Prudent dietary pattern influences homocysteine level more than folate, vitamin B12, and docosahexaenoic acid: a structural equation model approach.

PURPOSE: A structural equation model (SEM) was used to test multiple and simultaneous relationships between socio-demographic factors, dietary patterns, biochemical levels of folate, vitamin B12, docosahexaenoic acid (DHA), and its effects on homocysteine (Hcy) level. METHODS: Socio-demographic and lifestyle characteristics, blood sample, anthropometric measurements, and a food-frequency questionnaire (FFQ) were obtained from 281 individuals of ISA-Capital study (Sao Paulo, Brazil). The dietary patterns (DP) were estimated using factor analysis with principal component's estimation based on the frequency of daily intake derived from the 38-item FFQ. The SEM considered a theoretical model where the DP were expected to be directly associated with Hcy level, and indirectly via biochemical levels of folate, vitamin B12, and DHA. The variables sex, age, ethnicity, and MTHFR C677T polymorphism were included in the model. RESULTS: The Prudent DP (- 0.12, p = 0.04) had a negative effect, while MTHFR C677T polymorphism (0.16, p = 0.01), age (0.22, p < 0.01), and being man (0.16, p = 0.01) had a positive effect on Hcy level. There were no indirect effects of any dietary patterns on Hcy level, neither via folate, vitamin B12, nor DHA. DHA was negatively associated with the Modern DP (- 0.12, p = 0.04) and positively associated with the Prudent DP (0.19, p < 0.01). CONCLUSIONS: The DP mainly composed of fruits and vegetables, natural juices, potato/cassava/cooked cornmeal, fish, and chicken, which was negatively associated with the Hcy level in this population. These findings support the role of a healthy dietary pattern in health outcomes, rather than promoting specific foods or nutrients, for policy-based health promotion strategies.

Main meal quality in Brazil and United Kingdom: Similarities and differences.

Consumption of fast food and ready-to-eat meals has been positively associated with obesity. In the UK, ready-made meals are more often consumed than in Brazil, a country in which nutrition transition is relatively low. This study aimed to compare the nutritional quality of the main meal consumed by adults in Brazil and UK. Food record data was obtained from representative samples from UK and Brazil databases. The Main Meal Quality Index (MMQI) was applied to estimate the quality of the main meal consumed in Brazil and UK. Differences in food groups consumed in the main meal in Brazil and UK were observed using classification decision tree. Meals with higher average energy content were lunch for Brazil, and dinner for the UK. On average, the Brazilian main meal had better nutritional quality (4.42 times higher), independently of sex, age, family income, nutritional status and energy consumed, with higher scores of fiber, carbohydrate, total fat, saturated fat and energy density. However, UK's main meal included more fruits and vegetables. Food preparations combined with rice and beans were classified as Brazilian main meal, while combinations with fast food items, as fried potatoes, sandwiches and sugary beverages, were classified as UK main meals. In Brazil, the main meal quality was lower among women and obese individuals, presenting significant positive association with age, and negative association with energy intake and family income; while in UK, only age was positively associated with MMQI. Although main meals in Brazil had higher nutritional quality compared to the UK, main meals consumed in both countries need nutritional improvement.

The interaction of the FTO gene and age interferes with macronutrient and vitamin intake in women with morbid obesity.

Fat mass and obesity-related (FTO) gene single nucleotide polymorphisms (SNPs) interferes with food preferences that impact macronutrient intake. Few studies have investigated the relationship of this polymorphisms with the intake of micronutrients. Moreover, studies have shown multiple micronutrient deficiencies in patients with obesity. This work evaluated the effect of the FTO rs9939609 gene polymorphism on dietary nutritional quality and food intake of macronutrients and vitamins in of women with obesity candidates for metabolic surgery. The study included 106 women (24 to 60 years old) with BMIs of 36.1 to 64.8 kg/m2. A food frequency questionnaire validated for the local population was applied to obtain information about food intake. The Index of Nutritional Quality (INQ) was used to assess the adequacy of macronutrient and vitamin intake. Energy, protein and lipid intakes were higher in carriers of the A allele compared to TT in the younger age groups but were similar in the class of subjects aged ≥45 years. The INQ for protein was higher in carriers of the A allele than in carriers of the TT allele. The INQs for protein, carbohydrate, vitamins B2, B3 and B6 decreased, whereas the INQ for vitamin C increased with advancing age. The INQ for vitamin A was lower in AA than in TT, regardless of age, whereas vitamin E was higher in younger AA than in older AA. The INQ for vitamin B9 was higher in younger women than in older women. In conclusion, the FTO gene contributed to the intake of more energy, protein and lipids and interfered with the intake of vitamins B9, A and E. With the exception of vitamin A, the effect of the genotype was attenuated with ageing.

How many meals and snacks do Brazilians eat a day? Findings from the 2017-2018 Brazilian National Dietary Survey.

The habit of eating specific meals has been addressed in several studies, but the evaluation of meal patterns has received less attention. This study aimed to describe the meal patterns of the Brazilian population. A complex sampling design was used to select the 46,164 ≥ 10-year-old individuals examined in the Brazilian National Dietary Survey. Food consumption was assessed by two non-consecutive 24-hour recalls applied throughout a one-week period. The exploratory data analysis approach was used to determine the meal patterns, i.e., how individuals combined the main meals (breakfast, lunch, dinner) and snacks (morning, afternoon, evening/night) throughout the day. The most common meal patterns were three main meals + one snack, reported by 25.1% of the individuals, and three main meals + two snacks (24.6%). Other meal patterns identified were: three main meals + three snacks (18.5%); three main meals and no snacks (10.9%); one or two main meals + two snacks (7.4%); one or two main meals + one snack (6.9%); one or two main meals + three snacks (4.2%); and one or two main meals and no snacks (2.3%). Meal patterns varied according to gender and age group, and on typical versus atypical food consumption days. We found that eight patterns characterized the daily meal consumption in Brazil. Furthermore, around 80% of the population had three main meals every day and about 13% did not report having any snacks. The characterization of meal habits is important for tailoring and targeting health promotion actions.

Nutritional quality of major meals consumed away from home in Brazil and its association with the overall diet quality.

OBJECTIVE: The objective of the study is to evaluate the nutritional quality of meals consumed away from home and its association with overall diet quality. METHOD: Data was obtained from 834 participants of a Health Survey in São Paulo, Brazil. Food intake was measured by a 24-hour dietary recall applied telephonically using the Automated Multiple-Pass Method. Overall dietary quality was assessed by the Brazilian Healthy Eating Index Revised (B-HEIR) and the Meal Quality Index (MQI) was used to evaluate dietary quality of the main meals. The association between the B-HEIR and the MQI was assessed by linear regression analysis. RESULTS: The consumption of at least one of the three main meals away from home was reported for 32% of respondents (70 adolescents, 156 adults and 40 elderly). The average MQI score of lunch consumed away from home was lower than lunch consumed at home, with higher amounts of total and saturated fats. The average score of B-HEIR was 58 points and was associated with the MQI score, energy, meal consumption location and gender. CONCLUSION: Lunch consumed away from home presented the worst quality, being higher in total and saturated fat. However, the meals consumed at home also need improvement.

Food Insecurity and Associated Factors in Brazilian Undergraduates during the COVID-19 Pandemic.

Undergraduates may face challenges to assure food security, related to economic and mental distress, especially during the COVID-19 pandemic. This study aimed to assess food insecurity and its associated factors in undergraduates during the COVID-19 pandemic. An online cross-sectional study was conducted from August 2020 to February 2021 with 4775 undergraduates from all Brazilian regions. The questionnaire contained socio-economic variables, the validated Brazilian food insecurity scale, and the ESQUADA scale to assess diet quality. The median age of the students was 22.0 years, and 48.0% reported income decreasing with the pandemic. Food insecurity was present in 38.6% of the students, 4.5% with severe food insecurity and 7.7% moderate. Logistic regressions showed students with brown and black skin color/race presented the highest OR for food insecurity; both income and weight increase or reduction during the pandemic was also associated with a higher OR for food insecurity, and better diet quality was associated with decreased OR for food insecurity. Our study showed a considerable presence of food insecurity in undergraduates. Policy for this population must be directed to the most vulnerable: those with brown and black skin color/race, who changed income during the pandemic, and those presented with difficulties maintaining weight and with poor diet quality.

Association of dietary patterns with blood pressure and body adiposity in adolescents: a systematic review.

This paper aimed to systematically review the results of observational studies that investigated the association of dietary patterns with blood pressure and body adiposity markers in adolescents. Articles were searched in July 2020 in PubMed, Scopus, Web of Science, and Scientific Electronic Library Online (SciELO). Of the 3408 studies found, 24 fulfilled the inclusion criteria and were considered in this review. Almost all studies (n = 23) identified at least one unhealthy pattern, predominantly characterized as consumption of confectionery, refined grains, sweets, sweetened drinks, red meats, and processed meats. Fourteen of the twenty-four studies found a significant association between any dietary pattern and blood pressure and/or body adiposity markers. There was a positive association of dietary patterns - characterized by the consumption of foods rich in sodium, animal fat, refined carbohydrates, and low in fiber - with increased blood pressure and body adiposity. Our findings highlight the importance of studies with this scope, whose results can support the surveillance of adolescent's health. However, considering the limited number of studies that found a significant association and their limitations, the present results should be interpreted carefully. More prospective studies are needed to determine how adherence to dietary patterns could influence blood pressure and body adiposity markers in the long term.

Breakfast skipping and cardiometabolic risk factors in adolescents: Systematic review.

OBJECTIVE: To systematically review the results of the association between breakfast skipping and cardiometabolic risk factors in adolescents. METHODS: The articles were searched in May 2020 from PubMed, Virtual Health Library, Scopus, Web of Science and Scientific Electronic Library Online (SciELO). The review included observational studies conducted with adolescents (10-19 years old), which estimated the association of breakfast skipping with at least one outcome (markers of body adiposity, blood pressure, serum lipid and glucose levels). Regarding the risk of bias, the articles were evaluated using the Research Triangle Institute (RTI) Item Bank on bias risk and accuracy of observational studies. The quality of the evidence was assessed by the Grade rating. RESULTS: A total of 43 articles involving 192,262 participants met the inclusion criteria and were considered in this review. The prevalence of breakfast skipping ranged from 0.7% to 94% and 60.5% of studies were classified with low risk of bias. The significant association between breakfast skipping and cardiometabolic risk factors was found in twenty-nine cross-sectional articles (n = 106,031) and four longitudinal articles (n = 5,162) for excess adiposity, in three articles (n = 8,511) for high total cholesterol levels, low-density lipoprotein and triglycerides, and in three studies (n = 6,303) for high blood pressure levels. However, there was no significant association between breakfast skipping and glycemic profile. According to the Grade rating, all the associations had low quality of evidence. CONCLUSION: The results of this review suggest that breakfast skipping is associated with cardiometabolic risk factors in adolescents aged 10 to 19 years. However, considering the low quality of the evidence, the present results should be interpreted carefully. In addition, our findings highlight the importance of standardizing the definition of breakfast skipping and that more prospective studies are needed to determine how skipping breakfast can affect cardiometabolic risk factors in the long time.

Principal Component Analysis and Factor Analysis: differences and similarities in Nutritional Epidemiology application.

INTRODUCTION: Statistical methods such as Principal Component Analysis (PCA) and Factor Analysis (FA) are increasingly popular in Nutritional Epidemiology studies. However, misunderstandings regarding the choice and application of these methods have been observed. OBJECTIVES: This study aims to compare and present the main differences and similarities between FA and PCA, focusing on their applicability to nutritional studies. METHODS: PCA and FA were applied on a matrix of 34 variables expressing the mean food intake of 1,102 individuals from a population-based study. RESULTS: Two factors were extracted and, together, they explained 57.66% of the common variance of food group variables, while five components were extracted, explaining 26.25% of the total variance of food group variables. Among the main differences of these two methods are: normality assumption, matrices of variance-covariance/correlation and its explained variance, factorial scores, and associated error. The similarities are: both analyses are used for data reduction, the sample size usually needs to be big, correlated data, and they are based on matrices of variance-covariance. CONCLUSION: PCA and FA should not be treated as equal statistical methods, given that the theoretical rationale and assumptions for using these methods as well as the interpretation of results are different.

Food (in) security and nutritional dietary quality In Brazil / Insegurança alimentar e nutricional e qualidade da dieta no Brasil

ABSTRACT Objective Verify association between the perception of food insecurity and the diet quality of the Brazilian population, applying The Brazilian Food Insecurity Scale and the Brazilian Healthy Eating Index Revised. Methods Cross-sectional study using data from the Householder Budget Survey collected in 2017/18 with two 24-hour recalls. A multinomial regression model was used with Odds Ratio and a 95% confidence interval, with the final model being the insertion of variables according to the theoretical model of hierarchy adopted. Results A total of 57,920 households were analyzed, and of these, 39.22% lived with some degree of Food Insecurity. There was a significant difference between female heads of the household, mixed race and black race, households with adults and children and living in rural regions as the three levels of AI [Food insecure] (p=<0.001), with a greater chance of food insecurity in these households. The average Brazilian Healthy Eating Index Revised for the 46,152 individuals was 54.23 points for those who were not food insecure, and 54.11 points for those who experienced severe food insecurity. Conclusion It is concluded that there is an association between the perception of food insecurity and the nutritional quality of the diet of the Brazilian population, which can lead to malnutrition and obesity.

RESUMO Objetivo Verificar a associação entre a percepção de insegurança alimentar e a qualidade da dieta da população brasileira, aplicando a Escala Brasileira de Insegurança Alimentar e o Índice de Qualidade da Dieta Revisado a partir de dois recordatórios de 24 horas. Métodos Estudo transversal que utilizou dados da Pesquisa de Orçamentos Familiares de 2017-2018. Utilizou-se o modelo de regressão multinomial com Odds Ratio e intervalo de confiança de 95%, sendo o modelo final com inserção das variáveis de acordo com o modelo teórico de hierarquia adotado. Resultados Foram analisados 57.920 domicílios, e destes, 39,22% viviam com algum grau de Insegurança Alimentar. Verificou-se diferença significativa entre pessoas do sexo feminino como chefe do domicílio, raça pardo e preto, domicílios com adultos e crianças e residir na região rural como os três níveis de Insegurança Alimentar (p=<0,001), havendo uma maior chance de insegurança alimentar nesses domicílios. A média do Índice de Qualidade da Dieta Revisado para os 46.152 indivíduos foi de 54.23 pontos para os que não apresentavam insegurança alimentar, e 54.11 pontos para aqueles que vivenciaram insegurança alimentar grave. Conclusão Conclui-se que existe associação entre a percepção de insegurança alimentar e a qualidade nutricional da dieta da população brasileira, o que pode levar à desnutrição e obesidade.

How many meals and snacks do Brazilians eat a day? Findings from the 2017-2018 Brazilian National Dietary Survey / Quantas refeições e lanches os brasileiros fazem por dia? Resultados do Inquérito Nacional de Alimentação de 2017-2018 / ¿Cuántas comidas y meriendas tienen los brasileños por día? Resultados de la Encuesta Nacional de Alimentación 2017-2018

The habit of eating specific meals has been addressed in several studies, but the evaluation of meal patterns has received less attention. This study aimed to describe the meal patterns of the Brazilian population. A complex sampling design was used to select the 46,164 ≥ 10-year-old individuals examined in the Brazilian National Dietary Survey. Food consumption was assessed by two non-consecutive 24-hour recalls applied throughout a one-week period. The exploratory data analysis approach was used to determine the meal patterns, i.e., how individuals combined the main meals (breakfast, lunch, dinner) and snacks (morning, afternoon, evening/night) throughout the day. The most common meal patterns were three main meals + one snack, reported by 25.1% of the individuals, and three main meals + two snacks (24.6%). Other meal patterns identified were: three main meals + three snacks (18.5%); three main meals and no snacks (10.9%); one or two main meals + two snacks (7.4%); one or two main meals + one snack (6.9%); one or two main meals + three snacks (4.2%); and one or two main meals and no snacks (2.3%). Meal patterns varied according to gender and age group, and on typical versus atypical food consumption days. We found that eight patterns characterized the daily meal consumption in Brazil. Furthermore, around 80% of the population had three main meals every day and about 13% did not report having any snacks. The characterization of meal habits is important for tailoring and targeting health promotion actions.

Os hábitos de consumo de refeições específicas têm sido abordados em diversos estudos, no entanto, a avaliação dos padrões refeições tem recebido menos atenção. O objetivo deste estudo foi descrever os padrões de refeições da população brasileira. Um desenho amostral complexo foi utilizado para selecionar os 46.164 indivíduos de ≥ 10 anos examinados no Inquérito Nacional de Alimentação de 2017-2018. O consumo alimentar foi avaliado por meio de dois recordatórios de 24 horas não consecutivos, aplicados durante um período de uma semana. A análise exploratória de dados foi utilizada para determinar os padrões de refeições, ou seja, como os indivíduos combinam as principais refeições (café da manhã, almoço, jantar) e lanches (manhã, tarde, noite) ao longo do dia. Os padrões de refeições mais frequentes foram três refeições principais + um lanche, conforme relatado por 25,1% dos indivíduos, e três refeições principais + dois lanches (24,6%). Outros padrões de refeições identificados foram: três refeições principais + três lanches (18,5%); três refeições principais e nenhum lanche (10,9%); uma ou duas refeições principais + dois lanches (7,4%); uma ou duas refeições principais + um lanche (6,9%); uma ou duas refeições principais + três lanches (4,2%); e uma ou duas refeições principais e nenhum lanche (2,3%). Os padrões de refeições variaram de acordo com o sexo e a faixa etária, e nos dias típicos em comparação com os atípicos de consumo alimentar. Verificou-se que oito padrões caracterizaram o consumo diário de refeições no Brasil. Além disso, cerca de 80% da população realizava três refeições principais diárias e cerca de 13% reportaram não lanchar. A caracterização dos padrões de refeições é importante para adequar e direcionar ações de promoção da saúde.

Los hábitos alimenticios específicos se han abordado en varios estudios, sin embargo, poco se sabe sobre la evaluación de los patrones de alimentación. El objetivo de este estudio fue describir el patrón de alimentación de la población brasileña. Se utilizó un diseño de muestra complejo para seleccionar a 46.164 individuos de ≥ 10 años quienes participaron en la Encuesta Nacional de Alimentación 2017-2018. El consumo alimentario se evaluó mediante dos registros de 24 horas no consecutivos, aplicados durante una semana. Para determinar el patrón de alimentación, se aplicó el análisis exploratorio, es decir, cómo las personas combinan las comidas principales (desayuno, almuerzo, cena) y las meriendas (mañana, tarde, noche) a lo largo del día. Los patrones de alimentación más frecuentes fueron tres comidas principales + una merienda según informan el 25,1% de los individuos, y tres comidas principales + dos meriendas (24,6%). Otros patrones identificados destacaron tres comidas principales + tres meriendas (18,5%); tres comidas principales sin merienda (10,9%); una o dos comidas principales + dos meriendas (7,4%); una o dos comidas principales + una merienda (6,9%); una o dos comidas principales + tres meriendas (4,2%); y una o dos comidas principales sin merienda (2,3%). Los patrones de alimentación tuvieron una variación según el sexo y el grupo de edad, y en días típicos en comparación con los atípicos de consumo de alimentos. Se encontró que ocho patrones caracterizan el consumo diario de comidas en Brasil. Por lo tanto, aproximadamente el 80% de la población tienen tres comidas principales al día y aproximadamente el 13% informan que no tienen merienda. Es importante caracterizar los patrones de alimentación para adaptar y orientar las acciones de promoción de la salud.

Lunch quality and sociodemographic conditions between Brazilian regions.

The objective of this study was to assess the quality of lunch consumed by adults in Brazil and its sociodemographic determinants in each Brazilian region. A cross-sectional study was carried out and a representative sample of regional populations was used. The sample comprised of 16,096 adults from the Brazilian National Dietary Survey, part of the Brazilian Household Budget Survey (POF). The lunch quality was evaluated by applying the main meal quality index (MMQI), comprised of 10 items of equal weights that resulted in a score that ranged from zero to 100 points. Linear regression models measured the association between lunch quality and sociodemographic factors. The average energy consumption at lunch was 704kcal (SD = 300), and the meal quality score mean was 57 points (SE = 0.30). The North Region had the worst MMQI score (56 points, SE = 0.07), while the Central had the best MMQI adjusted score (59 points, SE = 0.05). The MMQI final score was positively associated with male gender and ages between 20-39 years, and was inversely associated with having eight years or more of education, per capita income of at least three minimum wages, and with the consumption of meals prepared away from home. Despite differences among sociodemographic factors, all Brazilian regions had a lunch composed of foods rich in sugars and fats, with insufficient portions of fruits and vegetables, resulting in a low meal quality.

Consumption of free sugars and dietary sources in the diet of university students according to socioeconomic and lifestyle factors / Consumo de açúcar livre e fontes dietéticas na dieta de estudantes universitários segundo fatores socioeconômicos e de estilo de vida

ABSTRACT Objective To evaluate the consumption of free sugars and associated factors in the diet of university students entering full-time courses at a public university in Mato Grosso. Methods Cross-sectional study with students aged 16 to 26 years in the first semester of 2016, 2017, and 2018. Average sugar consumption was estimated using a 24-hour diet recall, evaluating the percentage of free sugars in total energy intake and the prevalence of consumption greater than 10.0% of total energy intake, according to socioeconomic and lifestyle variables, stratified by sex, and the foods that most contributed to its consumption. Results A total of 1,063 students were evaluated, the percentage of free sugars in the students' diet was on average 14.3% among men and 15.4% among women, with the prevalence of consumption above 10.0% also being higher among women (72.6 vs. 66.6%). There was a direct relationship between the participation of free sugars in the highest tertiles of energy intake, and the main food groups sources of sugar were desserts, juices, soft drinks, and coffee. There was a significant association between courses outside the health sciences, tobacco use, and unsatisfactory meal consumption profile with higher consumption of free sugars among women. Among men, sugar consumption was higher among those who were not overweight compared to those who were overweight. Conclusion The consumption of free sugars is high among university students, being associated with higher energy consumption, especially for sweetened beverages.

RESUMO Objetivo Avaliar o consumo de açúcar livre e os fatores associados na alimentação de universitários ingressantes em cursos de período integral em uma universidade pública de Mato Grosso. Métodos Estudo transversal com estudantes de 16 a 26 anos de idade no primeiro semestre de 2016, 2017 e 2018 (n=1.063). O consumo médio de açúcar foi estimado por meio de recordatório de 24 horas, sendo avaliada a participação do açúcar livre na ingestão energética total e a prevalência de participação do consumo superior a 10,0% da ingestão energética, segundo variáveis socioeconômicas, de estilo de vida e fatores dietéticos, , estratificadas por sexo. Resultados A participação do açúcar livre na dieta foi, em média, de 14,3% entre os homens e 15,4% entre as mulheres, sendo a prevalência de consumo acima de 10,0% também maior entre as mulheres (72,6 vs. 66,6%). Foi maior a participação do açúcar livre nos tercis mais elevados de ingestão energética, sendo verificado que os principais grupos de alimentos fontes foram sobremesas, sucos, refrigerantes e café. Entre as mulheres, verificou-se maior consumo de açúcar livre entre aquelas que faziam uso de tabaco e que apresentavam perfil de consumo de refeições insatisfatório. Por outro lado, menor consumo de açúcar livre foi observado entre as estudantes da área da saúde. Entre os homens, o consumo de açúcar livre foi maior entre aqueles sem excesso de peso, comparados aos com excesso. Conclusão O consumo de açúcar livre foi elevado entre estudantes universitários, sendo maior entre os estudantes com maior consumo energético. Verificou-se que as bebidas adoçadas estiveram entre as principais fontes.

Breakfast skipping and cardiometabolic risk factors in adolescents: Systematic review

ABSTRACT OBJECTIVE To systematically review the results of the association between breakfast skipping and cardiometabolic risk factors in adolescents. METHODS The articles were searched in May 2020 from PubMed, Virtual Health Library, Scopus, Web of Science and Scientific Electronic Library Online (SciELO). The review included observational studies conducted with adolescents (10-19 years old), which estimated the association of breakfast skipping with at least one outcome (markers of body adiposity, blood pressure, serum lipid and glucose levels). Regarding the risk of bias, the articles were evaluated using the Research Triangle Institute (RTI) Item Bank on bias risk and accuracy of observational studies. The quality of the evidence was assessed by the Grade rating. RESULTS A total of 43 articles involving 192,262 participants met the inclusion criteria and were considered in this review. The prevalence of breakfast skipping ranged from 0.7% to 94% and 60.5% of studies were classified with low risk of bias. The significant association between breakfast skipping and cardiometabolic risk factors was found in twenty-nine cross-sectional articles (n = 106,031) and four longitudinal articles (n = 5,162) for excess adiposity, in three articles (n = 8,511) for high total cholesterol levels, low-density lipoprotein and triglycerides, and in three studies (n = 6,303) for high blood pressure levels. However, there was no significant association between breakfast skipping and glycemic profile. According to the Grade rating, all the associations had low quality of evidence. CONCLUSION The results of this review suggest that breakfast skipping is associated with cardiometabolic risk factors in adolescents aged 10 to 19 years. However, considering the low quality of the evidence, the present results should be interpreted carefully. In addition, our findings highlight the importance of standardizing the definition of breakfast skipping and that more prospective studies are needed to determine how skipping breakfast can affect cardiometabolic risk factors in the long time.

Principal Component Analysis and Factor Analysis: differences and similarities in Nutritional Epidemiology application / Análise de Componentes Principais e Análise Fatorial: diferenças e similaridades na aplicação em Epidemiologia Nutricional

ABSTRACT: Introduction: Statistical methods such as Principal Component Analysis (PCA) and Factor Analysis (FA) are increasingly popular in Nutritional Epidemiology studies. However, misunderstandings regarding the choice and application of these methods have been observed. Objectives: This study aims to compare and present the main differences and similarities between FA and PCA, focusing on their applicability to nutritional studies. Methods: PCA and FA were applied on a matrix of 34 variables expressing the mean food intake of 1,102 individuals from a population-based study. Results: Two factors were extracted and, together, they explained 57.66% of the common variance of food group variables, while five components were extracted, explaining 26.25% of the total variance of food group variables. Among the main differences of these two methods are: normality assumption, matrices of variance-covariance/correlation and its explained variance, factorial scores, and associated error. The similarities are: both analyses are used for data reduction, the sample size usually needs to be big, correlated data, and they are based on matrices of variance-covariance. Conclusion: PCA and FA should not be treated as equal statistical methods, given that the theoretical rationale and assumptions for using these methods as well as the interpretation of results are different.

RESUMO: Introdução: Métodos estatísticos de análise multivariada, tais como Análise de Componentes Principais e Análise Fatorial, têm sido cada vez mais utilizados nos estudos em Epidemiologia Nutricional, no entanto equívocos quanto à escolha e aplicação dos métodos são observados. Objetivos: Os objetivos deste estudo são comparar e apresentar as principais diferenças e similaridades conceituais e metodológicas entre Análise de Componentes Principais e Análise Fatorial visando à aplicabilidade nos estudos em nutrição. Métodos: Análise de Componentes Principais e Análise Fatorial foram aplicadas em uma matriz de 34 grupos de alimentos que expressaram o consumo alimentar médio de 1.102 indivíduos de um estudo populacional. Resultados: Um total de dois fatores foi extraído e juntos explicaram 57,66% da variância comum entre as variáveis dos grupos alimentares, enquanto um total de cinco componentes foi extraído e juntos explicaram 26,25% da variância total. Entre as principais diferenças envolvendo os dois métodos estão: pressuposto de normalidade; as matrizes de variância-covariância/correlação, com consequente quantidade de variância explicada; a carga fatorial/componente e o erro associado. Entre as similaridades estão: ambas as técnicas são usadas para redução de dados; necessitam de um grande tamanho de amostra; os dados precisam ser correlacionados e são baseadas nas matrizes de variância-covariância/correlação. Conclusão: Análise de Componentes Principais e Análise Fatorial não devem ser tratadas como métodos estatísticos iguais e intercambiáveis, uma vez que o racional teórico e os pressupostos para o uso dos métodos, assim como a interpretação dos resultados, são diferentes.

Lunch quality and sociodemographic conditions between Brazilian regions / Qualidade do almoço e condições sociodemográficas entre as macrorregiões brasileiras / Calidad del almuerzo y condiciones sociodemográficas entre regiones brasileñas

The objective of this study was to assess the quality of lunch consumed by adults in Brazil and its sociodemographic determinants in each Brazilian region. A cross-sectional study was carried out and a representative sample of regional populations was used. The sample comprised of 16,096 adults from the Brazilian National Dietary Survey, part of the Brazilian Household Budget Survey (POF). The lunch quality was evaluated by applying the main meal quality index (MMQI), comprised of 10 items of equal weights that resulted in a score that ranged from zero to 100 points. Linear regression models measured the association between lunch quality and sociodemographic factors. The average energy consumption at lunch was 704kcal (SD = 300), and the meal quality score mean was 57 points (SE = 0.30). The North Region had the worst MMQI score (56 points, SE = 0.07), while the Central had the best MMQI adjusted score (59 points, SE = 0.05). The MMQI final score was positively associated with male gender and ages between 20-39 years, and was inversely associated with having eight years or more of education, per capita income of at least three minimum wages, and with the consumption of meals prepared away from home. Despite differences among sociodemographic factors, all Brazilian regions had a lunch composed of foods rich in sugars and fats, with insufficient portions of fruits and vegetables, resulting in a low meal quality.

O estudo teve como objetivo avaliar a qualidade do almoço consumido por adultos brasileiros e os determinantes sociodemográficos em cada macrorregião brasileira, com delineamento transversal e uma amostra representativa das populações regionais. A amostra incluiu 16.096 adultos, participantes do Inquérito Nacional de Alimentação, um componente da Pesquisa de Orçamentos Familiares. A qualidade do almoço foi avaliada através do main meal quality index (MMQI), com 10 itens de pesos iguais que resultaram em um escore que variava entre zero e 100 pontos. Nas análises, modelos de regressão linear mediram a associação entre a qualidade do almoço e fatores sociodemográficos. O consumo energético médio no almoço foi 704kcal (DP = 300), e o escore médio da qualidade do almoço foi 57 pontos (DP = 0,30). A Região Norte teve o pior MMQI (56 pontos, DP = 0,07), enquanto o Centro-oeste teve o melhor MMQI ajustado (59 pontos, DP = 0,05). O escore final do MMQI mostrou associação positiva com o gênero masculino e idade de 20-39 anos, e associação negativa com escolaridade de oito anos ou mais, renda per capita de pelo menos três salários mínimos e consumo de refeições preparadas fora de casa. Apesar das diferenças entre fatores sociodemográficos, em todas a macrorregiões brasileiras os adultos consumiam um almoço rico em alimentos com alto teor de açúcar e gordura e com porções insuficientes de frutas e verduras, resultando em um almoço de baixa qualidade alimentar.

El objetivo de este estudio fue evaluar la calidad del almuerzo que consumen los adultos en Brasil y sus determinantes sociodemográficos en cada región brasileña. Se trata de un estudio transversal con una muestra representativa de las poblaciones regionales. La muestra comprendió a 16.096 adultos de la Encuesta Nacional sobre Dieta, Encuesta sobre Presupuestos Familiares en Brasil. La calidad del almuerzo fue evaluada aplicando el main meal quality index (MMQI), que comprendía 10 ítems de pesos equivalentes que resultaron en un marcador que abarcaba de cero a 100 puntos. El análisis se realizó mediante modelos de regresión lineal que midieron la asociación entre el almuerzo de calidad y sus factores sociodemográficos. El promedio de consumo de calorías en el almuerzo fue 704kcal (SD = 300), y la media del índice de calidad de la comida fue 57 puntos (SE = 0,30). La región Norte tuvo el peor índice de MMQI (56 puntos, SE = 0,07), mientras que el Centro-oeste tuvo el mejor índice de MMQI ajustado (59 puntos, SE = 0,05). El índice final de MMQI se asoció positivamente al género masculino y edades comprendidas entre los 20-39 años, y fue inversamente asociado con contar con ocho años o más de educación, unos ingresos per cápita de al menos tres salarios mínimos, y un consumo de comidas preparadas fuera de casa. A pesar de las diferencias entre los factores sociodemográficos, todas las regiones brasileñas contaron con un almuerzo compuesto por comidas ricas en azúcares y grasas, con insuficiente porciones de frutas y verduras, constituyendo una comida de baja calidad.

Prevalência de omissão do café da manhã e seus fatores associados em adolescentes de São Paulo: estudo ISA-Capital / Prevalence of breakfast omission and associated factors among adolescents in São Paulo: ISA-Capital

Objective: To describe the patterns of food intake for breakfast, the prevalence of omission of this meal, its relative share in the total intake of energy and nutrients, and the factors associated with its omission. Methods: A population-based, cross-sectional study (ISA - Capital) with 795 adolescents. The prevalence of omission of breakfast was analyzed using Chi-square test and Poisson regression considering a significance level of 5%. Differences in the intake of energy and nutrients among adolescents who omit and have breakfast was determined by the Student?s t-test and differences in the relative share of breakfast were verified by the test of proportion. The pattern of consumption of breakfast was investigated by factor analysis. Results: The prevalence of omission of breakfast was 38%, higher among female adolescents. The energy contribution of breakfast was 23%, with contribution in vitamins ranging from 17% in vitamin C, for males, up to 37% in vitamin A and D, for females. Through factor analysis, 12 food groups consumed for breakfast were characterized in five factors that demonstrate a pattern of consumption. Conclusion: The results show the need for actions that promote regular consumption and selection of appropriate food for this meal.

Objetivos: Caracterizar os padrões de café da manhã, verificar a prevalência e os fatores associados à omissão desta refeição, e a participação relativa na ingestão calórica total e de nutrientes entre adolescentes. Metodologia: Estudo transversal de base populacional (ISA - Capital), com 795 adolescentes. O padrão de consumo de café da manhã foi analisado através da análise fatorial. Para verificar a prevalência de omissão do café da manhã, foram utilizados os Testes qui-quadrado e regressão de Poisson, considerando um nível de significância de 5%. Diferenças da ingestão de energia e nutrientes entre adolescentes que omitem ou consomem o café da manhã, foi determinado pelo Teste t-Student. As diferenças na participação relativa do café da manhã foram verificadas através do teste de proporção. Resultados: Observou-se elevada omissão de café da manhã (38%), além de padrões não saudáveis, incluindo consumo de refrigerantes e salgados. Café e açúcares de adição contribuíram significativamente para o primeiro fator; pães, margarinas e manteigas contribuíram significativamente para o segundo fator; e leite e achocolatados foram os alimentos que contribuíram para o terceiro fator. No quarto fator estão embutidos e refrigerantes e no quinto fator, queijos e frutas. A contribuição energética foi de 23%, com contribuição em vitaminas variando de 17% em vitamina C, para o sexo masculino e 37% em vitaminas A e D, para o sexo feminino. Conclusão: Os resultados apontam para a necessidade de ações que visem não só estimular o consumo do café da manhã, mas também incentivar a oferta e seleção de alimentos ricos em fibras, vitaminas e minerais.

Away-from-home meals: Prevalence and characteristics in a metropolis / Alimentação fora do lar: prevalência e características em uma metrópole

Objective: This study aimed to characterize away-from-home meals. Methods: This population-based, cross-sectional study measured dietary intake by administering 24-hour recalls by telephone. Away-from-home breakfast, lunch, and dinner were described and characterized according to the foods that contribute most to the intake of energy, fat, sodium, and added sugar per meal. Results: f the 834 respondents, 24% had had at least one meal away from home. The average energy intake per away-from-home meal was 628 kcal (±101 kcal), about 35% of the average daily intake for this population. Meals contained both healthy foods, such as rice, beans, and fish, and unhealthy foods, such as soft drinks, snacks, sandwiches, and pizza. Conclusion: Individuals who ate away from home had worse diets. However, the presence of healthy foods indicates a possibility of improvement if purposeful programmatic actions are taken. .

Objetivo: O presente estudo tem como objetivo caracterizar as refeições realizadas fora do lar. Métodos: Trata-se de estudo transversal, de base populacional representativa do município de São Paulo, realizado por meio de inquérito domiciliar e telefônico. O consumo alimentar foi medido por aplicação telefônica do recordatório alimentar de 24 horas, em que as refeições café da manhã, almoço e jantar foram caracterizadas e descritas de acordo com os principais alimentos contribuintes para o consumo de energia, gordura, sódio e açúcar de adição. Resultados: Dentre os 834 entrevistados, 24% realizaram ao menos uma refeição fora de casa. O consumo energético médio por refeição realizada fora do lar foi de 628 kcal (±101kcal), cerca de 35% da média de consumo diário relatado nessa população. Pôde-se observar a presença tanto de alimentos marcadores de uma dieta saudável, a exemplo do arroz, feijão e peixe, quanto de alimentos integrantes de uma dieta não saudável, como refrigerantes, salgados, sanduíches e pizzas. Conclusão: De acordo com os dados obtidos, os indivíduos que se alimentaram fora do lar consumiram uma pior alimentação. No entanto, a presença de alimentos saudáveis aponta para potencialidades de melhora, se forem tomadas ações programáticas nesse ...

Diferenças e similaridades na qualidade da refeição do Brasil e Reino Unido: que lições podemos aprender? / Similarities and differences of meal quality between Brazil and United Kingdom what lessons can we learn?

Introdução. Apesar de consumirmos alimentos combinados e estruturados em refeições, a maioria dos estudos ainda se concentra em nutrientes ou alimentos consumidos isoladamente. Além disso, comparar a alimentação entre países em diferentes fases de transição nutricional e epidemiológica pode fornecer informações relevantes relacionadas à prevenção da obesidade e DCNT. Objetivo. Caracterizar e comparar a qualidade nutricional da principal refeição consumida por adultos residentes no Brasil e Reino Unido. Materiais e Métodos. A primeira etapa do estudo consistiu na revisão sistemática da literatura, que subsidiou a etapa seguinte, o desenvolvimento do Main Meal Quality Index. Para comparar a qualidade das refeições utilizou-se dados dos inquéritos alimentares Inquérito Nacional de Alimentação INA-POF 2008-09 e National Diet and Nutrition Survey - NDNS. Para a identificação e avaliação da qualidade da refeição utilizou-se duas diferentes abordagens: (1) abordagem híbrida, com a descrição da composição das refeições por meio da árvore de decisão de classificação, e (2) abordagem dirigida pela hipótese, através da aplicação do Main Meal Quality Index. Além disto foram analisados modelos de regressão múltipla a fim de identificar os fatores associados. Resultados. Considerando o horário de consumo e a contribuição energética, os eventos alimentares definidos como principal refeição foram o almoço, para o Brasil, e jantar, para o Reino Unido.

Introduction. Although individuals consume foods combined and structured at meals, most authors still have studied nutrient or single food. Furthermore, compare countries in different stages of nutritional and epidemiological transition can provide relevant information related to the prevention of obesity and NCDs. Objective. To characterize and compare the nutritional quality of meals consumed by adults living in Brazil and UK. Subjects and methods. The first stage of the study consisted of a systematic review of the literature, which subsidized the next step, the development of the Main Meal Quality Index. Data from food surveys "National Survey of Food - INA - HBS 2008-09" and "National Diet and Nutrition Survey - NDNS" were used to analyzed and compare the main meals quality. Two different approaches for the identification and evaluation of the main meal pattern were used: (1) hybrid approach, to evaluate of the meal patters using data reduction techniques; and (2) hypothesis-driven approach, with the Main Meal Quality Index. Then, regression models were applied to analyzed associated sociodemographic factors. Results. Considering time slot and energy content, the eating events defined as main meal were lunch, for Brazil, and dinner, for UK. Brazilian main meal (58 points) had better nutritional quality, with greater participation of fiber and carbohydrates, and lower content of total and saturated fat, and energy density.

Qualidade nutricional das refeições servidas em uma unidade de alimentação e nutrição de uma indústria da região metropolitana de São Paulo / Nutritional quality of meals served by the cafeteria of a company located in the metropolitan region of São Paulo, Brazil

OBJETIVO: Avaliar a qualidade nutricional das refeições servidas em uma Unidade de Alimentação e Nutrição de uma fábrica da região metropolitana da cidade de São Paulo. MÉTODOS: Dentre os cardápios praticados no período de um ano (242 dias) na unidade mencionada, foram selecionados 30 por cento por sorteio sistemático, e avaliados utilizando-se o Índice de Qualidade da Refeição, com base nas recomendações da Organização Mundial da Saúde e do Ministério da Saúde brasileiro. Esse índice compõe-se de cinco itens que variam entre zero e 20 pontos cada um: adequação na oferta de hortaliças e frutas; oferta de carboidratos; oferta de gordura total; oferta de gordura saturada e variabilidade do cardápio. No período analisado, foram servidas 367 preparações, agrupadas em 30 categorias, segundo composição e forma de preparo. A correlação de Spearman foi utilizada para investigar a correlação do índice com os nutrientes da refeição. As análises foram realizadas no pacote estatístico STATA, considerando-se o nível de significância de 5 por cento. RESULTADOS: O valor médio do Índice de Qualidade da Refeição foi de 64,60 (DP=21,18) pontos, sendo 44 por cento das refeições classificadas como "refeição que necessita de melhora" e apenas 25 por cento como "adequadas". Além do arroz e do feijão, servidos diariamente, as preparações mais frequentes foram: legumes e frutas (30 por cento), massas e cremes (12 por cento), frituras (9 por cento) e sobremesas com creme (8 por cento). Encontrou-se correlação positiva entre o Índice de Qualidade da Refeição e a vitamina C (r=0,32). CONCLUSÃO: Apesar da presença constante de frutas, legumes e verduras, há a necessidade de adequar a oferta das preparações às recomendações para uma alimentação saudável, que efetivamente colaborem na promoção da saúde.

OBJECTIVE: This study assessed the nutritional quality of meals served by the cafeteria of a company located in the metropolitan region of São Paulo city, Brazil. METHODS: Thirty percent of the dishes served during one year (242 days) by the said cafeteria were systematically selected and assessed by the Meal Quality Index in accordance with the recommendations of the World Health Organization and Brazilian Ministry of Health. This index consists of five items with a maximum of 20 points each: content of non-starchy vegetables and fruits; carbohydrate content; total fat content; saturated fat content; and within-meal diversity. Three-hundred sixty-seven meals grouped into 40 categories according to composition and preparation method were served during the study period. Spearman correlation was used to investigate a possible correlation between the index and nutrients in a meal. Analyses were done by the STATA software with the significance level set at 5 percent. RESULTS: The mean Meal Quality Index score was 64.60 points, with a standard deviation of 21.18. Forty-four percent of the meals were classified as needing improvement and only 25 percent were classified as appropriate. In addition to rice and beans which are served daily, the most common preparations were legumes and fruits (30 percent), pasta and creams (12 percent), deep-fried foods (9 percent) and deserts with cream (8 percent). The Meal Quality Index correlated positively with vitamin C (r=0.32). CONCLUSION: Although fruits and non-starchy vegetables were always available, the meals need improvement to meet healthy eating recommendations that effectively help to promote good health.