Prevalence and factors associated with dietary adherence in individuals with type 2 diabetes mellitus in Brazil: a systematic review with meta-analysis / Prevalência e fatores associados à adesão à dieta em indivíduos com diabetes mellitus tipo 2 no Brasil: Uma revisão sistemática com meta-análise

Introduction: Low adherence to the treatment is a major challenge faced by health professionals during the management of type 2 diabetes. Objective: To assess the prevalence and risk factors related to dietary adherence in individuals living with type 2 diabetes in Brazil. Material and Methods: PubMed, Embase, Cochrane Library and SciELO/Lilacs were searched without restriction to a year of publication and language. Results: From 3713 studies, 14 articles involving 2962 individuals living with type 2 diabetes were eligible. The combined proportion of adherence to the diet was 41% (95% CI: 0.267-0.562, p< 0.001; I2= 98.81%, p<0.001), with the highest 78% and lowest 3%. The combined proportion of nonadherence to the diet was 51% (95% CI: 0.268-0.754, p<0.001; I²= 99.25%, p<0.001), with the highest being 98% and the lowest being 9%. The main risk factors for nonadherence to nutritional treatment were low education, low income, and multimorbidity. Conclusion: Low adherence to the diet is a concern during nutritional counseling of individuals living with type 2 diabetes in Brazil.

Introdução: A baixa adesão ao tratamento é um dos principais desafios enfrentados pelos profissionais de saúde durante a gestão da diabetes tipo 2. Objetivo: Avaliar a prevalência e os fatores de risco relacionados à adesão à dieta em indivíduos vivendo com diabetes mellitus tipo 2 no Brasil. Material e Métodos: Foram pesquisadas as bases de dados PubMed, Embase, Cochrane Library e SciELO/Lilacs, sem restrição de ano de publicação e idioma. Resultados: De 3713 estudos, 14 artigos envolvendo 2962 indivíduos vivendo com diabetes mellitus tipo 2 foram elegíveis. A proporção combinada de adesão à dieta foi de 41% (IC 95%: 0,267-0,562, p<0,001; I2= 98,81%, p<0,001), sendo a maior 78% e a menor 3%. A proporção combinada de não adesão à dieta foi de 51% (IC 95%: 0,268-0,754, p<0,001; I²= 99,25%, p<0,001), sendo a mais elevada de 98% e a mais baixa de 9%. Os principais fatores de risco para a não adesão ao tratamento nutricional foram a baixa escolaridade, a baixa renda e a multimorbidade. Conclusão: A baixa adesão à dieta é uma preocupação durante o aconselhamento nutricional de indivíduos vivendo com diabetes mellitus tipo 2 no Brasil.

Association between abdominal obesity, screen time and sleep in adolescents

Abstract Objective: To assess the association between abdominal obesity, food intake, sleep deprivation, and screen time in adolescents. Methods: This cross-sectional study was conducted with 432 adolescents aged 14-19 years, from public and private schools. Anthropometric and body composition measures included body weight, waist circumference, body mass index for age, waist-to-hip ratio, waist-to-height ratio, and body fat percentage. Abdominal obesity was defined by age and sex specific cut-off points for waist circumference. Food intake, screen time, sexual maturation, and sleep duration were evaluated by self-administered questionnaires. Results: The prevalence of excess body weight and abdominal obesity was 16.7% and 27.5%, respectively. Students in the adult phase (post-puberty), with inadequate waist-to-height ratio, high body fat percentage, and screen time ≥ 3 h/day were, respectively, 2.5 (95% CI 1.40-4.46), 7.44 (95% CI 1.08-51.46), 2.79 (95% CI 1.04-7.50), and 1.43 (95% CI 1.24-3.89) more likely to have abdominal obesity. Low intake of unprocessed or minimally processed foods was associated with inadequate sleep duration, while high intake of ultra-processed foods was associated with high screen time. Conclusions: Abdominal obesity was associated with the adult phase, short sleep duration and high screen time. The degree of food processing was associated with screen time and sleep duration. Assessing the risk factors of abdominal obesity may be a useful strategy for preventing cardiovascular disease in adolescents.

Consumption of ultra-processed foods and associated factors in children from Barbacena (MG), Brazil / Consumo de alimentos ultraprocessados e fatores associados em crianças de Barbacena (MG), Brasil

Abstract Objective: To evaluate the prevalence of ultra-processed food consumption and associated factors among children enrolled in the public school system of the city of Barbacena, Minas Gerais, Brazil. Methods: This is a cross-sectional study conducted with schoolchildren aged 7-9 years, of both sexes, enrolled in state public schools. Food intake was assessed using the Previous Day Food Questionnaire and the level of physical activity by the Previous Day Physical Activity Questionnaire. The listed foods were classified according to the extent and purpose of industrial processing, using the NOVA classification. Pearson's χ2 test, Fisher's exact test, χ2 with Yates correction, and Poisson regression were used in the statistical analysis, estimating the crude and adjusted prevalence ratio, with 95% confidence intervals. Results: The prevalence of daily ultra-processed food consumption was 69.6%. After adjusted analyses, the consumption of ultra-processed food was associated with the omission of breakfast, mid-afternoon snack, supper, low physical activity, and consumption of risk foods. On the other hand, consumption of in natura or minimally processed foods was associated with older age, the consumption of lunch, mid-afternoon snack, dinner, and protective foods. Conclusions: There is a high prevalence of ultra-processed foods consumption, associated with unhealthy dietary habits among schoolchildren. This highlights the need for nutritional counseling and educational actions, favoring healthy eating in childhood.

RESUMO Objetivo Avaliar a prevalência de consumo de alimentos ultraprocessados e fatores associados em crianças matriculadas na rede pública do município de Barbacena, Minas Gerais, Brasil. Métodos Trata-se de um estudo transversal realizado com escolares de 7 a 9 anos de ambos os sexos, matriculados na rede pública estadual de ensino. O consumo alimentar foi avaliado utilizando o Questionário Alimentar do Dia Anterior e o nível de atividade física pelo Questionário de Atividade Física do Dia Anterior. Os alimentos listados foram classificados segundo a extensão e propósito do processamento industrial, conforme proposto pela classificação NOVA. Na análise estatística foram utilizados os testes χ2 de Pearson, Exato de Fisher, χ2 com correção de Yates e regressão de Poisson, estimando-se a razão de prevalência bruta e ajustada, com intervalos de confiança de 95%. Resultados A prevalência de consumo de alimentos ultraprocessados foi de 69,6%. Após análises ajustadas, o consumo de alimentos ultraprocessados foi associado à omissão do café da manhã, lanche da tarde e ceia, baixo nível de atividade física e ao consumo de alimentos de risco. Por outro lado, o consumo de alimentos in natura ou minimamente processados foi associado à maior idade, consumo de almoço, lanche da tarde, jantar e alimentos protetivos. Conclusões Verificamos uma alta prevalência no consumo de alimentos ultraprocessados, associada a hábitos alimentares não saudáveis, em crianças escolares. Isso destaca a necessidade de ações de educação alimentar e nutricional, favorecendo o consumo alimentar saudável na infância.

Abdominal obesity-related risk factors in children from public schools of Barbacena, Minas Gerais, Brazil / Fatores associados à obesidade abdominal em crianças matriculadas na rede pública de ensino, Barbacena, Minas Gerais

ABSTRACT Objective: To evaluate the sociodemographic and lifestyle factors associated with abdominal obesity in children from public schools in Barbacena, state of Minas Gerais, Brazil. Methods: This is a cross-sectional study conducted on 326 students aged 7 to 9 years from public schools in the urban area of the city. Anthropometric data included body weight, height, body mass index according to age, waist circumference, and waist-to-height ratio. Food consumption was evaluated using the Previous Day Food Questionnaire. Abdominal obesity was assessed based on waist circumference and waist-to-height ratio. The bivariate and multivariate analyses were performed by logistic regression, estimating the crude and adjusted odds ratio (OR), with 95% confidence interval. Results: The prevalence of overweight was 30.7%; whereas the prevalence of abdominal obesity was 9.2 and 12.6% according to waist circumference and waist-to-height ratio, respectively. Boys (OR 2.76; 95%CI 1.22-6.25) and children from central schools (OR 2.73; 95%CI 1.08-6.80) presented an increased chance of abdominal obesity according to waist circumference. Abdominal obesity according to waist-to-height ratio was associated with the central location of the schools (OR 2.18; 95%CI 1.02-4.63) and the habit of skipping supper (OR 2.01; 95%CI 1.00-4.09). Conclusions: The findings showed that being a boy, studying in a central school, and skipping supper were the main risk factors associated with abdominal obesity.

RESUMO Objetivo: Avaliar os fatores sociodemográficos e de estilo de vida associados à obesidade abdominal em crianças de escolas públicas de Barbacena, Minas Gerais. Métodos: Trata-se de estudo transversal realizado com 326 escolares de sete a nove anos, matriculados em escolas da zona urbana da cidade. As variáveis antropométricas avaliadas foram peso, estatura, índice de massa corpórea por idade, circunferência da cintura e relação cintura-estatura. O consumo alimentar foi registrado pelo Questionário Alimentar do Dia Anterior. A obesidade abdominal foi avaliada com base na circunferência da cintura e relação cintura-estatura. As análises bivariada e multivariada foram realizadas por meio de regressão logística, estimando-se a Odds Ratio (OR) bruta e ajustada, com os intervalos de confiança de 95% (IC95%). Resultados: A prevalência de excesso de peso foi de 30,7%, enquanto a prevalência de obesidade abdominal foi de 9,2 e 12,6%, de acordo com circunferência da cintura e relação cintura-estatura, respectivamente. Crianças do sexo masculino (OR 2,76; IC95% 1,22-6,25) e de escolas centrais (OR 2,73; IC95% 1,08-6,80) tiveram maior chance de apresentar obesidade abdominal segundo a circunferência da cintura. A obesidade abdominal, de acordo com a relação cintura-estatura, associou-se à localização central das escolas (OR 2,18; IC95% 1,02-4,63) e à omissão da ceia (OR 2,01; IC95% 1,00-4,09). Conclusões: Os achados mostraram que ser do sexo masculino, estudar em escola central e omitir a ceia foram os principais fatores de risco associados à obesidade abdominal.

Low glycemic index diet reduces body fat and attenuates inflammatory and metabolic responses in patients with type 2 diabetes

ABSTRACT Objective The aim of this study was to verify the effects of glycemic index (GI) on body composition, and on inflammatory and metabolic markers concentrations in patients with type 2 diabetes. Subjects and methods In this randomized controlled parallel trial, twenty subjects (aged 42.4 ± 5.1 years, BMI 29.2 ± 4.8 kg.m-2) were allocated to low GI (LGI) (n = 10) or high GI (HGI) (n = 10) groups. Body composition, inflammatory and metabolic markers were assessed at baseline and after 30 days of intervention. Food intake was monitored during the study using three-day food records completed on two non-consecutive weekdays and on a weekend day. Results Body fat reduced after the LGI intervention compared with baseline (P = 0.043) and with the HGI group (P = 0.036). Serum fructosamine concentration (P = 0.031) and TNF-α mRNA expression (P = 0.05) increased in the HGI group. Serum non-esterified fatty acids were greater in the HGI than in the LGI group (P = 0.032). IL-6 mRNA expression tended to decrease after the consumption of the LGI diet compared to baseline (P = 0.06). Conclusion The LGI diet reduced body fat and prevented the negative metabolic and inflammatory responses induced by the HGI diet.