc. A positive association was found between ceruloplasmin (ß = 0.011; p < 0.001), gamma-glutamyl transferase (ß = 0.001; p < 0.001), albumin (ß = 0.077; p = 0.001), and high-sensitivity c-reactive protein (ß = 0.001; p = 0.024) and plasma copper.Conclusion: Zinc and copper biomarkers in clinically stable patients with heart failure did not seem to be responsive to the differences in zinc and copper intake observed in this study, regardless of heart failure etiology. The predictors of plasma zinc and copper levels related to oxidative stress and inflammation should be monitored in heart failure clinical practice.

Chronic diseases and emotional disorders are associated with low perception of quality of life in food insecurity/security.

Understanding individual perception of Quality of Life (QoL) can help combat social and health inequalities. We aimed to identify factors associated with Low Perceived Quality of Life (LPQoL) in 295 adults and older adults with food security and food insecurity, in the city of Natal, Brazil. A cross-sectional study was conducted from June to December 2019, with collection of data on socioeconomic demographic status, lifestyle information, non-communicable diseases (NCDs) and risk factors, emotional disorders, food (in) security and quality of life. To assess food insecurity, the Brazilian Scale of Food Insecurity-EBIA was used, and the WHOQOL-Bref questionnaire was used to assess quality of life. Poisson's Regression was used to verify associations between variables and LPQoL, stratifying the sample into food secure (FS) and food insecure (FI) groups. In the FI group, being overweight, older adult, having no partner, drinking alcoholic beverages twice a week or more, and not having daily availability of water were associated with LPQoL, and in the FS group, having diabetes, monthly family income in the 1st and 2nd tertiles, and never having studied was associated with LPQoL. Reporting emotional disorders and sleeping < 7 h/day were associated with LPQoL in both FI and FS groups. LPQoL was associated with the occurrence of NCDs and risk factors, and emotional disorders, regardless of the food security measure. However, the lack of adequate access to water highlights the social vulnerability of the FI group.