Dietary inflammatory index and inflammatory markers in Brazilian adolescents.

OBJECTIVE: To evaluate the association between the inflammatory potential of the diet measured by the energy-adjusted diet inflammatory index (E-DII) and inflammatory markers in adolescents. METHODS: This cross-sectional study was conducted among 518 adolescents aged 18 and 19 years from São Luís, Maranhão, Brazil in 2016. A semiquantitative food frequency questionnaire (FFQ) was used to assess dietary intake from which E-DII scores were calculated to determine the inflammatory potential of the diet. The associations between E-DII and inflammatory markers (hs-CRP, IL-6, IL-4, TNF-α, and IFNγ) were analyzed using multivariable linear regression. The variables included in the adjusted model were identified using the directed acyclic graph. RESULTS: The diet of these adolescents was mostly pro-inflammatory; mean E-DII score was 1.71 and ranged from -2.44 to 5.58. Higher E-DII scores were positively associated with higher levels of IFNγ in the adjusted analysis (Adjusted Coef.: 1.19; 95%CI: 0.36-12.04). We observed no associations between E-DII and other inflammatory markers (hs-CRP, IL-6, IL-4, TNF-α). Study results indicate that E-DII is useful in evaluating the inflammatory potential of the diet of Brazilian adolescents. CONCLUSIONS: Cross-sectionally E-DII scores were positively associated with IFNγ concentrations. Future research should examine the association between changes in E-DII scores and levels of inflammatory markers longitudinally.

Equations for Prediction of Body Adiposity in Patients With Chronic Kidney Disease Undergoing Hemodialysis.

OBJECTIVES: The prevalence of obesity in the population has increased and excess body adiposity is one of the main nutritional disorders in patients with chronic kidney disease (CKD) on hemodialysis (HD). The objective of this study was to develop equations using anthropometric measurements to predict the total and abdominal body adiposity of patients with CKD on HD. METHODS: This is a cross-sectional study evaluating 323 patients with CKD on HD in city in northeastern Brazil. Measurements and anthropometric indicators were correlated with percentage of body fat (%BF) and visceral fat (VF, in kg) measured by dual energy X-ray absorptiometry. Multiple linear regression models based on different combinations of anthropometric measurements were adjusted to develop the equations, with subsequent cross-validation. RESULTS: Of the 323 patients, 62.2% were male and 46.5% were aged between 40 and 59 years. The equation selected to estimate %BF included weight, height, waist and hip circumferences, and triceps and suprailiac skin folds, presenting high predictive capacity (R2 = 0.771). The equation selected to estimate VF included weight, height, waist circumference, hip circumference, and sum of skin folds (R22 = 0.796). CONCLUSIONS: The proposed equations efficiently predicted the %BF and VF (kg) of patients with CKD on HD, thereby serving as viable indicators in clinical practice.

Dietary inflammatory index and inflammatory markers in Brazilian adolescents

ABSTRACT OBJECTIVE To evaluate the association between the inflammatory potential of the diet measured by the energy-adjusted diet inflammatory index (E-DII) and inflammatory markers in adolescents. METHODS This cross-sectional study was conducted among 518 adolescents aged 18 and 19 years from São Luís, Maranhão, Brazil in 2016. A semiquantitative food frequency questionnaire (FFQ) was used to assess dietary intake from which E-DII scores were calculated to determine the inflammatory potential of the diet. The associations between E-DII and inflammatory markers (hs-CRP, IL-6, IL-4, TNF-α, and IFNγ) were analyzed using multivariable linear regression. The variables included in the adjusted model were identified using the directed acyclic graph. RESULTS The diet of these adolescents was mostly pro-inflammatory; mean E-DII score was 1.71 and ranged from -2.44 to 5.58. Higher E-DII scores were positively associated with higher levels of IFNγ in the adjusted analysis (Adjusted Coef.: 1.19; 95%CI: 0.36-12.04). We observed no associations between E-DII and other inflammatory markers (hs-CRP, IL-6, IL-4, TNF-α). Study results indicate that E-DII is useful in evaluating the inflammatory potential of the diet of Brazilian adolescents. CONCLUSIONS Cross-sectionally E-DII scores were positively associated with IFNγ concentrations. Future research should examine the association between changes in E-DII scores and levels of inflammatory markers longitudinally.

Proposition of an Energy Intake Estimating Scale through Item Response Theory.

BACKGROUND: Traditional methods for assessing individual energy consumption often involve lengthy and intricate procedures. This study aims to introduce an Energy Consumption Estimation Scale, utilizing Item Response Theory (IRT) for adolescents aged 18-19 years. METHODS: This psychometric investigation applies IRT to 93 items extracted from a validated food frequency questionnaire. The study encompasses a representative sample of 2515 adolescents from the São Luís birth cohort in Brazil. The latent trait, energy intake, is derived using IRT and subsequently validated through hierarchical multiple linear regression modeling. Significance was established at p < 0.05. RESULTS: A Samejima's model was successfully fitted (CFI and TLI > 0.9 and RMSEA < 0.08), effectively capturing variations across all energy consumption levels. Factors associated with the latent trait demonstrate consistent behavioral patterns. Adolescents with higher energy intake exhibited increased consumption of dairy products, artificially sweetened beverages, and seasonal fruits and vegetables. CONCLUSIONS: The proposed Energy Consumption Estimation Scale demonstrates a reliable measurement of energy intake and serves as a practical and concise alternative for assessing energy consumption among adolescents. These findings suggest the potential for adapting similar models for different age groups and incorporating diverse food items based on the obtained results.

Dietary Patterns, Nutritional Status and Inflammatory Biomarkers in Adolescents from the RPS Birth Cohort Consortium.

This study aimed to identify the dietary patterns (DPs) of adolescents and assess indicators of subclinical inflammation. It was a cross-sectional study aligned with the RPS cohort with data from São Luís, Maranhão, Brazil. We evaluated 511 adolescents between 18-19 years old. DPs were identified with a factor analysis of the principal components. Nutritional status was assessed with body mass index and body fat percentages. Hierarchical modeling was performed using a linear regression to estimate the beta coefficient (ß) of the independent variables with the dependent variables interleukin-6 and high-sensitivity C-reactive protein (hs-CRP). Five DPs were identified: energy-dense, sugar-sweetened beverages and breakfast cereals, prudent, traditional Brazilian and alcoholic and energy beverages. Greater adherence to the prudent DP was associated with a lower concentration of interleukin-6 (ß = -0.11; p value = 0.040). Greater adherence to the DP "traditional Brazilian" and "alcoholic and energy beverages" were associated with increased IL-6, mediated by the nutritional status. A higher BMI (ß = 0.36; p value = <0.001) and %BF (ß = 0.02; p value = 0.014) were associated with higher hs-CRP concentrations. The nutritional status and "prudent" pattern were associated with inflammatory biomarkers. These findings show that a higher consumption of fresh and minimally processed foods and the adequacy of the nutritional status are protective factors for the inflammatory process.

Risco cardiovascular em hipertensos e diabéticos acompanhados em uma unidade básica de saúde / Cardiovascular risk in hypertensive and diabetic patients followed up in a basic health unit

Determinar o risco cardiovascular pelo Escore de Framingham em indivíduos hipertensos e/ou diabéticos acompanhados em uma unidade de saúde. Estudo transversal com 141 indivíduos com avaliação de dados sociodemográficos, econômicos, clínicos, nutricionais e laboratoriais e aplicação do Escore de Framingham. A média de idade foi 58,5 ±10,5 anos; 67,4% foram mulheres; prevalência de hipertensão arterial, 79,4%, diabetes mellitus, 46,8%; e ambas as comorbidades, 26,2%. A análise apontou diferença por sexo: mulheres apresentaram maior índice de massa corporal (p=0,002), colesterol total (p=0,047) e lipoproteína de alta densidade (p<0,001). O risco cardiovascular foi: 27%, risco baixo; 35,4%, moderado; e 37,6%, alto. Houve maior predomínio de alto risco cardiovascular nos homens (56,5%). Na estratificação do risco cardiovascular, os fatores relacionados ao alto risco foram: maiores idades (p<0,001), maiores valores de colesterol total (p=0,002) e pressão arterial sistólica (p=0,001), maior prevalência de diabetes mellitus (p=0,041) e menores valores de lipoproteína de alta densidade (p=0,016).

To determine the cardiovascular risk using the Framingham Risk Score in hypertensive and/or diabetic individuals followed-up in a health unit. Cross-sectional study with 141 individuals evaluating sociodemographic, economic, clinical, nutritional, and laboratory data, and application of the Framingham Risk Score. Mean age was 58.5 ±10.5 years; 67.4% were women; the prevalence of hypertension was 79.4%; diabetes mellitus, 46.8%; and both comorbidities, 26.2%. The analysis pointed out difference by sex: women had higher body mass index (p=0.002), total cholesterol (p=0.047), and high-density lipoprotein (p<0.001). Cardiovascular risk was: 27%, low risk; 35.4%, moderate risk; and 37.6%, high risk. There was a higher predominance of high cardiovascular risk in men (56.5%). In the stratification of cardiovascular risk, the factors related to high risk were older age (p<0.001), higher values of total cholesterol (p=0.002) and systolic blood pressure (p=0.001), higher prevalence of diabetes mellitus (p=0.041), and lower values of high-density lipoprotein (p=0.016).

Appropriate neck circumference and waist-to-height ratio cut-off points as predictors of obesity and cardiovascular risk in adolescents.

OBJECTIVE: To determine neck circumference (NC) and waist-to-height ratio (WHtR) cut-off points as predictors of obesity and cardiovascular risk in adolescents. METHODS: Cross-sectional study developed with a subsample of 634 adolescents aged 18 and 19 years belonging to the third phase of the "RPS" cohort (Ribeirão Preto, Pelotas and São Luís) carried out in 2016. The area under the ROC curve (AUC) was identified to assess the predictive capacity of NC and WHtR in relation to the percentage of body fat (%BF), obtained by air displacement plethysmography (ADP), and the cardiovascular risk estimated by the Pathobiological Determinants of Atherosclerosis in Youth (PDAY). RESULTS: The prevalence of obesity by %BF was 7.6% in males and 39.4% in females (p-value <0.001), and the high PDAY risk was 13.8% and 10.9%, respectively. For males, NC cut-off point was 44.0 cm and the AUCs were 0.70 (95%CI 0.58-0.83) to predict obesity and 0.71 (95%CI 0.62-0.80) to predict high cardiovascular risk; for females, NC cut-off point was 40 cm and the AUCs were 0.75 (95%CI 0.69-0.80) and 0.63 (95%CI 0.53-0.73), respectively. WHtR cut-off point was 0.50 for both sexes; for males, the AUCs to predict obesity and high risk according to PDAY were 0.90 (95%CI 0.80-0.99) and 0.73 (95%CI 0.63-0.82), respectively; for females, they were 0.87 (95%CI 0.83-0.90) and 0.55 (95%CI 0.45-0.65), respectively. CONCLUSION: WHtR and NC are good discriminators to assess obesity and cardiovascular risk in adolescents, especially in males.

Dietary evaluation of sodium intake in patients with chronic kidney disease.

Introduction: Introduction: high sodium intake is a risk factor for diseases such as systemic arterial hypertension, stroke, left ventricular hypertrophy, and chronic kidney disease (CKD). Objective: to evaluate the correlation between estimated sodium intake by dietary intake and 24-hour urinary excretion in patients with non-dialysis CKD. Material and Methods: a cross-sectional study with 151 individuals. Demographic, socioeconomic, clinical and lifestyle data were evaluated. Sodium was dosed in 24-hour urine and estimated by 24-hour Food Recall (R24h). To evaluate the association between demographic, anthropometric, nutritional and laboratory variables with sodium excretion in 24-hour urine, variance analysis (ANOVA) or Kruskal-Wallis test were used. The correlation between 24-hour urinary sodium excretion and dietary sodium intake was performed by Spearman's correlation coefficient. Results: mean age was 60.8 ± 11.8 years, 51.7 % were women. Hypertensive patients, 88.9 %; diabetics, 45.0 %; and 39.1 % were in stage 3B of CKD. Median sodium excretion in 24-hour urine was 112.2 mmol/L and R24h intake was 833.8 mg/day. Individuals belonging to the highest tertile of sodium excretion (T3) presented lower PTH values, and those with lower tertile (T1), higher serum HDL-c levels (p < 0.05). There was no statistical correlation between dietary sodium intake and 24-hour urine excretion (p-value = 0.241). Conclusion: the non-correlation between sodium obtained by 24-hour urinary excretion and dietary intake demonstrates the fragility of the estimation of sodium excretion through the dietary survey.

Introducción: Introducción: la ingesta elevada de sodio es un factor de riesgo para enfermedades como la hipertensión arterial sistémica, el accidente cerebrovascular, la hipertrofia ventricular izquierda y la enfermedad renal crónica (ERC). Objetivo: evaluar la correlación entre la ingesta estimada de sodio y la excreción urinaria de 24 horas en pacientes con ERC sin diálisis. Métodos: estudio transversal con 151 individuos. Se evaluaron datos demográficos, socioeconómicos, clínicos y de estilo de vida. El sodio se cuantificó en orina de 24 horas y se estimó en Food Recall (R24h) de 24 horas. Para evaluar la asociación entre variables demográficas, antropométricas, nutricionales y de laboratorio con la excreción de sodio en orina de 24 horas, se utilizó el análisis de varianza (ANOVA) o la prueba de Kruskal-Wallis. La correlación entre la excreción urinaria de sodio de 24 horas y la ingesta de sodio en la dieta se realizó mediante el coeficiente de correlación de Spearman. Resultados: la edad media fue de 60,8 ± 11,8 años, el 51,7 % eran mujeres. Los pacientes hipertensos eran el 88,9 %; los diabéticos, el 45,0 %, y el 39,1 % se encontraban en estadio 3B de ERC. La mediana de excreción de sodio en orina de 24 horas fue de 112,2 mmol/L y la ingesta de R24h fue de 833,8 mg/día. Los individuos pertenecientes al tercil más alto de excreción de sodio (T3) presentaron valores de PTH más bajos y aquellos con niveles más bajos de tercil (T1), mayores niveles séricos de HDL-c (p < 0,05). No hubo correlación estadística entre la ingesta de sodio en la dieta y la excreción de orina durante 24 horas (valor p = 0,241). Conclusión: la ausencia de correlación entre el sodio obtenido por excreción urinaria de 24 horas y la ingesta dietética demuestra la fragilidad de la estimación de la excreción de sodio a través de la encuesta dietética.

Appropriate neck circumference and waist-to-height ratio cut-off points as predictors of obesity and cardiovascular risk in adolescents / Pontos de corte da circunferência do pescoço e da relação cintura-estatura como preditores da obesidade e risco cardiovascular em adolescentes

ABSTRACT OBJECTIVE To determine neck circumference (NC) and waist-to-height ratio (WHtR) cut-off points as predictors of obesity and cardiovascular risk in adolescents. METHODS Cross-sectional study developed with a subsample of 634 adolescents aged 18 and 19 years belonging to the third phase of the "RPS" cohort (Ribeirão Preto, Pelotas and São Luís) carried out in 2016. The area under the ROC curve (AUC) was identified to assess the predictive capacity of NC and WHtR in relation to the percentage of body fat (%BF), obtained by air displacement plethysmography (ADP), and the cardiovascular risk estimated by the Pathobiological Determinants of Atherosclerosis in Youth (PDAY). RESULTS The prevalence of obesity by %BF was 7.6% in males and 39.4% in females (p-value <0.001), and the high PDAY risk was 13.8% and 10.9%, respectively. For males, NC cut-off point was 44.0 cm and the AUCs were 0.70 (95%CI 0.58-0.83) to predict obesity and 0.71 (95%CI 0.62-0.80) to predict high cardiovascular risk; for females, NC cut-off point was 40 cm and the AUCs were 0.75 (95%CI 0.69-0.80) and 0.63 (95%CI 0.53-0.73), respectively. WHtR cut-off point was 0.50 for both sexes; for males, the AUCs to predict obesity and high risk according to PDAY were 0.90 (95%CI 0.80-0.99) and 0.73 (95%CI 0.63-0.82), respectively; for females, they were 0.87 (95%CI 0.83-0.90) and 0.55 (95%CI 0.45-0.65), respectively. CONCLUSION WHtR and NC are good discriminators to assess obesity and cardiovascular risk in adolescents, especially in males.

RESUMO OBJETIVO Determinar os pontos de corte da circunferência do pescoço (CP) e da relação cintura-estatura (RCEst) para a predição da obesidade e do risco cardiovascular em adolescentes. MÉTODOS Estudo transversal desenvolvido com uma subamostra de 634 adolescentes de 18 e 19 anos de idade pertencentes à terceira fase da coorte "RPS" (Ribeirão Preto, Pelotas e São Luís) realizada em 2016. Identificou-se a área sob a curva ROC (AUC) para avaliar a capacidade preditiva da CP e RCE em relação ao percentual de gordura corporal (%GC), obtido pela pletismografia por deslocamento de ar (PDA), e do risco cardiovascular estimado pelo Phatobiological Determinants of Atherosclerosis in Youth (PDAY). RESULTADOS A prevalência de obesidade pelo %GC foi de 7,6% no sexo masculino e 39,4% no sexo feminino (p-valor < 0,001) e o alto risco para PDAY foi de 13,8% e 10,9%, respectivamente. Para a CP, o ponto de corte identificado para o sexo masculino foi de 44,0 cm e as AUC foram de 0,70 (IC95% 0,58-0,83) para predição de obesidade e de 0,71 (IC95% 0,62-0,80) para predição do alto risco cardiovascular; e para o sexo feminino foi de 40 cm e as AUC foram de 0,75 (IC95% 0,69-0,80) e de 0,63 (IC95% 0,53-0,73), respectivamente. Para a RCEst, o ponto de corte identificado foi de 0,50 para ambos os sexos e as AUC para a predição da obesidade e do alto risco segundo o PDAY foram de 0,90 (IC95% 0,80-0,99) e 0,73 (IC95% 0,63-0,82), respectivamente, para o sexo masculino; e de 0,87 (IC95% 0,83-0,90) e 0,55 (IC95% 0,45-0,65), respectivamente, para o sexo feminino. CONCLUSÃO RCEst e CP como bons discriminadores para avaliar a obesidade e risco cardiovascular em adolescentes, especialmente no sexo masculino.

Validation of a food frequency questionnaire for assessing the intake of food groups and nutrients in adults / Validação de um questionário de frequência alimentar para avaliação do consumo de grupos de alimentos e nutrientes em adultos

ABSTRACT Objective: To validate a food frequency questionnaire used to assess food consumption among adults in a Brazilian cohort. Methods: Cross-sectional study conducted on 100 adults. Food intake was assessed by the food frequency questionnaire and by two 24-hour recalls. Validation was performed for nutrients (n=19) and food groups (n=21). Results: Moderate deattenuated Pearson's correlation coefficients (>0.4) were observed for the consumption of dairy products, breads and crackers, rice, pasta and tubers, leafy vegetables, other vegetables, fats, sweetened drinks, sandwiches and savory snacks, and nuts, and for the following nutrients (deattenuated and adjusted for energy intake): fiber, calcium, and vitamins A, B2, and C. Based on almost all food groups and nutrients assessed, ≥70% of the individuals were classified into the same or adjacent quartile for both methods, except for red and pork meat, snacks, nuts, phosphorus, potassium, and vitamin B3. The food groups and nutrients with fair kappa agreement (>0.2) were: dairy products, other vegetables, sweetened drinks, breakfast cereals, energy, carbohydrate, iron, and vitamin A. Conclusion: The food frequency questionnaire has proven useful for estimating the intake of some nutrients and food groups of the subjects evaluated. Only the intake of red and pork meat, snacks, nuts, vitamin B3, phosphorus and potassium were estimated with less accuracy.

RESUMO Objetivo: Validar um questionário de frequência alimentar para avaliar o consumo alimentar de adultos em uma coorte brasileira. Métodos: Estudo transversal realizado com 100 adultos. A ingestão alimentar foi avaliada pelo questionário de frequência alimentar e por dois recordatórios de 24 horas. A validação foi realizada para nutrientes (n=19) e grupos de alimentos (n=21). Resultados: Coeficientes de correlação de Pearson deatenuados moderados (>0,4) foram observados para o consumo de laticínios, pães e biscoitos, arroz, macarrão e tubérculos, vegetais folhosos, outros vegetais, gorduras, bebidas adoçadas, sanduíches e salgadinhos, e nozes, e para os seguintes nutrientes (deatenuados e ajustados para ingestão de energia): fibra, cálcio e vitaminas A, B2 e C. Com base em quase todos os grupos de alimentos e nutrientes avaliados, ≥70% dos indivíduos foram classificados no mesmo quartil ou quartil adjacente para ambos os métodos, exceto para carnes vermelhas e suínas, salgadinhos, nozes, fósforo, potássio e vitamina B3. Os grupos de alimentos e nutrientes com concordância kappa justa (>0,2) foram: laticínios, outras verduras, bebidas açucaradas, cereais matinais, energia, carboidratos, ferro e vitamina A. Conclusão: O questionário de frequência alimentar mostrou-se útil para estimar a ingestão de alguns nutrientes e grupos de alimentos dos sujeitos avaliados. Apenas o consumo de carnes vermelhas e suínas, salgadinhos, nozes, vitamina B3, fósforo e potássio foi estimado com menor precisão.

Waist-to-height ratio cut-off points to predict obesity in adolescents and associa-tion with inflammatory markers.

Introduction: Introduction: obesity increases inflammatory molecules and cardiovascular risk even in young populations. New indicators are being investigated, including the waist-to-height ratio (WHtR) to predict obesity and the relationship with inflammatory markers in childhood and adolescence. Objective: to identify the cut-off points of the WHtR to determine obesity and its association with inflammatory markers in adolescents in São Luís, state of Maranhão, Brazil. Methods: this is a cross-sectional study, with 2,209 adolescents aged 18 and 19, belonging to the third phase of the birth cohort entitled "RPS", carried out in 2016. The total area under the ROC curve (AUC) was identified to assess the predictive capacity of WHtR in relation to body fat percentage (%BF), obtained by air displacement plethysmography (ADP). The association of WHtR with inflammatory markers interleukin-6 (IL-6), tumor necrosis factor (TNF-α) and c-reactive protein (CRP) was evaluated. Results: prevalence of obesity by the %BF was 10.3 % in males and 40.4 % in females. The cut-off points for the WHtR were 0.50 for females and 0.51 for males, with an AUC of 0.90 (95 % CI: 0.88-0.92) and 0.93 (95 % CI: 0.90-0.97). There was an association of elevated WHtR with higher levels of IL-6 and CRP (p < 0.05). Conclusion: the predictive capacity of WHtR for obesity was excellent. Elevated values of the WHtR were associated with early inflammatory markers. This study contributed to the identification of cut-off points for simple and low-cost anthropometric indicators.

Introducción: Introducción: la obesidad aumenta las moléculas inflamatorias y el riesgo cardiovascular incluso en poblaciones jóvenes. Se están investigando nuevos indicadores, incluida la relación cintura-altura (RCE) para predecir la obesidad y la relación con los marcadores inflamatorios en la infancia y la adolescencia. Objetivo: identificar los puntos de corte de la RCE para determinar la obesidad y su asociación con marcadores inflamatorios en adolescentes de São Luís, estado de Maranhão, Brasil. Métodos: se trata de un estudio transversal con 2.209 adolescentes de 18 y 19 años pertenecientes a la tercera etapa de la cohorte de nacimiento denominada "RPS", realizado en 2016. Se identificó el área total bajo la curva ROC (AUC) para evaluar la capacidad predictiva del RCE en relación al porcentaje de grasa corporal (%GC), obtenido a través del pletismografía por desplazamiento de aire (PDA). Se evaluó la asociación de la RCE con los marcadores inflamatorios interleucina-6 (IL-6), factor de necrosis tumoral (TNF-α) y proteína C reactiva (PCR). Resultados: se halló una prevalencia de obesidad por %GC del 10,3 % en hombres y 40,4 % en mujeres. Los puntos de corte para la RCE fueron 0,50 para mujeres y 0,51 para hombres, con un AUC de 0,90 (IC 95 %: 0,88-0,92) y 0,93 (IC 95 %: 0,90-0,97). Hubo una asociación de RCE de nivel superior con niveles más altos de IL-6 y PCR (p < 0,05). Conclusión: la capacidad de predicción de la RCE para la obesidad fue excelente y los valores elevados de RCE se asociaron con marcadores inflamatorios tempranos. Este estudio contribuyó a la identificación de puntos de corte para indicadores antropométricos simples y de bajo coste.

Early weaning and family characteristics are associated with greater sodium intake in children between 13 and 35 months: BRISA birth cohort.

Children are consuming less healthy foods, and this eating behaviour exposes the child to greater Na intake. The association between family, maternal and child characteristics with Na intake by children aged 13-35 months was evaluated. A study carried out with retrospective data on 1,185 children from the Brisa cohort. The children's dietary Na intake was assessed by a 24-h diet recall survey. Values ≥ 1200 mg were considered excessive intake. The association between Na intake and independent variables was assessed by a three-level logistic hierarchical regression model. Variables with P-value < 0·05 were retained in the model. Most children were male (51·2 %), eutrophic (63·2 %) and not exclusively breast-feeding (EBF) for 6 months (58·4 %). The average Na intake was 925 mg (±410·4). The prevalence of excessive Na intake was 18·5 % and was associated with the variables children of younger mothers (< 20 years old OR = 4·04, 95 % CI 1·64, 9·99; ≥ 20 to < 35 years old OR = 2·48, 95 % CI 1·10, 5·63), having four or more children (OR = 2·51, 95 % CI 1·29, 4·89), lower family income (≥ 1 and < 3 minimum wages OR = 0·60, 95 % CI 0·39, 0·93; ≥ 3 minimum wages OR = 0·50, 95 % CI 0·30, 0·82) and not being EBF until 6 months (OR = 1·64, 95 % CI 1·14, 2·34). The average Na intake of children was higher than the recommendation for adequate intake, pointing to a high consumption of this micronutrient in the first years of life. Excessive Na intake seems to be linked to unfavourable socio-economic conditions. Avoiding early weaning is the only possible intervention in this scenario.

Intake of ultra-processed foods is associated with inflammatory markers in Brazilian adolescents.

OBJECTIVE: To evaluate the association of the consumption of foods of the ultra-processed group (UPF) with inflammatory markers in the adolescent population in Northeastern Brazil. DESIGN: A cross-sectional population-based study. Food consumption was evaluated using two 24-h dietary recalls using the NOVA classification for food processing levels. The following inflammatory markers were evaluated: adiponectin, IL-6, IL-8, C-reactive protein (CRP) and TNF-α. Multivariate linear regression was used to investigate the association between the percentage of UPF energy contribution and inflammatory markers. SETTING: São Luís, Maranhão, Brazil. PARTICIPANTS: The sample consisted of 391 male and female adolescents, aged from 17 to 18 years. RESULTS: The average daily energy consumption by adolescents was 8032·9 kJ/d, of which 26·1 % originated from UPF. The upper tertile (T3) of UPF consumption presented higher intake of simple carbohydrates, lipids, saturated fat, and Na and lower protein intake. Individuals in T3 presented higher serum leptin and CRP levels (P < 0·05). Adolescents with UPF energy consumption ≥30·0 % (tertile 3 of UPF) had a 79 % (exp (0·58) = 1·79) increase in IL-8 levels when compared with adolescents in tertile 1 of UPF (P = 0·013). CONCLUSIONS: The association between the consumption of UPF, poor quality diet and pro-inflammatory markers have important harmful effects that can be observed as early as in adolescence.

Association of insufficient practice of physical activity with demographic, anthropometric and biochemical factors in hypertensive patients / Fatores associados à atividade física em pacientes com hipertensão tratados e monitorados pelo Hiperdia

Resumo Introdução Considerando-se a magnitude da hipertensão arterial sistêmica e suas complicações, assim como a importância da atividade física regular na sua prevenção e/ou tratamento, é necessário identificar os fatores associados à prática de atividade física insuficiente. Objetivo Analisar os fatores associados à atividade física insuficiente em hipertensos atendidos na atenção primária à saúde. Método Estudo transversal realizado com amostra aleatória de 305 hipertensos em três unidades de saúde de São Luís (MA). Foi realizada análise bivariada, com estimativas de razões de prevalência, intervalos de confiança e análise multivariada por regressão de Poisson. Resultados A atividade física insuficiente foi observada em 38,7% da amostra. Atividade física insuficiente foi associada a menos de 8 anos de educação formal (razão de prevalência - RP = 1,58; intervalo de confiança de 95% - IC = 1,04-2,39), colesterol total ≥200 mg/dL (RP = 0,78; IC 95% = 0,58 -1,04), lipoproteína de baixa densidade colesterol-LDLc ≥100 mg/dL (RP = 0,79; IC 95% = 0,53-0,95) e lipoproteína de alta densidade colesterol-HDLc <40 mg / dL entre homens e <50 mg/dL entre mulheres (RP = 1,21; IC 95% = 0,90-1,64). A escolaridade <8 anos (RP = 1,50; IC 95% = 0,99-2,29) e LDLc ≥100 mg/dL (RP = 0,72; IC 95% = 0,54-0,96) também estiveram associados na regressão multivariada. Conclusão Observou-se alta prevalência de atividade física insuficiente e sua associação com baixa escolaridade e LDLc alterado em hipertensos.

Abstract Background Considering the magnitude of systemic hypertension (SH) and its complications, as well as the importance of regular physical activity in its prevention and/or treatment, there is a necessity to identify the factors associated with insufficient practice of physical activity. Objective To analyze factors associated with insufficient physical activity in hypertensive patients treated at Primary Health Care (PHC). Method This cross-sectional study was performed with a random sample of 305 hypertensive patients in three PHC units in São Luis, state of Maranhão, Brazil. A bivariate analysis was performed with estimates of prevalence ratios and confidence intervals, and multivariate analysis using Poisson regression. Results Insufficient physical activity was observed in 38.7% of the sample. Insufficient physical activity was associated with having <8 years of formal education (prevalence ratio-PR=1.58; 95% confidence interval-CI=1.04-2.39), total cholesterol ≥200 mg/dL (PR=0.78; 95% CI=0.58-1.04), low-density lipoprotein cholesterol-LDL ≥100 mg/dL (PR=0.79; 95% CI=0.53-0.95), and high-density lipoprotein cholesterol-HDL <40 mg/dL among men and <50 mg/dL among women (PR=1.21; 95% CI=0.90-1.64). Length of education <8 years (PR=1.50; 95% CI=0.99-2.29) and LDL ≥100 mg/dL (PR=0.72;95% CI=0.54-0.96) were also associated in the multivariate regression. Conclusion High prevalence of insufficient physical activity and its association with low education level and altered LDL serum levels were observed in hypertensive patients.

[Factors associated with inflammatory biomarkers in adolescents: analysis by structural equation modeling]. / Fatores associados aos biomarcadores inflamatórios em adolescentes: análise por modelagem de equações estruturais.

The study aimed to analyze factors associated with inflammatory biomarkers in adolescents. This was a cross-sectional study in 391 adolescents 17-18 years of age in public schools in São Luís, Maranhão State, Brazil. Three-stage random cluster sampling was performed in schools, classes, and students. Food consumption was studied with a food frequency questionnaire, and dietary patterns were extracted by principal components factor analysis. Assessment of factors associated with inflammatory biomarkers used structural equation modeling. Latent variables were constructed: socioeconomic status, which included maternal schooling, family income, and economic class; and inflammation, consisting of interleukin-1ß, interleukin-6, and interleukin-8. A theoretical model was developed to assess factors associated with inflammatory biomarkers, indicating direct and indirect effects between the latent and observed variables. Three dietary patterns were identified (Western, basic Brazilian, and healthy), with 31% explained variance and the Western pattern with the largest share. No associations were found between the patterns and the latent variable inflammation (standardized coefficients = 0.281; p = 0.002). Extraction of the three patterns evidenced higher consumption of foods high in carbohydrates and fats, which are nutrients associated directly with the increase in chronic noncommunicable diseases. Excess weight was associated with higher levels of inflammatory biomarkers.

O objetivo foi avaliar os fatores associados aos biomarcadores inflamatórios em adolescentes. Trata-se de estudo transversal com 391 adolescentes entre 17 e 18 anos de escolas públicas em São Luís, Maranhão, Brasil. Realizou-se amostragem aleatória com conglomeração em três estágios: escola, turma e aluno. O consumo alimentar foi investigado por meio do Questionário de Frequência Alimentar, e os padrões alimentares foram extraídos por análise fatorial por componentes principais. Para avaliar os fatores associados aos biomarcadores inflamatórios, foi utilizada modelagem de equações estruturais. Foram construídas variáveis latentes: condição socioeconômica, que incluiu escolaridade materna, renda familiar e classe econômica; e inflamação, constituída pela interleucina-1ß, interleucina-6 e interleucina-8. Um modelo teórico foi elaborado para avaliar fatores associados aos biomarcadores inflamatórios, indicando os efeitos diretos e indiretos entre as variáveis latentes e observadas. Três padrões alimentares foram identificados (ocidental, básico brasileiro e saudável), com variância explicada de 31%, e padrão ocidental o de maior contribuição. Não foram encontradas associações dos padrões com a variável latente inflamação. O excesso de peso foi positivamente associado com a variável latente inflamação (coeficientes padronizados = 0,281; p = 0,002). A extração dos três padrões evidencia maior consumo de alimentos ricos em carboidratos e gorduras que são nutrientes diretamente relacionados ao aumento das doenças crônicas não transmissíveis. O excesso de peso foi associado com maiores níveis de biomarcadores inflamatórios.

El objetivo fue evaluar los factores asociados con biomarcadores inflamatorios en adolescentes. Se trata de un estudio transversal con 391 adolescentes entre 17 e 18 años de escuelas públicas en São Luís, Maranhão, Brasil. Se realizó una muestra aleatoria por conglomerados en tres etapas: escuela, grupo y alumno. El consumo alimentario fue investigado mediante el cuestionario de frecuencia alimentaria, y los patrones alimentarios fueron extraídos por análisis factorial por componentes principales. Para evaluar los factores asociados a los biomarcadores inflamatorios se utilizó un modelado de ecuaciones estructurales. Se construyeron variables latentes: condición socioeconómica, que incluyó escolaridad materna, renta familiar y clase económica; e inflamación, constituida por la interleucina-1ß, interleucina-6 e interleucina-8. Un modelo teórico se elaboró para evaluar factores asociados a los biomarcadores inflamatorios, indicando los efectos directos e indirectos entre las variables latentes y observadas. Se identificaron tres patrones alimentarios (occidental, básico brasileño y saludable), con variancia explicada de un 31% y patrón occidental o de mayor contribución. No se encontraron asociaciones de los patrones con la variable latente inflamación. El exceso de peso estuvo positivamente asociado con la variable latente inflamación (coeficientes estandarizados = 0,281; p = 0,002). La extracción de los tres patrones evidencia mayor consumo de alimentos ricos en carbohidratos y grasas que son nutrientes directamente relacionadas con el aumento de las enfermedades crónicas no transmisibles. El exceso de peso estuvo asociado con mayores niveles de biomarcadores inflamatorios.

Excess weight and obesity prevalence in the RPS Brazilian Birth Cohort Consortium (Ribeirão Preto, Pelotas and São Luís).

Our objective was to estimate the prevalence of excess weight and obesity, according to sex and income in the RPS Brazilian Birth Cohort Consortium (Ribeirão Preto, Pelotas, and São Luís). Participants in the Ribeirão Preto (1978/1979 and 1994), Pelotas (1982, 1993 and 2004) and São Luís (1997/1998) birth cohorts were included in different follow-ups from 7 years old onwards. Excess weight (overweight and obesity) were assessed by body mass index. The highest prevalences were observed in Ribeirão Preto (excess weight: 27.7% at 9-11 and 47.1% at 22-23 years; obesity: 8.6% at 9-11 and 19.8% at 22-23 years) while the smallest was in São Luís (excess weight: 5.4 to 7-9 and 17.2% at 18-19 years; obesity: 1.8% at 7-9 and 3.6% at 18-19 years). The younger the cohort, the greater the prevalence of excess weight and obesity when comparing similar age groups. Increases in obesity prevalence were greater than in excess weight prevalence. Women had lower excess weight prevalence in older cohorts and higher obesity prevalence in younger cohorts. Higher excess weight and obesity prevalence were observed in higher income children and adolescents, and in poorer adults. Differences in the prevalence of excess weight and obesity evidenced that individuals from younger cohorts are more exposed to this morbidity, as well as those who were born in the most developed city, low-income adults as well as children and adolescents belonging to families of the highest income tertile. Therefore, the results of this study indicate the need to prioritize actions aimed at younger individuals.

High sugar content and body mass index: modelling pathways around the first 1000 d of life, BRISA cohort.

OBJECTIVE: Few studies are focused on sugar consumption around the first 1000 d of life. Thus, this work modelled the pathways linking the consumption of sugary drinks in pregnancy and maternal pre-gestational BMI to early child's exposure to products with high sugar content and to BMI z-score in the second year of life. DESIGN: BRISA cohort, São Luís, Brazil was used from the baseline to the follow-up at the second year of life. SETTING: A theoretical model was constructed to analyse associations between variables from prenatal period (socio-economic status, age, frequency of sugary drinks consumption during pregnancy and pre-gestational BMI), birth weight, exclusive breast-feeding and two outcomes: higher calories from products with added sugar as a percentage of the total daily energy intake and BMI z-score at follow-up at the first 2 years of life, using structural equation modelling. PARTICIPANTS: Data of pregnant women (n 1136) and their offspring. RESULTS: Higher pre-gestational BMI (standardised coefficient (SC) = 0·100; P = 0·008) and higher frequency of sugary drinks consumption during pregnancy (SC = 0·134; P < 0·001) resulted in high percentage of daily calories from products with added sugar in the second year of child, although no yet effect was observed on offspring weight at that time. CONCLUSIONS: Maternal obesity and sugary drinks consumption in pregnancy increased the risk of early exposure (before to 2 years) and high exposure of child to added sugar, showing perpetuation of the unhealthy dietary behaviours in the first 1000 d of life.

Birth by cesarean delivery and central adiposity in adolescents from a birth cohort.

The aim of this study was to analyze the association between birth by cesarean section and central adiposity in adolescents in São Luís, Maranhão State, Brazil. This was a cohort study that included 601 participants evaluated at birth and at 18-19 years. At birth we assessed type of delivery, maternal education, family income, maternal marital status, maternal body mass index before pregnancy, prenatal care, maternal smoking habit, gestational age at delivery and intrauterine growth restriction. In the adolescents, we evaluated central adiposity using the dual X-ray energy absorptiometry method. The indicators of central fat used were the trunk-to-total fat mass ratio (T/T), the android-to-gynoid fat mass ratio (A/G), the trunk-to-limb fat mass ratio (T/Lb), and the trunk-to-leg fat mass ratio (T/Lg). A theoretical model for the study of associations was developed using directed acyclic graphs, which allowed selecting the variables that required minimum adjustment for inclusion in the predictive model of exposure to cesarean delivery. The data were analyzed with marginal structural models weighted by the inverse of the probability of selection. A total of 38.6% of the adolescents studied were delivered by cesarean section. There was no significant difference in the central adiposity of adolescents delivered by cesarean section according to the indicators used: T/T ( coefficient = -0.003; 95%CI: -0.013; 0.007), A/G (coefficient = 0.001; 95%CI: -0.015; 0.018); T/Lb (coefficient = -0.016; 95%CI: -0.048; 0.016); T/Lg (coefficient = 0.014; 95%CI: -0.060; 0.030). In conclusion, there was no association between cesarean section delivery and greater central adiposity in the studied adolescents.

Factors associated with the inflammatory potential of the Brazilian population's diet.

The aim of the study was to assess the inflammatory potential of the Brazilian population's diet and its association with demographic, socio-economic and anthropometric characteristics. A cross-sectional study was performed with 34 003 individuals aged 10 years and older, evaluated by the National Diet and Nutrition Survey from the Consumer Expenditure Survey (POF 2008-2009). The Energy-adjusted Dietary Inflammatory Index (E-DII™) was determined using thirty-four dietary parameters calculated through non-consecutive 2-d dietary records. Positive scores indicate a pro-inflammatory diet, while negative scores indicate an anti-inflammatory diet. A bivariate and multivariate linear regression analysis based on a hierarchical theoretical model was performed to verify the factors associated with the E-DII. The mean of the E-DII was 1·04 (range of -4·77 to +5·98). The highest values of the pro-inflammatory E-DII were found among adolescents (1·42; P < 0·001) and individuals with higher income (1·10; P < 0·001) and level of education (1·18; P < 0·001). In the final model, the E-DII was associated with higher income quartiles and was higher in the Northeast and South regions, in white people, individuals with ≥9 years of education and adults and adolescents age group. The Brazilian population consumes a diet with high inflammatory potential, especially adolescents, white people and those with higher income and level of education. Thus, the index presented uneven distribution among the population, emphasising groups with higher dietary inflammatory potential. The socio-economic risk profile of a diet with higher inflammatory potential in medium-income countries is different from what is observed in high-income nations.

Sum of skinfolds measurement can be used in the estimation of total body fat in patients with chronic kidney disease undergoing hemodialysis.

INTRODUCTION: Introduction: body fat reflects important clinical impacts among hemodialysis patients; thus, simple and safe methods are required for a careful evaluation of this body compartment. Objectives: to evaluate the concordance of estimates of total body fat percentage (%BF), calculated using bioelectrical impedance analysis (BIA) and sum of four skinfolds (SSKD) measures, with those obtained using dual-energy X-ray absorptiometry (DEXA) in patients with chronic kidney disease (CKD) receiving hemodialysis. Methods: a cross-sectional study was conducted in 317 patients undergoing hemodialysis. The %BF was evaluated using BIA, SSKD measurement, and DEXA, and stratified by sex and tertiles. The Wilcoxon test for paired samples was used to compare the %BF obtained using the different methods, and Lin's concordance correlation coefficient (CCC-L) to evaluate concordance. Results: the average %BF estimated using DEXA was 29.3 ± 9.3 %, with significant differences among the three methods (p < 0.05). SSKD measurement presented a higher CCC-L concordance with DEXA, regardless of sex. After stratification of the sample in tertiles, BIA presented a higher CCC-L concordance with DEXA among the patients with CKD with a %BF above 34.4 % (third tertile). Conversely, SSKD measurement presented better concordance with DEXA for those with a %BF equal to or less than 34.4 %. Conclusions: in terms of the estimates of the %BF, SSKD measurement displayed a better concordance with DEXA.

INTRODUCCIÓN: Introducción: la grasa corporal refleja importantes impactos clínicos entre los pacientes en hemodiálisis; por lo tanto, se requieren métodos simples y seguros para una evaluación cuidadosa de este compartimiento del cuerpo. Objetivos: evaluar la concordancia de las estimaciones del porcentaje de grasa corporal total (%GC), calculadas mediante el análisis de impedancia bioeléctrica (BIA) y la suma de las medidas de cuatro pliegues cutáneos (CPC), con las obtenidas mediante absorciometría dual energética de rayos X (DEXA) en pacientes con enfermedad renal crónica (ERC) que reciben hemodiálisis. Métodos: se realizó un estudio transversal en 317 pacientes en hemodiálisis. La %GC se evaluó mediante BIA, medición de CPC y DEXA, y se estratificó por sexos y terciles. Se utilizó la prueba de Wilcoxon para muestras pareadas para comparar los %GC obtenidos con los diferentes métodos, y el coeficiente de correlación de concordancia de Lin (CCC-L) para evaluar la concordancia. Resultados: el %GC promedio estimado usando DEXA fue del 29,3 ± 9,3 %, con diferencias significativas entre los tres métodos (p < 0,05). La medición de los CPC presentó una mayor concordancia de CCC-L con DEXA, independientemente del sexo. Tras la estratificación de la muestra en terciles, la BIA presentó una mayor concordancia de CCC-L con DEXA entre los pacientes con ERC con un %GC superior al 34,4 % (tercer tercil). Por el contrario, la medición de los CPC presentó una mejor concordancia con la DEXA para aquellos con un %GC igual o inferior al 34,4 %. Conclusión: en términos de las estimaciones del %GC, la medición de los CPC mostró una mejor concordancia con la DEXA.