Twenty-year associations between disordered eating behaviors and sociodemographic features in a multiple cross-sectional sample.

BACKGROUND: Disordered eating behaviors (DEB) impact on health and wellbeing worldwide. This study aimed to examine sociodemographic trends in the prevalence of DEB over 20 years in the Australian general population. METHODS: Data were derived from five sequential cross-sectional surveys (1998, 2008, 2009, 2016 and 2017) with population-representative samples of adults and adolescents residing in South Australia (N = 15 075). DEBs investigated were objective binge eating (OBE), strict dieting/fasting, and purging. Sociodemographic data included gender, age, educational level, work and marital status, and residence. RESULTS: OBE prevalence increased significantly. Strict dieting/fasting also increased from 1998 to 2008/9 but remained stable between 2008/9 and 2016/7. Purging prevalence did not change significantly over time. All survey years were associated with a significantly higher odds of OBE, and strict diet/fasting compared to 1998. Lower age, a higher Accessibility Remoteness Index of Australia (ARIA) score, higher body mass index (BMI), higher educational attainment, and not being in a married or de facto relationship were independently associated with greater adjusted odds for endorsing OBE. Younger age, female gender, and higher BMI were also independently associated with greater adjusted odds for endorsing strict dieting/fasting. CONCLUSIONS: The increased prevalence of DEBs in various strata of Australian society has both public health and clinical implications. The results refute the stereotype that eating disorders (EDs) predominantly affect young women. They build impetus for future research on EDs among men and older individuals, with a view to developing tailored public health and clinical interventions for these populations.

Reliability of the Brazilian version of the questionnaire on eating and weight patterns-5 (QEWP-5).

PURPOSE: The Questionnaire on Eating and Weight Patterns-5 (QEWP-5) is a self-report instrument developed to screen individuals for binge eating disorder (BED) and bulimia nervosa (BN) as diagnosed by the DSM-5. This instrument was cross-culturally adapted for the Brazilian Portuguese and well understood by the target sample. The present study aimed to assess the test-retest reliability of the Brazilian version of QEWP-5 in a sample of undergraduate students from Dietitian and Psychology courses. METHODS: The Brazilian version of QEWP-5 was administered to a sample of 345 male and female undergraduate students, from dietitian (n = 179) and psychology (n = 166) courses. The instrument was applied twice with a time interval of 2 weeks between the applications. The kappa coefficient was used to assess the temporal stability of the questionnaire in the screening of BED and BN. RESULTS: Overall, the kappa coefficient for the screening of BED was .48, and for the screening of BN was .71. In the dietitian course, the temporal stability was .60 (for the assessment of BED) and .80 (for BN). In the psychology course, the kappa values for the assessment of BED and BN were .27 and .60, respectively. All values were statistically significant (p < .001). CONCLUSION: In general, the stability of the Brazilian version of QEWP-5 was considered moderate to assess BED and substantial for the screening of BN in undergraduate students. Stratifying by course, the questionnaire had higher stability for the assessment of BED and BN in dietitian students. LEVEL OF EVIDENCE: Level V, descriptive study.

Associations between weight/shape overvaluation, sociodemographic features and BMI: 10-year time trends.

PURPOSE: To investigate the prevalence of overvaluation across sociodemographic features and weight status over time. METHODS: The data included sequential cross-sectional surveys with representative samples of the adolescent and adult (15 years or older) population in South Australia. Five surveys that assessed overvaluation were conducted in the years 2005 (n = 3047), 2008 (n = 3034), 2009 (n = 3007), 2015 (n = 3005) and 2016 (n = 3047). Overvaluation was assessed by structured interview based on the Eating Disorder Examination. To examine unique effects of demographic variables on the likelihood to report overvaluation, and also to examine whether this varied as a function of time, a multivariate binary logistic regression was computed. RESULTS: Across survey years, participants who were more likely to endorse overvaluation were female (2005: OR 2.85, CI 2.04-3.99; 2008/9: OR 1.74, CI 1.50-2.01; 2015/6: OR 1.54, CI 1.34-1.76), had a BMI > 30 (2005: OR 3.93, CI 1.49-10.34; 2008/9: OR 2.22, CI 1.31-3.78; 2015/6: OR 2.09, CI 1.19-3.67), had left school (2015/6: OR 1.36, CI 1.14-1.63), and lived in the country (2015/6: OR 1.95, CI 1.69-2.24). Being in the oldest age group was protective against endorsing overvaluation in each survey year. There was also a main effect of survey year, with participants in the 2015/6 survey more likely to endorse overvaluation (p < 0.001). CONCLUSIONS: Female, young and obese people were more likely to endorse overvaluation; however, the prevalence of overvaluation increased significantly in all sociodemographic and BMI groups in since 2005-2016. EVIDENCE-BASED MEDICINE: Level IV, evidence obtained from multiple time series with or without the intervention, such as case studies.

Associations of changes in BMI and body fat percentage with demographic and socioeconomic factors: the ELANA middle school cohort.

BACKGROUND AND OBJECTIVES: Adolescent weight and fat gain is determined by multiple factors. This study examined the association between changes in body fat indicators, excessive weight and fat gain, and sociodemographic factors among Brazilian adolescents over a 4-year period. METHODS: Body mass index (BMI) and body fat percentage (BFP) of 809 middle school students (mean age: 11.8 ± 1.15 years) were evaluated annually, from 2010 to 2013. Linear mixed effects models were used to assess the trajectories of BMI and BFP in both boys and girls according to the type of school attended (public or private) and skin colour. General estimating equations logistic regression analyses were performed to investigate associations between sociodemographic variables and the development of overweight or high BFP. RESULTS: Girls from private schools (p = 0.003) and white boys (p = 0.041) experienced bigger increases in BMI, as compared to girls from public schools and black/brown boys, respectively. White boys also had an increased chance of presenting excessive weight (OR = 3.28; CI 95%: 1.13-9.52) and BFP (OR = 3.32; CI 95%: 1.38-8.01) gain than black/brown boys. Conversely, white girls were less likely to present excessive body fat gain when compared to black/brown girls (OR = 0.42; CI 95%: 0.18-0.96). CONCLUSIONS: Adolescents who experienced better socioeconomic conditions, especially boys, were more likely to have greater increases in body fat indicators. Our findings contribute to the better understanding of BMI trajectories and body composition changes during puberty, as well as demonstrates the relationship between socioeconomic variables and adiposity indicators among adolescents in middle-income countries.

Ten-year time trends in mental and physical health correlates of weight/shape overvaluation.

OBJECTIVE: To investigate the relationships between weight/shape overvaluation, health-related quality of life (HRQoL) and functional role impairment (days out of role [DOR]) in the general population over 11 years. METHOD: Five cross-sectional surveys of men and women representative of the South Australian population were conducted in 2005, 2008, 2009, 2015, and 2016 (ntotal  = 15,140). Data were collected on demographics, overvaluation, HRQoL, DOR, and eating disorder behaviours. RESULTS: Between 2005 and 2016, the prevalence of moderate overvaluation increased from 18.1% to 40.0%, marked overvaluation from 7.5% to 23.7%, and extreme overvaluation from 3.1% to 9.2% (all p < 0.001). Overvaluation at any level was associated with more DOR in 2005 but not in 2016, and the association between HRQoL impairment and overvaluation weakened over time. CONCLUSION: Although the population prevalence of overvaluation has increased significantly in the past decade, the impairment associated with it appears to have reduced.

Clustering of multiple energy balance related behaviors is associated with body fat composition indicators in adolescents: Results from the HELENA and ELANA studies.

The objective of this study was to identify clustering patterns of four energy balance-related behaviors (EBRB): television (TV) watching, moderate and vigorous physical activity (MVPA), consumption of fruits and vegetables (F&V), and consumption of sugar-sweetened beverages (SSB), among European and Brazilian adolescents. EBRB associations with different body fat composition indicators were then evaluated. Participants included adolescents from eight European countries in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescents) study (n = 2,057, 53.8% female; age: 12.5-17.5 years) and from the metropolitan region of Rio de Janeiro/Brazil in the ELANA study (the Adolescent Nutritional Assessment Longitudinal Study) (n = 968, 53.2% female; age: 13.5-19 years). EBRB data allowed for sex- and study-specific clusters. Associations were estimated by ANOVA and odds ratios. Five clustering patterns were identified. Four similar clusters were identified for each sex and study. Among boys, different cluster identified was characterized by high F&V consumption in the HELENA study and high TV watching and high MVPA time in the ELANA study. Among girls, the different clusters identified was characterized by high F&V consumption in both studies and, additionally, high SSB consumption in the ELANA study. Regression analysis showed that clusters characterized by high SSB consumption in European boys; high TV watching, and high TV watching plus high MVPA in Brazilian boys; and high MVPA, and high SSB and F&V consumption in Brazilian girls, were positively associated with different body fat composition indicators. Common clusters were observed in adolescents from Europe and Brazil, however, no cluster was identified as being completely healthy or unhealthy. Each cluster seems to impact on body composition indicators, depending on the group. Public health actions should aim to promote adequate practices of EBRB.

Disordered eating behaviors and energy and nutrient intake in a regional sample of Brazilian adolescents from public schools.

PURPOSE: To estimate the prevalence of disordered eating behaviors and the association with energy and nutrient intake and nutritional status in adolescents. METHODS: A school-based cross-sectional study was performed involving a probabilistic sample of 487 teenagers (aged 15-19 years) from public schools in the Metropolitan area of Rio de Janeiro, Brazil. The Eating Attitude Test and the Bulimic Investigatory Test Edinburgh questionnaires were applied to identify abnormal eating patterns and unusual dietary patterns, respectively. Nutritional status was defined by sex- and age-specific body mass index cutoffs. Energy and nutrient intake were assessed by a 3-day food record. The association between variables was assessed by the prevalence ratio and 95% confidence intervals, Pearson's Chi-square test, and linear regression. RESULTS: The prevalence of abnormal eating patterns was 7.4% and that of unusual dietary patterns was 18.9%. Vitamin C intake was higher among girls with abnormal dietary patterns, with a consequent lower frequency of vitamin C deficiency when compared to those with normal dietary patterns. Calcium intake was lower in boys with unusual dietary pattern than in those without this behavior. Excess weight was associated with the presence of unusual dietary pattern in girls (PR: 2.4, 95% CI 1.6-3.5). CONCLUSIONS: The prevalence of disordered eating behaviors was high, mainly in those who were overweight. It was associated with lower calcium intake in boys and with higher Vitamin C intake in girls. LEVEL OF EVIDENCE: Level V, descriptive studies.

Discouraging soft drink consumption reduces blood glucose and cholesterol of Brazilian elementary students: Secondary analysis of a randomized controlled trial.

The objective of this study was to evaluate the effect of an educational program aimed at discouraging sugar-sweetened carbonated beverages intake on blood fasting glucose and total cholesterol. Forty-seven fourth grade classes in twenty-two schools have participated in a randomized controlled trial aimed at discouraging soft drink intake in order to prevent excessive weight gain during a school year, in the city of Niterói, Rio de Janeiro. Of 1140 randomized students, 478 (238 in intervention group and 240 in control group) aged 9-12years old had at least one result on biochemical data and were analyzed to evaluate the effect of the intervention on changes in fasting glucose and total cholesterol at the end of follow-up. Intention-to-treat analysis was performed taking into account the cluster (classes) effect. Statistically significant decrease in fasting glucose (-9.12mg/dL vs. +0.51mg/dL, p<0.001) and total cholesterol (-10.34mg/dL vs. +2.14mg/dL, p<0.001) were observed among students in the intervention group in comparison with controls. In addition, the prevalence of impaired fasting glucose and hypercholesterolemia decreased in interventions and increased in controls (-2.4% vs. +8.8%, p=0.04 and -10.0% vs. +2.7%, p=0.03, respectively). Discouraging soft drink consumption among children has led to a reduction in fasting glucose and total cholesterol, suggesting that these beverages may play a role in the development of cardiometabolic risk in childhood.

The Study of Cardiovascular Risk in Adolescents--ERICA: rationale, design and sample characteristics of a national survey examining cardiovascular risk factor profile in Brazilian adolescents.

BACKGROUND: The Study of Cardiovascular Risk in Adolescents (Portuguese acronym, "ERICA") is a multicenter, school-based country-wide cross-sectional study funded by the Brazilian Ministry of Health, which aims at estimating the prevalence of cardiovascular risk factors, including those included in the definition of the metabolic syndrome, in a random sample of adolescents aged 12 to 17 years in Brazilian cities with more than 100,000 inhabitants. Approximately 85,000 students were assessed in public and private schools. Brazil is a continental country with a heterogeneous population of 190 million living in its five main geographic regions (North, Northeast, Midwest, South and Southeast). ERICA is a pioneering study that will assess the prevalence rates of cardiovascular risk factors in Brazilian adolescents using a sample with national and regional representativeness. This paper describes the rationale, design and procedures of ERICA. METHODS/DESIGN: Participants answered a self-administered questionnaire using an electronic device, in order to obtain information on demographic and lifestyle characteristics, including physical activity, smoking, alcohol intake, sleeping hours, common mental disorders and reproductive and oral health. Dietary intake was assessed using a 24-hour dietary recall. Anthropometric measures (weight, height and waist circumference) and blood pressure were also be measured. Blood was collected from a subsample of approximately 44,000 adolescents for measurements of fasting glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, glycated hemoglobin and fasting insulin. DISCUSSION: The study findings will be instrumental to the development of public policies aiming at the prevention of obesity, atherosclerotic diseases and diabetes in an adolescent population.

Association between nutrient intake and anemia in Brazilian adolescents.

AIMS: The association between the intake of iron, vitamins A and C and calcium and the prevalence of anemia and hemoglobin (Hb) levels was investigated in adolescents. METHODS: A cross-sectional study was developed with 529 Brazilian students. Anemia was defined in terms of Hb concentration. Nutrient intake was assessed by a 3-day food record. The association between the prevalence of inadequate nutrient intake and anemia was estimated by the χ(2) test, and that between nutrient intake and Hb by linear regression. RESULTS: The prevalence of inadequate nutrient intake did not differ between nonanemic and anemic subjects. Anemic adolescents had a lower mean intake of iron than nonanemic adolescents. Among boys aged 11-13 years, the anemic subjects had lower vitamin C intake than those who were nonanemic (41.1 vs. 62.6 mg, p < 0.01), and among those aged 14-19 years, there was a tendency for a positive association between Hb and heme iron intake (ß = 0.64, p = 0.06) and a negative association with calcium intake (ß = -0.003, p = 0.02). In females, daily nutrient intake did not differ between anemic and nonanemic individuals. CONCLUSIONS: Heme iron and vitamin C are possible protective factors against anemia in boys. However, the lack of association between inadequate iron intake and anemia, especially in girls, suggests that other factors beyond diet could explain anemia in this age range.

Relationship between psychopathology and binge size in binge eating spectrum disorders.

INTRODUCTION: Food intake during binge eating episodes has been found to be associated with symptoms of depression and anxiety in individuals with eating disorders. OBJECTIVE: To evaluate the association between caloric intake during binge eating episodes (BEE) and psychopathology in individuals with binge eating spectrum disorders (BSD). METHODS: One-hundred and fourteen outpatients diagnosed with bulimia nervosa (BN) and binge eating disorder were sequentially assessed. MINI PLUS was used to assess psychiatric diagnoses. Validated self-report instruments were used to assess general and eating-related psychopathology. The assessment of caloric consumption during BEE was performed through Dietpro Clinical Program. Data analysis was performed with independent Student's t test, effect size (Cohen's d) and Pearson's correlation. RESULTS: Participants with BSD comorbid with a depressive disorder consumed significantly more calories during BEE than those without depression. Furthermore, participants with BSD and higher levels of impulsivity had a greater caloric intake during the episode. Specifically, regarding BN, participants with greater disease severity consumed more calories during the episode than those with less severity. CONCLUSIONS: Overall, depression and high impulsivity were associated with a higher caloric intake during BEE in individuals with BSD. For those with BN, the disease severity was associated with greater caloric consumption during the episode. Our results support the relevance of early identification of psychiatric comorbidities and the implementation of strategies to control mood and impulsivity aiming at a better prognosis in the treatment of BSD.

Anaemia in pregnant women before and after the mandatory fortification of wheat and corn flours with iron.

OBJECTIVE: To estimate the frequency of anaemia in pregnant women before and after the fortification of flours with Fe. DESIGN: Retrospective study developed from secondary data obtained from medical records. SETTING: Two health units in Rio de Janeiro, Brazil. SUBJECTS: Socio-economic, demographic, obstetric and Hb concentration data were collected of 778 pregnant women attending prenatal care. Two study groups were created: the first referred to the period before fortification (G1, n 391), including women whose parturition happened before June 2004; and the second referred to the period after fortification (G2, n 387), including women whose last menstrual cycle happened after June 2005. The Hb cut-off point adopted for anaemia diagnosis was <11.0 g/dl. RESULTS: In linear regression models, when Hb concentration was expressed as a dependent variable, women in G2 presented Hb concentration 0.26 g/dl and 0.36 g/dl higher during the second and third trimesters of pregnancy, respectively, compared with G1. In logistic regression models where the dependent variable was anaemia during the second and third trimesters, it was verified that being a member of G2 was a protective factor against anaemia in the third trimester. Regarding the presence of anaemia at any gestational moment, it was verified that being a member of G2 represented a protective factor against anaemia during pregnancy. CONCLUSIONS: Results indicate the protective effect of the fortification of flours with Fe in the fight against gestational anaemia, contributing to prevention and control of this nutritional disorder among pregnant women.

Validation of capillary glycemia as a strategy for the screening of diabetes mellitus in adolescents.

OBJECTIVE: To compare the degree of concordance between plasma and capillary glucose for screening of diabetes mellitus in adolescents. METHODS: The plasma and capillary glucose of 119 adolescents aged 10-19 yr (36 males and 83 females) from public schools in Niterói, Rio de Janeiro State, Brazil, were verified after a 12-h fast. Agreement was assessed through kappa statistics (k), McNemar's chi-squared test, and the intraclass correlation coefficient (ICC). The paired Student's t-test for comparison of means, the approaches by Altman and Bland, and the survival-agreement plot were also applied. RESULTS: Mean values of plasma glucose were 7.9 points higher than the capillary values (91.5 vs. 83.6 mg/dL, p < 0.001; ICC = 0.419). A regular agreement between the methods (k = 0.31, p < 0.001) for assessing proportions of adolescents with glycemia > or =100 mg/dL is observed. Using the strategy of adding 8 mg/dL to the capillary levels, the agreement improved (k = 0.46, p < 0.001) and a significant difference was not observed between the estimated prevalences (p = 0.815). CONCLUSIONS: The results suggest a satisfactory agreement between the two methods when capillary glucose is corrected, and this may be a useful and low-cost tool for the epidemiologic investigation of diabetes mellitus prevalence in adolescents.

Meal consumption patterns and anthropometric measurements in adolescents from a low socioeconomic neighborhood in the metropolitan area of Rio de Janeiro, Brazil.

We investigated the association between meal consumption and anthropometric measurements in a probabilistic sample of 528 12-18-year-old adolescents assessed in a population-based cross-sectional study developed in the Rio de Janeiro Metropolitan Area, Brazil. A score ranging from zero to nine according to the frequency of meal consumption (breakfast, lunch and dinner) assessed meal patterns which were defined as satisfactory or unsatisfactory. Nutritional status was defined by the sex- and age-specific body mass index cut-offs. Underweight was observed in 5.7% of the adolescents (8.6% boys, 2.5% girls) and overweight in 20.9%. The omission of breakfast was observed in 4.5% of the boys and 12.4% of the girls. Unsatisfactory meal consumption pattern was more frequent among girls (38.7% vs. 29.2%), and among teenagers over 15 years of age (40.0% vs. 25.4%). Boys with unsatisfactory patterns of meal consumption presented higher means of BMI and of waist and hip circumferences than the ones with satisfactory patterns. The higher values of anthropometric measurement observed among adolescents with an unsatisfactory meal pattern indicate that they may be at risk for overweight or obesity.

Breakfast Consumption, Family Breakfast, and Adiposity Trajectory in Adolescence-The Adolescent Nutritional Assessment Longitudinal Cohort Study.

BACKGROUND: The relationship between breakfast and family breakfast and adiposity gain during adolescence remains inconclusive. OBJECTIVE: This study aimed to investigate the relationship between breakfast and family breakfast frequency and adiposity trajectory in adolescence. DESIGN: Prospective cohort study with middle school students aged 10 to 16 years enrolled in 2010 (baseline) and followed for 3 years. PARTICIPANTS/SETTING: A total of 945 students from two public and four private schools in the metropolitan area of Rio de Janeiro were included. Among 945 students, 809 participated in the study at baseline. Pregnant or lactating students and those with physical or mental disabilities were excluded. MAIN OUTCOME MEASURES: Body mass index (BMI) was assessed by measuring the participants' weight and height, and percent body fat (%BF) was assessed by performing bioelectrical impedance analysis. STATISTICAL ANALYSES PERFORMED: Linear mixed-effect models were used to examine the relationship between baseline and persistence of breakfast consumption and family breakfast over a 3-year period and change in BMI and %BF. Breakfast and family breakfast were assessed by questions on frequency of consumption. Both variables were classified as regular, intermediate, and no consumption at baseline. Persistence was divided into persistently regular, persistently irregular, changing from regular to irregular, and contrariwise. RESULTS: Overall, frequent breakfast consumption and family breakfast did not have protective effects against adiposity. At baseline, these behaviors were associated with low BMI and %BF among girls. During follow-up, these behaviors and persistence of regular breakfast consumption were associated with an increase in %BF (P<0.05). In boys, those who increased or decreased family breakfast frequency had greater decrease in %BF compared with those persistently regular at both time points. CONCLUSION: Breakfast had no consistent relationship with adolescence adiposity trajectory, which is in line with the results of experimental studies and in contrast with those of many cross-sectional studies.

Associations between self-reported diabetes mellitus, disordered eating behaviours, weight/shape overvaluation, and health-related quality of life.

BACKGROUND: Eating disorders (ED) and disordered eating behaviours (DEB) have been found to be common in people with diabetes mellitus (DM). However, findings have been inconsistent. OBJECTIVE: This study investigated the association between self-reported diabetes (Type 1 or 2) with ED/DEB (binge eating, subjective binge eating or loss of control overeating, severe dieting and purging) weight/shape overvaluation, and health-related quality of life (HRQoL) in a household survey in South Australia. METHOD: In 2017 2977 people aged ≥15 years, who were representative of the general population, were interviewed. Participants reported their gender, age, household income, highest educational attainment, area of residence, presence of DM, ED/DEB, level of overvaluation, current HRQoL and height and weight. For the analyses between ED/DEB, self-reported DM and HRQoL, a grouping variable was created: 1) people without ED/DEB or self-reported DM; 2) people without ED/DEB and with self-reported DM; 3) people with ED/DEB and without self-reported DM; and 4) people with ED/DEB and self-reported DM. Analyses were stratified by sex and age group. RESULTS: Subjective binge eating prevalence was higher in people with self-reported DM (6.6% vs 2.8%, p = 0.016), and overvaluation was lower in those with DM (36% vs 43.8%, p = 0.007). In analyses stratified by sex and age group, subjective binge eating was higher in women and in people over 45 years with self-reported DM and overvaluation was lower in men and in people over 45 years with self-reported DM. However, these differences were not significant on tests of gender and age interaction. People in both DM groups scored significantly lower than people without DM groups on physical HRQoL. In contrast, people in both ED/DEB groups scored lower than people without ED/BEB on mental HRQoL. CONCLUSION: People with self-reported DM had a higher prevalence of subjective binge eating, a lower prevalence of overvaluation and there were no significant effects of age or gender. Furthermore, participants with self-reported DM and comorbid ED or DEB had impairments of both mental and physical HRQoL. Assessing an individual's sense of control over eating along with other DEB is likely important for identification of these mental health problems.

Changes in breakfast frequency and composition during adolescence: The Adolescent Nutritional Assessment Longitudinal Study, a cohort from Brazil.

OBJECTIVES: To estimate changes over time of breakfast frequency and foods/food groups consumed at breakfast. METHODS: Cohort of 809 students aged 10-16 years old from Rio de Janeiro, Brazil, enrolled in 2010, and followed for three years. Breakfast skippers were those not eating breakfast. Those with breakfast frequency of 4 or less times per week were considered irregular breakfast eaters. Changes over time of breakfast frequency and breakfast foods/food groups were analyzed by generalized estimating equations. RESULTS: At baseline, overweight/obese girls had higher prevalence of irregular breakfast than those non-overweight/obese (40% vs. 26%; p = 0.005); among boys, there was no significant difference in the prevalence of irregular breakfast according to weight status. After three years, among girls there was an increase in the risk of irregular breakfast consumption (RR = 1.29; 95% CI: 1.08; 1.54) and breakfast skipping (RR = 1.63; 95% CI: 1.12; 2.38). Also, overweight/obese boys (RR = 1.40, 95% CI: 1.03, 1.89) and non-overweight/obese girls (RR = 1.54, 95% CI: 1.17, 2.04) had higher risk of irregular breakfast in three years, compared to baseline. After three years, boys changed the consumption of foods/food groups at breakfast and presented higher risk of decreased intake of fruits (RR = 1.60, 95% CI: 1.20, 2.13), sandwiches and snacks (RR = 1.58, 95% CI: 1.12, 2.22), chips (RR = 1.43, 95% CI: 1.01, 2.13), and ham (RR = 1.52, 95% CI: 1.12, 2.07), and lower risk of cheese intake (RR = 0.73, 95% CI: 0.53, 1.00). Girls had higher risk of decreased intake of fruits (RR = 2.08, 95% CI: 1.47, 2.95), milk (RR = 1.49, 95% CI: 1.07, 2.08), chocolate powder (RR = 1.54, 95% CI: 1.11, 2.14) and ham (RR = 1.65, 95% CI: 1.16, 2.36). CONCLUSIONS: Changes in breakfast patterns are different according to sex. Also, different changes in breakfast frequency according to BMI category were found. Consumption patterns of some foods/food groups have a tendency to become changed from initial to middle adolescence.

Ultra-processed food consumption and adiposity trajectories in a Brazilian cohort of adolescents: ELANA study.

BACKGROUND/OBJECTIVES: In Brazil, the increase in obesity rates has been accompanied by increased consumption of ultra-processed food (UPF). The objective of this paper was to evaluate body mass index (BMI) and body fat percentage (%BF) trajectories in adolescents over a 3-year follow-up according to the frequency of UPF consumption. SUBJECTS/METHODS: Data of three consecutive years (2010, 2011, and 2012) were obtained from the Adolescent Nutritional Assessment Longitudinal Study (ELANA) that aimed to assess changes in anthropometric indicators of nutritional status, and 1035 adolescents enrolled in the 1st year of high school from six schools (four private and two public) in the metropolitan area of Rio de Janeiro, Brazil were included. At three follow-ups, they had their weights and heights measured. Body composition was measured at the first and second follow-ups. Mixed linear regression models were used to estimate BMI and %BF trajectories based on quartiles of UPF intake, adjusting for type of school, sex, physical activity, and underreporting. RESULTS: Compared to their counterparts in the 1st quartile, adolescents in the 4th quartile of UPF consumption had a lower daily intake of fruits, cooked vegetables, and raw vegetables and a higher intake of total sugar and physical activity levels (p < 0.001). There was an inverse association between UPF consumption and BMI both at baseline and at follow-up. Values for %BF followed the same trend. Adolescents in the 4th quartile had the greatest level of physical activity and lowest total energy intake. CONCLUSION: This study confirmed that greater intake of UPF is a marker of an unhealthy diet, but did not support the hypothesis of a high rate of change in BMI associated with greater UPF consumption, even after adjusting for physical activity.

Temporal changes in the prevalence of disordered eating behaviors among adolescents living in the metropolitan area of Rio de Janeiro, Brazil.

To investigate temporal changes in the prevalence of disordered eating behaviors among adolescents, and their association with socio demographic factors and overweight. Using probability sampling, two population-based cross-sectional surveys were conducted: one in 2005 (n=511) and the other in 2010 (n=314). The frequency of disordered eating behaviors (binge eating, strict dieting or fasting and compensatory behaviors) was investigated using a self-administered questionnaire. The presence of binge eating increased by 18.4% in the 5 years between the two surveys. In 2005, girls were 1.95 times more likely to engage in strict dieting or fasting than boys, and this difference increased to 7.02 times in 2010. Overweight adolescents were 2.29 times more likely to undertake strict dieting than non-overweight adolescents in 2005 and 3.65 times more likely to do so in 2010. No significant associations were found for compensatory behaviors. A pronounced increase in the prevalence of binge eating was observed, and girls and overweight adolescents were more likely to engage in strict dieting or fasting.