Da medicalização da comida à gourmetização do medicamento: análise da campanha publicitária que transformou um comprimido efervescente em febre nacional / From the medicalization of food to the gourmetization of medicines: analysis of the advertising campaign that turned an effervescent tablet into a national fever / De la medicalización de los alimentos a la gourmetización de los medicamentos: análisis de la campaña publicitaria que convirtió un comprimido efervescente en fiebre nacional

O aumento da longevidade humana veio acompanhado de uma maior preocupação com os hábitos alimentares e de uma banalização das dietas prescritas, favorecendo um contexto de medicalização da comida, no qual a fronteira entre alimento e medicamento fica imprecisa. Isto tem sido usado mercadologicamente pelas indústrias alimentícias, farmacêuticas e de suplementos alimentares. Este artigo visa discutir como o ecossistema publicitário contemporâneo e a ciberpublicidade são utilizados para naturalizar a presença de suplementos e medicamentos na dieta cotidiana. Usou-se como estudo de caso uma campanha publicitária vietnamita, em que um comprimido foi posicionado como ingrediente culinário. A partir de outros casos descritos na literatura, discutem-se os resultados encontrados no contexto ocidental. Nas considerações finais, apresentam-se alguns desafios regulatórios; apontam-se perspectivas para pesquisas futuras; e defende-se a educação como elemento fundamental para a construção de uma sociedade em que a saúde seja valorizada e exigida como bem coletivo e direito de todos

As human longevity increases, a greater concern with eating habits is visible. Furthermore, the number of people who trivialize prescribed diets increases. This context favors the medicalization of food, in which the boundary between food and medicine is blurred. Industries take advantage of this situation to promote several products. This article discusses how the contemporary advertising ecosystem and the cyber advertising techniques are used to naturalize the presence of supplements and medications in the daily diet. We used as a case study a Vietnamese campaign, in which a tablet was positioned as a culinary ingredient. Based on other cases described in the literature, the results found in the Western context are discussed. In the last section, some regulatory challenges are presented, prospects for future research are pointed out, and education is defended as fundamental for the development of citizens who value Public Health as a collective good and a right of all

El aumento de la longevidad humana ha venido acompañado de una mayor preocupación por los hábitos alimentarios y de una banalización de las dietas prescritas, favoreciendo un contexto de medicalización de la alimentación, en el que la frontera entre alimento y medicamento se esfuma. Esto viene siendo utilizado comercialmente por industrias alimentarias, farmacéuticas y de complementos alimenticios. Este artículo tiene el objetivo de discutir como el ecosistema publicitario contemporáneo y la publicidad cibernética son usados para naturalizar la presencia de suplementos y medicamentos en la dieta diaria. Se utilizó como estudio de caso una campaña publicitaria vietnamita, en la que se posicionó un comprimido como ingrediente culinario. Con base en otros casos descritos en la literatura, se discuten los resultados encontrados en el contexto occidental. En las reflexiones finales, se presentan algunos desafíos regulatorios; se señalan perspectivas para futuras investigaciones; y la educación es defendida como elemento fundamental para la construcción de una sociedad en la que se valore y exija la salud como bien colectivo y derecho de todos.

Prevalence of Cardiovascular Risk Factors among Young Adults (18-25 Years) in Mozambique.

The life course development of cardiovascular diseases (CVDs) and the undergoing epidemiological transition in Mozambique highlight the importance of monitoring the cardiovascular risk profile in young adults. Therefore, this study aims to estimate the prevalence of CVD risk factors in a population aged 18-25 years living in Mozambique. A total of 776 young adults from a nationally representative sample were evaluated in 2014/2015 following the World Health Organization's STEPwise approach to chronic disease risk factor surveillance. Current smoking was the most prevalent among rural men (10.8%, 95%CI: 6.3-17.8), and drinking was most prevalent among urban men (38.6%, 95%CI: 29.3-48.8). The proportion of young adults not engaging in at least 75 min of vigorous physical activity per week ranged between 14.5% in rural men and 61.6% in urban women. The prevalence of being overweight/obese and hypertension were highest among urban women (21.6%, 95%CI: 14.7-30.6) and urban men (25.2%, 95%CI: 15.9-37.6), respectively. Education >8 years (vs. none) was independently associated with lower odds of being a current smoker, and increased monthly household income was associated with increased odds of low levels of physical activity. This study shows that important CVD risk factors are already common in the young adult population of Mozambique.

An anti-inflammatory and low fermentable oligo, di, and monosaccharides and polyols diet improved patient reported outcomes in fibromyalgia: A randomized controlled trial.

Background: Fibromyalgia (FM) has been associated with dysbiosis and low-grade inflammation. Studies have reported that diet influences clinical features in FM. Objective: To evaluate the effect of an anti-inflammatory and low fermentable oligo, di, and monosaccharides and polyols (FODMAP) diet on clinical outcomes of patients with FM. Methods: This two arms Randomized Controlled Trial (NCT04007705) included 46 female patients with FM. The intervention group (n = 22) adopted an anti-inflammatory diet for 3 months, excluding gluten, dairy, added sugar, and ultra-processed foods, along with a low FODMAPs diet in the first month. The control group (n = 24) followed general healthy eating recommendations. Both diets were applied by a certified dietitian. Before and after the intervention, participants were assessed regarding pain, fatigue, gastrointestinal symptoms, quality of sleep, and quality of life, through the Revised Fibromyalgia Impact Questionnaire (FIQR), Visual Analogue Pain Scale (VAS), Visual Analog Scale from gastrointestinal symptoms (VAS GI), Brief Pain Inventory (BPI), Pittsburg Sleep Quality Index (PSQI), Fatigue Severity Survey (FSS), and The Short Form Health Survey (SF-36). A blood sample was collected and high-sensitive C-Reactive Protein and Erythrocyte Sedimentation Rate were quantified. Paired Samples t-test/Wilcoxon and independent samples t-test/Mann-Whitney were used to compare variables between groups. Results: After intervention, there was an improvement in intervention group scores of FIQR (p = 0.001), VAS (p = 0.002), BPI (p = 0.011), FSS (p = 0.042), VAS_GI (p = 0.002), PSQI (p = 0.048), and SF36 (p = 0.045) compared to control group. Inflammatory biomarkers (hs-CRP, ESR) did not change in both groups. The intervention was beneficial in the intervention group, regardless of age, disease duration, body mass index variation, and body fat change between baseline and post-intervention. Conclusion: An anti-inflammatory and low-FODMAP diet improved clinical features in patients with FM and may be useful as a complement to pharmacological therapy. Clinical Trial Registration: [https://clinicaltrials.gov/ct2/show/NCT04007705], identifier [NCT04007705].

The Effectiveness of Web-Based Interventions to Promote Health Behaviour Change in Adolescents: A Systematic Review.

Although web-based interventions are attractive to researchers and users, the evidence about their effectiveness in the promotion of health behaviour change is still limited. Our aim was to review the effectiveness of web-based interventions used in health behavioural change in adolescents regarding physical activity, eating habits, tobacco and alcohol use, sexual behaviour, and quality of sleep. Studies published from 2016 till the search was run (May-to-June 2021) were included if they were experimental or quasi-experimental studies, pre-post-test studies, clinical trials, or randomized controlled trials evaluating the effectiveness of web-based intervention in promoting behaviour change in adolescents regarding those health behaviours. The risk of bias assessment was performed by using the Effective Public Health Practice Project (EPHPP)-Quality Assessment Tool for Quantitative Studies. Fourteen studies were included. Most were in a school setting, non-probabilistic and relatively small samples. All had a short length of follow-up and were theory driven. Thirteen showed significant positive findings to support web-based interventions' effectiveness in promoting health behaviour change among adolescents but were classified as low evidence quality. Although this review shows that web-based interventions may contribute to health behaviour change among adolescents, these findings rely on low-quality evidence, so it is urgent to test these interventions in larger controlled trials with long-term maintenance.

A study protocol for a randomized controlled trial of an anti-inflammatory nutritional intervention in patients with fibromyalgia.

BACKGROUND: This study aims to analyze the effects of a potentially anti-inflammatory nutritional intervention in disease assessment parameters, inflammatory markers, and quality of life of fibromyalgia (FM) patients. METHODS: A sample of 100 female patients diagnosed with FM, followed up at Portuguese Institute of Rheumatology (IPR) in Lisbon, is being randomly allocated in two groups. Patients in the intervention group are adopting an anti-inflammatory diet, characterized by the exemption of the intake of foods containing gluten, dairy, sugar, and ultra-processed foods, during 3 months. During the first month, a low fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) diet is implemented, along with the anti-inflammatory diet, followed by the reintroduction of all fruits and vegetables over a consecutive period of 2 months. Patients in the control group are adopting a diet based on general recommendations for healthy eating. The outcomes are pain, fatigue, quality of sleep, quality of life, gastrointestinal symptoms, and inflammation. Before and after the 3 months intervention, and also 1 month after beginning the intervention, the following questionnaires are applied: Revised Fibromyalgia Impact Questionnaire, visual analog pain scale, Brief Pain Inventory,visual analog scale from a list of common gastrointestinal and extraintestinal symptoms in FM, Short Form 36, Fatigue Severity Survey, and Pittsburg Sleep Quality Index. Ultra-sensitive serum C-reactive protein, eritrocyte sedimentation rate, and interleukin-8 are determined. Age, physical activity, anthropometric parameters, and body composition are being collected. Student's t test will assess the association between the disease evaluation parameters, the inflammatory markers, and the dietary interventions. DISCUSSION: The results of this study are expected to determine whether a change in patient nutrition helps to alleviate symptoms, which would optimize medical intervention. TRIAL REGISTRATION: www.ClinicalTrials.gov NCT04007705 . Registered on July 5, 2019.

Dietary interventions in fibromyalgia: a systematic review.

Fibromyalgia (FM) is a chronic non-degenerative disease, whose nutritional therapy seems controversial. This systematic review aimed to synthesize the knowledge about the effect of dietary interventions on patient-reported outcomes (PRO) and inflammation in patients with FM. Six electronic databases - PubMed, BioMed Central, Cochrane library, EMBASE, LILACS and ISI - were searched for clinical trials, in which a dietary intervention in patients with FM diagnosed was conducted. Quality of evidence assessment was measured in accordance with GRADE methodology. Seven clinical trials - 3 randomized controlled trials, 1 unrandomized clinical trial and 3 uncontrolled clinical trials were identified. Dietary approaches included gluten-free diet (n = 1), raw vegetarian diet (n = 2), low Fermentable oligo-, di- and monossacharides, alcohols and polyols (FODMAPs) diet (n = 1), hypocaloric diet (n = 2) and monosodium glutamate- and aspartame-free diet interventions (n = 1). The major PRO were pain and functional repercussion, with 5 out of 7 studies reporting an improvement. The progress in secondary outcomes was reported for fatigue (2/5 studies), sleep quality (2/3 studies), depression and anxiety (3/6 studies), quality of life (4/5 studies), gastrointestinal symptoms (1/2 studies) and inflammatory biomarkers (1/1 study). However, according to Cochrane Risk of Bias, these studies had poor statistical quality. Well-designed studies should be performed to investigate the dietary interventions effect on FM. Key messages Fibromyalgia (FM) is a chronic non-degenerative disease, whose nutritional therapy seems controversial but promising. Pain and functional repercussion in FM patients seem to improve with a hypocaloric diet, a raw vegetarian diet or a low FODMAPs diet, as much as quality of life, quality of sleep, anxiety and depression and inflammatory biomarkers. Existing studies in this subject are scarce and low quality, which does not allow conclusions to be drawn.

Body Mass Index Categories and Attained Height in Portuguese Adults.

OBJECTIVE: To analyze the associations between height and BMI categories in a Portuguese representative sample. METHODS: This is a cross-sectional study with a representative sample of 32,644 Portuguese adults (52.4% females). Sociodemographic and lifestyle characteristics were obtained along with self-reported height and weight. We performed generalized linear models to assess the differences in attained height across BMI categories; analyses were adjusted for age, gender, education, family income per month, proxy reporting information, dietary patterns, and smoking. RESULTS: BMI categories included underweight and normal weight (46.4%), overweight (37.6%), obese class I and II (15.2%), and obese class III (0.8%). Adults with normal weight had a significantly higher height (females +7 cm and males +5 cm) when compared to obese class III. As BMI categories increased, height decreased. In females and males, after adjusting for confounders, estimates of attained height decreased when compared to the unadjusted model (ß = -0.049, 95% CI = -0.050; -0.049 and ß = -0.030, 95% CI = -0.031; -0.029, respectively), although they remained still significant. CONCLUSION: Our results suggest a significant difference in attained height between BMI categories. Future intervention programs aiming at preventing overweight and obesity should monitor sociodemographic, health and environmental conditions that affect attained height potential.

Associations between fruit and vegetable variety and low-grade inflammation in Portuguese adolescents from LabMed Physical Activity Study.

PURPOSE: The dietary guidelines for the consumption of a variety of fruits and vegetables have been recognized as an important factor for achieving healthy eating patterns to reduce the risk of chronic disease throughout the lifespan. Our aim is to assess the association between fruit and vegetable variety and low-grade inflammation in adolescents. METHODS: This cross-sectional analysis was conducted with 412 adolescents (ages 14.4 ± 1.7 years; 52% girls). The consumption of a variety of fruits and vegetables was assessed with a food-frequency questionnaire, considering the number of individual/category of fruit or vegetable intake at least once month, and categorized into tertiles. Blood samples were collected to determine C-reactive protein (CRP), interleukin-6 (IL-6), complement component 3 (C3), and 4 (C4). We created categories of lower or higher (inflammatory state) for each biomarker, considering sex- and age-adjusted median values. Then, we computed an overall inflammatory score, by adding all points awarded wherein one point was assigned if biomarker was higher or zero if lower, and created categories of 0-1 or 2-4 biomarkers above the median. The odds ratio (OR) and 95% interval confidence (95% CI) were calculated from binary logistic regression to estimate the magnitude of association between fruit and vegetable variety and inflammatory biomarkers. RESULTS: Adolescents with a greater variety of vegetable consumption (≥13 categories/month) had lower odds of having a higher CRP (OR 0.31, 95% CI 0.15-0.64, p trend = 0.004) when compared to those with lower variety consumption (≤6 categories/month), independent of vegetable quantity intake. However, a greater variety of fruit consumption (≥12 categories/month) had higher odds of having a higher IL-6 (OR 4.41, 95% CI 1.67-11.71, p trend = 0.012), C3 (OR 3.30, 95% CI 1.23-8.86, p trend = 0.047), and inflammatory score (OR 4.90, 95% CI 1.62-14.86, p trend = 0.017), when compared to those with lower variety consumption (≤9 categories/month), independent of fruit quantity intake, only for girls. CONCLUSIONS: The consumption of a variety of vegetables is inversely associated with lower CRP. This finding supports the current dietary guidelines regarding the consumption of a variety of vegetables. The role of fruit variety in low-grade inflammation should be further studied.

Worldwide burden of gastric cancer in 2012 that could have been prevented by increasing fruit and vegetable intake and predictions for 2025.

The regional and temporal variation in patterns of fruit and vegetable intake contributes to differences in the impact on gastric cancer burden across regions and over the years. We aimed to estimate the proportion and absolute number of gastric cancer cases that could have been prevented in 2012 with an increase in fruit and vegetable intake up to the levels defined by the Global Burden of Disease as the theoretical minimum-risk exposure distribution (300 and 400 g/d, respectively), as well as the corresponding figures expected for 2025. Preventable fractions (PF) were computed for 161 countries, using data on fruit and vegetable availability in 1997 and 2010 and published estimates of the magnitude of the association between fruit and vegetable intake and gastric cancer, assuming a time lag of approximately 15 years. Countries classified as very high Human Development Index (HDI) presented median PF in 2012 much lower than low-HDI countries for both fruits (3·0 v. 10·2%, P<0·001) and vegetables (6·0 v. 11·9%, P<0·001). For vegetables only, PF significantly decreased until 2025 in most settings; however, this corresponded to a reduction in the absolute number of preventable gastric cancer cases in less than half of the countries. Increasing fruit and vegetable intake would allow preventing a relatively high proportion of gastric cancer cases, mostly in developing countries. Although declines in PF are predicted in the near future, changes in order to achieve healthier lifestyles may be insufficient to overcome the load of demographic variation to further reduce the gastric cancer burden.

Model-based patterns of cardiovascular risk factors in Mozambique.

BACKGROUND: Risk factors for cardiovascular diseases tend to cluster, although evidence from settings under epidemiological transition is scarce. AIM: To identify patterns of clustering of cardiovascular risk factors and to quantify their association with sociodemographic characteristics, in Mozambique. SUBJECTS AND METHODS: A national representative sample (n = 3323) of subjects aged 25-64 years was evaluated in 2005, using the World Health Organization Stepwise Approach to Chronic Disease Risk Factor Surveillance (STEPS). Patterns of joint exposure to high blood pressure, high fasting blood glucose, high body mass index, smoking, excessive alcohol consumption, low fruit/vegetables intake and insufficient physical activity were identified through latent class analysis. RESULTS: Three patterns were identified among women: (1) "healthier", lower frequency of most risk factors (53.0%); (2) "hypertension-overweight" (21.1%), more frequent among older and urban subjects; and (3) "hypertension-smoking-alcohol" (25.9%), whose frequency increased with age and decreased with education. In men, two clusters were identified: (1) "hypertension-overweight" (30.1%); and (2) "smoking" (69.9%). The frequency of the latter pattern was higher in urban areas and increased with age and education. CONCLUSION: Hypertension, overweight/obesity, smoking and excessive alcohol intake defined the main clusters of cardiovascular risk factors. This should be considered when planning prevention and control strategies for cardiovascular diseases in Mozambique.

Cardiovascular risk in Mozambique: who should be treated for hypertension?

AIM: To estimate the proportion of Mozambicans eligible for pharmacological treatment for hypertension, according to single risk factor and total cardiovascular risk approaches. METHODS: A representative sample of Mozambicans aged 40-64 years (n=1116) was evaluated according to the WHO STEPwise Approach to Chronic Disease Risk Factor Surveillance (STEPS). We measured blood pressure (BP) and 12-h fasting blood glucose levels and collected data on sociodemographic characteristics, smoking, and use of antidiabetic and antihypertensive drugs. We estimated the 10-year risk of a fatal or nonfatal major cardiovascular event (WHO/International Society of Hypertension risk prediction charts), and computed the proportion of untreated participants eligible for pharmacological treatment for hypertension, according to BP values alone and accounting also for the total cardiovascular risk (WHO guidelines for assessment and management of cardiovascular diseases). RESULTS: Among the Mozambicans aged 40-64 years and not taking antihypertensive drugs, less than 4% were classified as having cardiovascular risk at least 20% whereas the prevalence of SBP/DBP at least 140/90 mmHg was nearly 40%. A total of 19.8% of 40-64-year-olds would be eligible for pharmacological treatment of hypertension according to the WHO guidelines, all of whom had SBP/DBP at least 160/100 mmHg. CONCLUSION: Among the Mozambicans aged 40-64 years not taking antihypertensive drugs and having SBP/DBP at least 140/90 mmHg, only half were eligible for pharmacological treatment according to the WHO guidelines. Taking the latter into account, when defining strategies to control hypertension at a population level, may allow a more efficient use of the scarce resources available in developing settings.

Tobacco consumption in Mozambique: use of distinct types of tobacco across urban and rural settings.

INTRODUCTION: Monitoring tobacco consumption patterns is essential to define and evaluate strategies to control the tobacco epidemic. We aimed to quantify the use of smoked (manufactured/hand-rolled cigarettes) and smokeless (snuff/chew) tobacco, according to sociodemographic characteristics, in adult Mozambicans. METHODS: A national representative sample (n = 3,323) of subjects aged 25-64 years was evaluated in 2005 following the World Health Organization Stepwise Approach to Chronic Disease Risk Factor Surveillance (STEPS), which included the assessment of tobacco consumption with the quantification of each type of tobacco used daily. We computed prevalences, and age- and education-adjusted prevalence ratios (PRs), with 95% CIs. RESULTS: Daily smoking was reported by 9.1% (95% CI = 5.0-13.1) of women (manufactured, 3.4%; hand-rolled, 5.6%) and 33.6% (95% CI = 29.3-38.0) of men (manufactured, 18.7%; hand-rolled, 14.8%). Daily manufactured cigarette smoking was significantly more frequent in men (urban: PR = 14.62, 95% CI = 7.59-28.55; rural: PR = 4.32, 95% CI = 2.42-7.71). Daily hand-rolled cigarette smoking was three- to fourfold more frequent among men and nearly 80% less frequent in urban areas, regardless of sex. The prevalence of daily smokeless tobacco use was 7.4% (95% CI = 4.6-10.2) in women (chew, 6.4%; snuff, 1.0%) and 3.4% (95% CI = 1.7-5.2) in men (chew, 1.6%; snuff, 1.8%). Daily smokeless tobacco consumption was significantly less frequent in urban areas only among men (PR = 0.05, 95% CI = 0.01-0.33). CONCLUSIONS: Despite the relatively low levels of manufactured cigarette smoking, traditional forms of tobacco consumption are frequent, especially among women and in rural settings, showing the need for control measures to target specifically different patterns of consumption.

Association between tobacco consumption and alcohol, vegetable and fruit intake across urban and rural areas in Mozambique.

BACKGROUND: Smoking, alcohol consumption and unhealthy diet are known to cluster, but evidence from developing countries at the early phases of the tobacco epidemics and with markedly different cultures, lifestyles and forms of tobacco use is scarce. The objective of this study was to quantify the association between tobacco consumption (manufactured cigarettes, hand-rolled cigarettes and smokeless tobacco) and alcohol, fruit and vegetable intake in Mozambique according to place of residence (urban/rural). METHODS: A representative sample of 12 902 Mozambicans aged 25-64 years was evaluated in a national household survey conducted in 2003 using a structured questionnaire. Age- and education-adjusted ORs were computed to estimate the association between tobacco consumption and alcohol, fruit and vegetable intake. RESULTS: Tobacco use and overall alcohol drinking were positively associated, regardless of type of tobacco consumed, but smoking of hand-rolled cigarettes and consumption of smokeless tobacco was negatively associated with beer drinking. Smokers of manufactured cigarettes had a less frequent intake of fruit, but smokeless tobacco consumption and hand-rolled cigarette smoking were not inversely related with intake of fruit or vegetables. This pattern was relatively consistent across genders and urban/rural areas, with the observed differences likely to be explained either by random variation or heterogeneity in tobacco consumption patterns across genders or places of residence. CONCLUSION: Strong associations between tobacco consumption and the intake of alcoholic beverages, vegetable and fruit intake are found, but not consistently for all forms of tobacco use.

Food patterns according to sociodemographics, physical activity, sleeping and obesity in Portuguese children.

Our study aimed to describe the association between food patterns and gender, parental education, physical activity, sleeping and obesity in 1976 children aged 5-10 years old. Dietary intake was measured by a semi quantitative food frequency questionnaire; body mass index was calculated and categorized according to the IOTF classification. Factor analysis and generalized linear models were applied to identify food patterns and their associations. TV viewing and male gender were significant positive predictors for fast-food, sugar sweetened beverages and pastry pattern, while a higher level of maternal education and longer sleeping duration were positively associated with a dietary patterns that included fruit and vegetables.

[Fluid intake and overweight risk in children]. / Ingestão de alimentos fluidos. E risco de excesso de peso em crianças.

UNLABELLED: The global prevalence of overweight and obesity in children is growing. A number of eating patterns have been associated with different risks of overweight. Sugar sweetened beverages have received considerable attention as potential sources of energy in liquid form that could be responsible for body weight gain. OBJECTIVE: Evaluate the association between fluid intake and overweight in schoolchildren. MATERIAL AND METHODS: The final sample of the study includes 1675 children schools between 5 and 10 years old, after excluding dietary misreporting and questionnaires with incomplete information. After parental written consent, children's height and weight were measured according to international standards, and body mass index was calculated. The definition of overweight was based on average centiles according to the International Obesity Task Force cutoffs. We administered a questionnaire to parents that included information about physical activity, dietary intake (food frequency questionnaire that included information on milk, vegetable soup, cola, ice-tea and other sugar-sweetened beverages) and socio-demographic information. Adjusted odds ratios were computed using logistic regression. RESULTS: We found a high prevalence of overweight (including obesity) being 36,6% for girls, and 38,8% for boys. In girls the probability of being overweight increased significantly for those having low consumption of vegetable soup (equal or lower tan the median) compared to those with high consumption (higher than the median), even after adjusting for confounders (OR = 0,68, CI 95% 0,48-0,96, p = 0,030). We didn't find any significant association between sugar sweetened beverages and milk intake with overweight in both genders. CONCLUSION: In girls, high vegetable soup consumption significantly decreased the probability of being overweight, independently of other characteristics.

The role of economic and educational factors in asthma: evidence from the Portuguese health survey.

OBJECTIVE: To evaluate the importance of economic and educational factors in determining the risk of asthma in adults. STUDY DESIGN AND METHODS: This was a cross-sectional study in a representative sample of Portuguese adults (20,977 females and 18,663 males) from the main regions of mainland Portugal. Participants were categorized according to years of education (< or = 4, 5-9, 10-12 and >12 years) and income (< or = 314, 315-547, 548-815 and >815Euros/month). Information on asthma was based on answers to the following question: 'Have you had asthma in the previous year?' Logistic regression models were fitted to estimate the magnitude of the association between asthma and education/income, adjusting for confounders (body mass index, age, smoking habits, physical activity, area of residence, number of household members and income/education). RESULTS: In females and males, the odds of having asthma decreased with increasing income (P-value for trend <0.001), with odds ratios of 0.52 [95% confidence intervals (CI) 0.41-0.66] and 0.55 (95%CI 0.44-0.68) for those with a monthly income >815 Euros compared with those with a monthly income 314 Euros, respectively. For both genders, the odds of having asthma were not significantly associated with years of education. CONCLUSION: A significant positive association between per capita national income and asthma reinforces that public policy should stress the importance of economic growth as a means for preventing asthma occurrence and improving quality of life.

Smoking, alcohol, and dietary choices: evidence from the Portuguese National Health Survey.

BACKGROUND: Unhealthy lifestyle choices tend to cluster, but controversy remains regarding relationships between smoking and dietary habits. The aim of this study was to compare dietary intake and alcohol consumption, according to smoking status, in the Portuguese population. METHODS: The study sample included all participants in the third Portuguese National Health Survey who were older than 19 years (20,302 women and 17,923 men). Participants were selected from households in the five regions of Portugal (NUTS II classification), using a multi-stage random probability design. Trained interviewers conducted face-to-face interviews in each household and obtained information on social and demographic characteristics, lifestyle and health, smoking, and intakes of selected food and beverages. Age-adjusted and education-adjusted binomial and multinomial logistic regression models were fitted separately for males and females, to estimate the magnitude of the association between smoking and the consumption of various food and beverage groups. RESULTS: When heavy smokers were compared with non-smokers, the odds ratio (OR) favouring soup consumption was 0.60 (95% Confidence Interval [95%CI]: 0.54-0.68) in males and 0.46 (95% CI: 0.33-0.65) in females. Similar ORs were observed for vegetables (males: OR = 0.56, 95%CI: 0.49-0.64; females: OR = 0.47, 95%CI: 0.32-0.69) and fruit (males: OR = 0.36, 95%CI: 0.31-0.41; females: OR = 0.29, 95%CI: 0.19-0.44). Overall, these food items were consumed at significantly lower levels as cigarette consumption increased. Heavy male smokers, compared to non-smokers, presented lower odds favouring milk consumption (OR = 0.89; 95%CI: 0.67-0.89). When heavy smokers were compared with non-smokers, the ORs favouring wine drinking, among heavy drinkers, were 1.47 (95%CI: 1.27-1.70) in men and 3.97 (95%CI: 2.07-7.61) in women. Similar ORs were observed for beer (males: OR = 3.30; 95%CI: 2.87-3.78; females: OR = 23.1; 95%CI: 12.2-43.6), Port wine (males: OR = 2.21 95%CI: 1.65-2.98; females: OR = 2.85; 95%CI: 0.68-12.1), brandy (males: OR = 3.67 95%CI: 2.98-4.52; females: OR = 13.2; 95%CI: 3.72-46.6) and whisky (males: OR = 3.31; 95%CI: 2.71-4.03; females: OR = 41.4; 95%CI: 18.5-92.5). CONCLUSION: This study showed that smokers have a higher intake of alcoholic beverages and a lower consumption of food items rich in fibre, antioxidants, or phytochemicals, which are suspected to have beneficial roles in the prevention of multiple chronic diseases.

[Nutritional intake and bone mineral density in female adolescents]. / Ingestão nutricional e estimativa da densidade mineral óssea em adolescentes do sexo feminino.

INTRODUCTION: Adolescence is a critical time in skeletal development, during which the amount of bone gained along with the subsequent rate of bone loss have a crucial impact on an individual's total bone mass in adulthood and old age. Factors believed to influence bone accretion and peak bone mass include adequate nutritional intake, namely for calcium. However, the findings of several studies have raised questions about the benefit of the total dietary calcium consumption for young adult bone health. The objective of this study was to evaluate the association between nutritional intake, namely calcium, and bone mineral density in female teenagers. METHODS: The study design was a cross-sectional analysis and data derived from a school-based survey of adolescents from high schools. In all, the study sample included 254 female adolescents with ages between 15 and 17 years. The questionnaire was anonymous and confidential, and provided information on the following variables: bone mineral density (BMD), evaluated in the calcaneus by ultrasound through the Sahara Clinical Bone Sonometer from Hologic; weight and height, measured according to international standards; nutritional intake assessed by a food-frequency questionnaire developed by the Epidemiology Department, Faculty of Medicine, University of Porto; sociodemographic characteristics; age of first menstruation; regularity of menstrual cycles; use of contraceptives and drugs; history of bone fractures; smoking habits; and physical activity. In order to study the association between nutritional intake and BMD, uni and multivariate regression analysis (with adjustment for confounders, namely irregular menses, energy and protein intake) was used. RESULTS: The following main results were reached: positive and significant effects were found for calcium intake in BMD, even after adjustment for confounders (ss = 0.003, 95% CI = 0.000 - 0.006, p = 0.031); 15.1% of adolescents showed t-scores that suggested osteopenia; mean calcium intake (1229 +/- 778 mg/day) was lower than recommended for optimal bone acquisition in achieving maximal peak bone mass. CONCLUSION: Calcium intake was positively associated with BMD, but mean calcium intake was lower tan recommended. It should be therefore important to assure good dietary habits and adequate calcium intake in female adolescents for the development of peak bone mass, and reducing the risk of osteoporosis later in life.

Educational, economic and dietary determinants of obesity in Portuguese adults: a cross-sectional study.

In industrialized countries, studies have shown that lower socioeconomic status is generally associated with higher rates of obesity. Furthermore, poorer eating habits with insufficient intake of low energy-dense and micronutrient rich foods may increase the risk of obesity. The aim of this study was to evaluate the importance of educational, economic and dietary factors in determining obesity risk in a representative sample of the Portuguese general adult population. Study design was cross-sectional in a representative sample of Portuguese adults (20,977 women and 18,663 men). Participants were distributed in categories according to years of education (< or =4, 5-9, 10-12, and >12), income (< or =314 euros, 315-547 euros, 548-815 euros, and >815 euros), and dietary intake (vegetable soup, vegetable, fruit, bread and starchy foods). Logistic regression models were fitted to estimate the magnitude of the association between obesity and education/income, and food groups, adjusting for confounders. In women and men, the odds favouring obesity decreased with increasing education (p-value for trend <0.001) being the odds ratios, respectively, 0.19 (0.14-0.27), and 0.40 (0.30-0.54) for those having >12 years of education compared to those with < or =4 years vegetable; soup consumption also decreased the risk of obesity in both genders (odds ratios were very similar in women and men, being respectively, 0.86 and 0.89). The odds favouring obesity in women also decreased with consumption of fruit and starchy foods, being the odds ratios, respectively, 0.77 (0.64-0.92), and 0.65 (0.55-0.78). In conclusion, educational attainment and vegetable intake decreased significantly the risk of obesity in Portuguese adults from both genders; fruits and starchy foods consumption also decreased the risk of obesity in women.

Educational and economic determinants of food intake in Portuguese adults: a cross-sectional survey.

BACKGROUND: Understanding the influences of educational and economic variables on food consumption may be useful to explain food behaviour and nutrition policymaking. The aim of this study was to evaluate the importance of educational and economic factors in determining food pattern in Portuguese adults. METHODS: A cross-sectional study in a representative sample of Portuguese adults (20977 women and 18663 men). Participants were distributed in four categories according to years of education (12) and income (815 euros). Logistic regression models were fitted to estimate the magnitude of the association between food groups and education/income, adjusting for confounders. RESULTS: In both genders, the odds favouring milk, vegetable soup, vegetables, fruit, and fish consumption, increased significantly with education, for those having >12 years of education compared to those with 12 years of education compared to those with 815 euros compared to those with