Assessment of the Implementation of the International Health Regulations during the COVID-19 Pandemic: Portugal as a Case Study.

INTRODUCTION: The International Health Regulations (IHR) were developed to prepare countries to deal with public health emergencies. The spread of SARS-CoV-2 underlined the need for international coordination, although few attempts were made to evaluate the integrated implementation of the IHR's core capacities in response to the COVID-19 pandemic. The aim of this study was to evaluate whether IHR shortcomings stem from non-compliance or regulatory issues, using Portugal as a European case study due to its size, organization, and previous discrepancies between self-reporting and peer assessment of the IHR's core capacities. METHODS: Fifteen public health medical residents involved in contact tracing in mainland Portugal interpreted the effectiveness of the IHR's core capabilities by reviewing the publicly available evidence and reflecting on their own field experience, then grading each core capability according to the IHR Monitoring Framework. The assessment of IHR enforcement considered efforts made before and after the onset of the pandemic, covering the period up to July 2021. RESULTS: Four out of nine core IHR capacities (surveillance; response; risk communication; and human resource capacity) were classified as level 1, the lowest. Only two were graded level 3 (preparedness; and laboratory), the highest. The remaining three) (national legislation, policy & financing; coordination and national focal point communication; and points of entry) were classified as level 2. CONCLUSION: Portugal exemplifies the extent to which implementation of the IHR was not fully achieved, which has resulted in the underperformance of several core capacities. There is a need to improve preparedness and international cooperation in order to harmonize and strengthen the global response to public health emergencies, with better political, institutional, and financial support.

Methodological approaches for the assessment of bisphenol A exposure.

Bisphenol A (BPA) is an endocrine disruptor used in food contact materials, by the application of polycarbonate plastics and epoxy resins. The main objective of this study is to compare the estimate of daily BPA exposure at 13 years of age and in the adult Portuguese population, using different methodological approaches, and assess the associations between this exposure and sociodemographic characteristics. METHODOLOGY: Cross-sectional data of 13-years follow-up from a population-based birth cohort Generation XXI (GXXI) (n = 2804) and from the National Food, Nutrition and Physical Activity Survey (IAN-AF 2015-2016) (n = 3845, ≥18 years old) was used. Dietary information was collected through three food diaries for adolescents and two non-consecutive 24-hour-recalls for adults. To estimate the daily exposure to BPA, three methodological approaches were used. "Food groups attribution" merged the food consumption data with the concentration of BPA in food groups. "Regression tree model" and "random forest" combined food consumption information with urinary BPA, measured in a subsample of 24-hour urine (in adolescents n = 216, and in adults n = 82), both used to predict BPA exposure in the remaining sample. The fit-index of the methodologies was assessed through the root mean square error (RMSE), mean absolute error (MAE) and Spearman correlation coefficient (ρ). Associations between BPA exposure and sociodemographic variables were tested by linear regression models, adjusted for sex, age groups (in adults) and educational level. Tolerable Daily Intake (TDI) of 0.2 ng/kg body weight (bw), recently proposed by the European Food Safety Authority (EFSA), was used for the risk characterization of BPA exposure. RESULTS: The "random forest" was found as the best methodology to estimate the daily BPA exposure (adolescents: RMSE = 0.989, MAE = 0.727, ρ = 0.168; adults: RMSE = 0.193, MAE = 0.147, ρ = 0.250). The median dietary BPA exposure, calculated by "food groups attribution", was 79.1 and 46.1 ng/kg bw/day for adolescents and adults, respectively, while "random forest" estimated a BPA exposure of 26.7 and 38.0 ng/kg bw/day. 99.9% of the Portuguese population presented a daily exposure above TDI. Male adolescents, females and higher educated adults, were those more exposed to BPA. CONCLUSIONS: The estimated daily BPA exposure strongly depends on the methodological approach. Food groups attribution may overestimate the exposure while the random forest appears to be a better methodological approach to estimate BPA exposure. Nevertheless, for all methods, the Portuguese population presented an unsafe BPA exposure by largely exceeding the safe levels proposed by EFSA.

Maternal Urinary Iodine Concentration during Pregnancy and Its Impact on Child Growth and Neurodevelopment: An 11-Year Follow-Up Study.

Mild-to-moderate iodine deficiency during pregnancy is prevalent worldwide, but its consequences for maternal and child health are not clear. We aimed to investigate the impact of maternal iodine intake during pregnancy on the child's growth and neurodevelopment. This study involved a cohort of 11-year-old children (n = 70) whose mothers had participated in an iodine intake survey during pregnancy. Gestational, neonatal, anthropometric, intelligence quotient (IQ), and socioeconomic parameters were analyzed according to maternal urinary iodine concentration (UIC). There was a positive linear trend of current height Z-score, full-scale IQ, verbal IQ, family income, maternal education, and a negative trend of neonatal TSH levels with increasing maternal UIC levels. However, regression analysis indicated that maternal UIC was not an independent predictor of any gestational, neonatal, or childhood development parameter. Only maternal school education was positively associated with child height and IQ. In conclusion, we did not find any evidence of a direct effect of maternal iodine intake during pregnancy on the long-term growth and neurodevelopment of children. The results suggest that socioeconomic factors are important confounding factors that affect both maternal iodine intake and child development and must be considered when investigating the association between maternal iodine intake and child outcomes.

The influence of item order of the Household Food Security Survey Module on the assessment of food insecurity in households with children.

OBJECTIVE: Changes in the item order of the US Household Food Security Survey Module (USHFSSM) were performed throughout time. This study aimed to compare the psychometric properties of the general and specific factors of the 2000 and 2012 versions of the USHFSSM to measure the construct of food insecurity in two Portuguese samples of households with children. DESIGN: Cross-sectional. SETTING: Portugal. PARTICIPANTS: An adaptation of the 2000 version was applied to 839 adults (from households with children aged 7-17 years) from the National Food, Nutrition and Physical Activity Survey 2015-2016, while the 2012 version was used among 2855 families from the Generation XXI birth cohort. RESULTS: The 2000 version showed to have a stronger ωh than the 2012 version (0·89 v. 0·78 for the general factor), as well as eigenvalues higher than 1 for the general factor (eigenvalues equal to 9·54, 0·97 and 0·80, for the general factor, specific factor 1 and specific factor 2, respectively), while the 2012 version had also the contribution of specific factors to explain food insecurity (eigenvalues equal to 9·40, 2·40 and 1·20, for general factor and specific factors 1 and 2, respectively). Good internal consistency (ωt = 0·99, for both versions) was obtained. CONCLUSIONS: In conclusion, the 2000 and 2012 versions of the USHFSSM showed good psychometric properties; however, the 2000 version has stronger general factor, while the 2012 version also has the contribution of specific factors.

Quantitative risk-benefit assessment of Portuguese fish and other seafood species consumption scenarios.

Portugal has high fish/seafood consumption, which may have both risks and benefits. This study aims to quantify the net health impact of hypothetical scenarios of fish/seafood consumption in the Portuguese population using a risk-benefit assessment methodology. Consumption data from the National Food, Nutrition and Physical Activity Survey 2015-2016 (n 5811) were used to estimate the mean exposure to methylmercury and EPA + DHA in the current and the alternative scenarios considered. Alternative scenarios (alt) were modelled using probabilistic approaches to reflect substitutions from the current consumption in the type of fish/seafood (alt1: excluding predatory fishes; alt2: including only methylmercury low-level fishes) or in the frequency of weekly fish/seafood consumption (alt3 to alt6: 1, 3, 5 or 7 times a week, replacing fish/seafood meals with meat or others). The overall health impact of these scenarios was quantified using disability-adjusted life years (DALY). In the Portuguese population, about 11 450 DALY could be prevented each year if the fish/seafood consumption increased to a daily basis. However, such a scenario would result in 1398 extra DALY considering the consumption by pregnant women and the respective risk on fetal neurodevelopment. Our findings support a recommendation to increase fish/seafood consumption up to 7 times/week. However, for pregnant women and children, special considerations must be proposed to avoid potential risks on fetal neurodevelopment due to methylmercury exposure.

Interaction effects of socio-economic position in the association between eating location and diet quality in Portuguese children and adolescents: results from the National Food, Nutrition and Physical Activity Survey 2015-2016.

This study aims to evaluate the interaction effect of socio-economic environment (SEE) in the relationship between the eating location (EL) and diet quality, in children and adolescents. Data included Portuguese children and adolescents (3-17 years) from a National Dietary Survey Sample (IAN-AF 2015/2016, n 987). Dietary intake was obtained by 2-d food diaries (children) or 2-24-h-recall (adolescents). Participants were classified into four groups of EL: 'Home', 'Other homes', 'School' and 'Restaurants'. Diet quality was measured as a higher adherence to a healthy eating pattern. A previous developed socio-economic classification was used, and participants were grouped as belonging to a low socio-economic environment (LSE) or middle-high socio-economic environment (MHSE). Linear regression models were used to evaluate the association between EL and diet quality, stratified by the SEE. A statistically significant interaction effect was found (P < 0·01) for the SEE in the association between EL and diet quality. After adjustment for potential confounders, in LSE, participants belonging to 'Other homes' (ß = -2·07; 95 % CI:-3·70, -0·44) and 'Restaurants' (ß = -3·31; 95 % CI: -5·08, -1·54) had lower scores in the diet quality score, comparing to 'Home'. In MHSE, comparing with 'Home', 'Restaurants' showed lower diet quality (ß = -1·56; 95 % CI:-2·65, -0·48), while the 'School' had better diet quality (ß = 0·90; 95 % CI: 0·16, 1·64). The SEE influences the association between EL and diet quality and, belonging to more disadvantaged SEE, might represent a higher risk of unhealthy eating habits when eating out-of-home.

Adhering to a Mediterranean diet in a Mediterranean country: an excess cost for families?

Adherence to the Mediterranean diet (MD) has been decreasing in southern Europe, which could be linked to several cultural or educational factors. Our aim is to evaluate the extent to which economic aspects may also play a role, exploring the relationship between food prices in Portugal and adherence to the MD. We evaluated data from the Portuguese National Food, Nutrition, and Physical Activity Survey (IAN-AF 2015-2016) (n 3591). Diet expenditures were estimated by attributing a retail price to each food group, and the diet was transposed into the Mediterranean Diet Score used in the literature. Prices were gathered from five supermarket chains (65 % of the Portuguese market share). Linear regression models were used to assess the association between different adherence levels to the MD levels and dietary costs. Greater adherence to the MD was associated with a 21·2 % (P < 0·05) rise in total dietary cost, which accounts for more 0·59€ in mean daily costs when compared with low adherence. High adherence individuals (v. low adherence) had higher absolute mean daily costs with fish (0·62€/+285·8 %; P < 0·05), fruits (0·26€/+115·8 %; P < 0·05) and vegetables (0·10€/+100·9 %; P < 0·05). The analysis stratified by education and income level showed significantly higher mean daily diet cost only amongst higher income groups. Our findings suggest that greater adherence to the MD was positively and significantly associated with higher total dietary cost. Policies to improve population's diet should take into consideration the cost of healthy foods, especially for large low- and middle-income families.

Risk-Benefit Assessment of Cereal-Based Foods Consumed by Portuguese Children Aged 6 to 36 Months-A Case Study under the RiskBenefit4EU Project.

Cereal-based foods, including breakfast (BC) and infant cereals (IC), are among the first solid foods introduced to infants. BC and IC are sources of macro and micronutrients that have beneficial effects on health, but can also be sources of harmful chemical and microbiological contaminants and nutrients that may lead to adverse health effects at high consumption levels. This study was performed under the RiskBenefit4EU project with the aim of assessing the health impact associated with consumption of BC and IC by Portuguese children under 35 months. Adverse effects associated with the presence of aflatoxins, Bacillus cereus, sodium and free sugars were assessed against the benefits of fiber intake. We applied a risk-benefit assessment approach, and quantified the health impact of changes in consumption of BC and IC from current to various alternative consumption scenarios. Health impact was assessed in terms of disability-adjusted life years. Results showed that moving from the current consumption scenario to considered alternative scenarios results in a gain of healthy life years. Portuguese children can benefit from exchanging intake of IC to BC, if the BC consumed has an adequate nutritional profile in terms of fiber, sodium and free sugars, with levels of aflatoxins reduced as much as possible.

Deoxynivalenol exposure assessment through a modelling approach of food intake and biomonitoring data - A contribution to the risk assessment of an enteropathogenic mycotoxin.

Deoxynivalenol (DON), an enteropathogenic mycotoxin produced by Fusarium species, is usually associated with adverse health outcomes such as gastrointestinal diseases and immunotoxicity. To estimate DON exposure of the Portuguese population at national level, a modelling approach, based on data from 94 Portuguese volunteers, was developed considering the inputs of the food consumption data generated within the National Food and Physical Activity Survey and the human biomonitoring data used to assess the exposure to DON. Ten models of association between DON urinary biomarkers and food items (pasta, cookies, biscuits, sweets, bread, rusks, nuts, oilseeds, beer, meat, milk) were established. Applying the most adequate model to the consumption data (n = 5811) of the general population, the exposure estimates of the Probable Daily Intake revealed that a fraction (0.1%) of the Portuguese population might exceed the Tolerable Daily Intake defined for DON. The analysis stratified by age revealed children (3.2%) and adolescents (6.0%) are more likely to exceed the Tolerable Daily Intake for DON. Although the unavoidable uncertainties, these results are important contributions to understand the exposure to this mycotoxin in Portugal, to assess the associated risk and the potential public health consequences.

Socio-demographic factors associated with physical activity and sitting time patterns in adults: An analysis based on the Portuguese Food, Nutrition and Physical Activity Survey.

ABSTRACTPhysical activity (PA) and sedentary behaviours (SB) influence health. Since most people engage in different combinations of both behaviours every day, understanding the socio-demographic characteristics of adults with distinct PA and sitting time (ST) patterns is important to contribute to evidence-based planning of public health strategies. Data from a national survey on diet and activity behaviours (IAN-AF, 2015/16) including 1724 adults (50.5% women, 18-64 years) from a representative sample of Portuguese adults was used in this study. Participants were interviewed face-to-face, and the International Physical Activity Questionnaire (IPAQ) was used. Logistic regression examined the associations between socio-demographic factors each of the four-low/high PA-ST groups. PA low/high categories were defined as in IPAQ, while ST low/high categories were defined according to ST tertiles (≤180 min/day, ≥360 min/day). A 'higher risk' behaviour pattern (low PA/high ST) was present in 37.3% of the adults and was likely associated with a middle household income, and with having 12 or more years of education. The 'lower risk' (high PA/low ST) represented 26.6% of the sample and was likely associated with middle-aged adults and with having a lower educational level. Being male, young and highly educated was related to being physically active and spending large amounts of time in ST. Besides adding to the body of mixed evidence on this theme, the identification of the socio-demographic factors associated with each PA/ST pattern will permit national public health authorities to define policies and tailored actions to promote PA and reduce ST.

Geriatric Assessment of the Portuguese Population Aged 65 and Over Living in the Community: The PEN-3S Study.

INTRODUCTION: As populations live longer, they also aim to live better. A crucial step for this is to improve the understanding about older adults' physical and psychological health. Therefore, the aim of the present study was to characterise the Portuguese population over-65 regarding nutritional status, cognitive function, functional status, symptoms of depression, and loneliness, by sex and age groups. MATERIAL AND METHODS: Cross-sectional study including a nationally representative sample of community-dwelling adults aged 65 and over. Trained interviewers collected data face-to-face on demographic and socioeconomic characteristics, health status, nutritional status, cognitive function, functional status for activities of daily living, symptoms of depression, and loneliness feelings. Complex sample procedures were used in the statistical analysis. RESULTS: Overall, 1120 community-dwellers (49.0% women, 21.3% aged ≥ 85) participated in the study. The estimated prevalence of risk of malnutrition was 16.4% (95% confidence interval: 13.3 - 19.9), while 17.7% (95% confidence interval: 12.8 - 23.9) were cognitively impaired, and 28.5% (95% confidence interval: 23.7 - 33.8) presented limitations to perform daily living activities. Moreover, 23.5% (95% confidence interval: 19.7 - 27.7) presented symptoms of depression and 13.6% (95% confidence interval: 10.6 - 17.1) reported loneliness feelings. These conditions were more prevalent among women, and generally more frequent in the oldest individuals (≥ 85). DISCUSSION: Risk of malnutrition, cognitive impairment, functional limitations, depression and loneliness were moderately frequent, which may justify screening and preventive actions at a community level. CONCLUSION: This study contributed to a national characterisation of the health of older adults, that may inform policies and interventions targeted at the needs of the Portuguese aging population.

Introdução: Com o aumento de longevidade importa também viver melhor. Um passo crucial neste sentido é aumentar o conhecimento sobre a saúde física e psicológica da população mais velha. O objetivo deste estudo foi caraterizar o estado nutricional, função cognitiva, estado funcional, sintomas de depressão, e solidão dos Portugueses com 65 ou mais anos, por sexo e grupo etário. Material e Métodos: Estudo transversal incluindo uma amostra representativa nacional de indivíduos ≥ 65 anos a residir na comunidade. Entrevistadores treinados recolheram dados face-a-face sobre caraterísticas demográficas e socioeconómicas, estado de saúde, estado nutricional, função cognitiva, estado funcional (atividades instrumentais da vida diária), sintomas de depressão, e sentimentos de solidão. Procedimentos adequados a amostras complexas foram utilizados na análise estatística. Resultados: No total participaram 1120 indivíduos (49,0% mulheres; 21,3% ≥ 85 anos). A prevalência estimada de risco de malnutrição foi 16,4% (intervalo de confiança: 95%: 13,3 ­ 19,9), enquanto que 17,7% (intervalo de confiança: 95%: 12,8 ­ 23,9) apresentavam função cognitiva comprometida, e 28,5% (intervalo de confiança: 95%: 23,7 ­ 33,8) tinham limitações para realizar atividades da vida diária. Adicionalmente, 23,5% (intervalo de confiança: 95%: 19,7 ­ 27,7) apresentavam sintomas de depressão e 13,6% (intervalo de confiança: 95%: 10,6 ­ 17,1) relatavam sentimentos de solidão. Estas condições eram mais prevalentes nas mulheres, e geralmente mais frequentes nos mais velhos (≥ 85 anos). Discussão: Risco de malnutrição, comprometimento cognitivo, limitações funcionais, depressão e solidão são moderadamente frequentes, justificando rastreios e ações preventivas de base comunitária. Conclusão: Este estudo contribuiu para a caraterização da saúde dos Portugueses com mais de 65 anos, o que pode suportar políticas e intervenções dirigidas às necessidades da população mais velha.

The role of socio-economic factors in food consumption of Portuguese children and adolescents: results from the National Food, Nutrition and Physical Activity Survey 2015-2016.

This study aimed to evaluate the association between socio-economic factors and the food consumption of a young population. Participants were from the Portuguese National Food, Nutrition and Physical Activity Survey (IAN-AF 2015-2016) aged from 3 to 17 years (n 1153). Food consumption was assessed using two non-consecutive days of food diaries in children and two 24-h recalls for adolescents. A latent class analysis (LCA) was used to classify children's socio-economic status (socio-economic composite classification (SCC)), categorised in low, middle or high. The associations between socio-economic variables and food consumption were evaluated through linear or logistic regression models, weighted for the Portuguese population distribution. A positive association was found between belonging to a higher level of SCC and consumption of fruits and vegetables (FV), by children (ß = 2·4, 95 % CI 1·1, 3·8) and by adolescents (ß = 52·4, 95 % CI 9·6, 95·3). A higher SCC, but particularly higher maternal education, was positively associated with consumption of 'white meat, fish and eggs'. Both higher SCC and parental education were positively associated with salty snack consumption in the adolescents' group. In conclusion, children and adolescents with higher educated parents and belonging to a high socio-economic level have a higher daily intake of FV and white meat, fish and eggs. Socio-economic factors play an important role in justifying differences in the food consumption of children and adolescents and must be considered in future interventions. The relationship between higher socio-economic position and salty snack consumption in adolescents needs to be further explored in other populations.

Projected impact of the Portuguese sugar-sweetened beverage tax on obesity incidence across different age groups: A modelling study.

BACKGROUND: Excessive consumption of sugar has a well-established link with obesity. Preliminary results show that a tax levied on sugar-sweetened beverages (SSBs) by the Portuguese government in 2017 led to a drop in sales and reformulation of these products. This study models the impact the market changes triggered by the tax levied on SSBs had on obesity incidence across various age groups in Portugal. METHODS AND FINDINGS: We performed a national market analysis and population-wide modelling study using market data for the years 2014-2018 from the Portuguese Association of Non-Alcoholic Drinks (GlobalData and Nielsen Consumer Panel), dietary data from a national survey (IAN-AF 2015-2016), and obesity incidence data from several cohort studies. Dietary energy density from SSBs was calculated by dividing the energy content (kcal/gram) of all SSBs by the total food consumption (in grams). We used the potential impact fraction (PIF) equation to model the projected impact of the tax-triggered change in sugar consumption on obesity incidence, through both volume reduction and reformulation. Results showed a reduction of 6.6 million litres of SSBs sold per year. Product reformulation led to a decrease in the average energy density of SSBs by 3.1 kcal/100 ml. This is estimated to have prevented around 40-78 cases of obesity per year between 2016 and 2018, with the biggest projected impact observed in adolescents 10 to <18 years old. The model shows that the implementation of this tax allowed for a 4 to 8 times larger projected impact against obesity than would be achieved though reformulation alone. The main limitation of this study is that the model we used includes data from various sources, which can result in biases-despite our efforts to mitigate them-related to the methodological differences between these sources. CONCLUSIONS: The tax triggered both a reduction in demand and product reformulation. These, together, can reduce obesity levels among frequent consumers of SSBs. Such taxation is an effective population-wide intervention. Reformulation alone, without the decrease in sales, would have had a far smaller effect on obesity incidence in the Portuguese population.

Adherence to a healthy eating index from pre-school to school age and its associations with sociodemographic and early life factors.

Childhood is considered an important period for the development of healthy eating behaviours. This study aimed to evaluate the influence of early life factors and sociodemographic characteristics, including early diet quality, on diet quality at 7 years. The sample includes 5013 children evaluated at the ages of 4 and 7 years from the Portuguese birth cohort Generation XXI with complete information on FFQ. A healthy eating index was developed at both ages to assess adherence to the WHO's dietary recommendations, including eight food groups. Consumption quartiles were obtained for each group at 4 years and assigned a score between 1 and 4. A higher score represents a higher adherence to a better diet (range: 8 to 32). The associations between early life factors and sociodemographic characteristics and the score of the healthy eating index at 7 years were evaluated through linear regression models. The healthy eating index had an average score of 21⋅4 ± 3⋅53 (range: 12 to 32) at 4 years and 20⋅3 ± 3⋅36 (range: 11 to 31) at 7 years. After adjustment for confounders, a positive association was found between the healthy eating index at 4 and 7 years (ß = 0⋅384, 95 % CI 0⋅356, 0⋅441). Maternal years of education (ß = 0⋅094, 95 % CI 0⋅071, 0⋅116) and dietary score (ß = 0⋅182, 95 % CI 0⋅155, 0⋅209) were positively associated with increasing dietary quality from 4 to 7 years. A healthier diet at preschool age, higher maternal education and a healthier diet increase the likelihood of maintaining a high healthy eating index score at school age.

Evaluation of a short food frequency questionnaire for dietary intake assessment among children.

BACKGROUND/OBJECTIVES: The objective of this study was to evaluate the performance of a short food frequency questionnaire (FFQ) to assess dietary intake at 4 and 7 years of age, against 3d food diaries (FD) and serum biomarkers, using two methods to convert the FFQ to daily intake in grams and nutrients (standard and z-score method). SUBJECTS/METHODS: The present analysis comprises data from 2482 4-year-old children and 3511 7-year-old children, from the birth cohort Generation XXI (Porto, Portugal). To estimate daily consumption from the FFQ, the frequency response was multiplied by a standard mean portion (standard method) or adjusted with data from the FD (z-score method). The dietary intake obtained from the FFQ was compared with the FD and serum biomarkers, using Intra-Class Correlation Coefficients (ICC), de-attenuated Pearson's correlation coefficients and Bland Altman analysis. RESULTS: In general, the mean daily food intake estimated by the z-score method had a higher agreement with the FD, than the standard method. The highest ICC was obtained for "vegetable soup" (ICC = 0.536), using the z-score method, compared to an ICC of 0.373 using the standard method. Significant correlation coefficients were observed for all nutrients; the average of correlation coefficients was 0.39 at 4 years and 0.42 at 7 years of age. For the majority of nutrients, the correlation between mean and mean difference was lower using the z-score method, in comparison with the standard method. CONCLUSIONS: The results suggest that the FFQ is a reasonably good instrument to estimate dietary intake in children. Moreover, adjusting the FFQ portion size, by using a z-score method, seems to increase the accuracy of dietary data in children.

Synthesis and 2D-QSAR studies of neolignan-based diaryl-tetrahydrofuran and -furan analogues with remarkable activity against Trypanosoma cruzi and assessment of the trypanothione reductase activity.

Two series of diaryl-tetrahydrofuran and -furan were synthesised and screened for anti-trypanosomal activity against trypomastigote and amastigote forms of Trypanosoma cruzi, the causative agent of Chagas disease. Based on evidence that modification of a natural product may result in a more effective drug than the natural product itself, and using known neolignan inhibitors veraguensin 1 and grandisin 2 as templates to synthesise simpler analogues, remarkable anti-trypanosomal activity and selectivity were found for 3,5-dimethoxylated diaryl-furan 5c and 2,4-dimethoxylated diaryl-tetrahydrofuran 4e analogues with EC50 0.01 µM and EC50 0.75 µM, respectively, the former being 260-fold more potent than veraguensin 1 and 150-fold better than benznidazole, the current available drugs for Chagas disease treatment. The ability of the most potent anti-trypanosomal compounds to penetrate LLC-MK2 cells infected with T. cruzi amastigotes parasite was tested, which revealed 4e and 5e analogues as the most effective, causing no damage to mammalian cells. In particular, the majority of the derivatives were non-toxic against mice spleen cells. 2D-QSAR studies show the rigid central core and the position of dimethoxy-aryl substituents dramatically affect the anti-trypanosomal activity. The mode of action of the most active anti-trypanosomal derivatives was investigated by exploring the anti-oxidant functions of Trypanothione reductase (TR). As a result, diarylfuran series displayed the strongest inhibition, highlighting compounds 5d-e (IC50 19.2 and 17.7 µM) and 5f-g (IC50 8.9 and 7.4 µM), respectively, with similar or 2-fold higher than the reference inhibitor clomipramine (IC50 15.2 µM).

Association of maternal characteristics and behaviours with 4-year-old children's dietary patterns.

This study examined the association of family and maternal characteristics with preschool children's dietary patterns. Trained interviewers evaluated subsample 3422 mothers and children enrolled in the population-based birth cohort Generation XXI (Porto, Portugal, 2005-2006). Maternal characteristics and behaviours (exercise, smoking habits, diet and child-feeding practices) and family characteristics were evaluated. Maternal diet was classified by a dietary score, and children's dietary patterns were identified by latent class analysis. Odds ratios (OR) and confidence intervals (95% CI) were estimated by multinomial regression models. The analysis was based on a framework with four conceptual levels: maternal socio-economic position (SEP) at 12 years, maternal socio-economic and demographic characteristics at child's delivery, family characteristics and maternal behaviours at child's 4 years. Three dietary patterns were identified in children: high in energy-dense foods (EDF); low in foods typically consumed at main meals and intermediate in snacks (Snacking); higher in healthy foods; and lower in unhealthy ones (Healthier, reference). Lower maternal SEP had an overall effect on children's diet (low vs. high SEP; EDF, OR = 1.76, 95% CI: 1.42-2.18; Snacking, OR = 1.73, 95% CI: 1.27-2.35), while maternal education was directly associated with it (≤9 vs. >12 schooling years, EDF, OR = 2.19, 95% CI: 1.70-2.81; Snacking, OR = 2.22, 95% CI: 1.82-3.55). Children whose mothers had worse dietary score were significantly more likely to follow unhealthier patterns (first vs. fourth quartile; EDF, OR = 9.94, 95% CI: 7.35-13.44, P-trend < 0.001; Snacking, OR = 4.21, 95% CI: 2.94-6.05, P-trend < 0.001). Maternal diet was the key factor associated with children's diet, above and beyond socio-economic and demographic characteristics, accounting for one-third of the determination coefficient of the fully adjusted model. At preschool age, interventions should give a particular focus on maternal diet and low SEP groups.

National survey of the Portuguese elderly nutritional status: study protocol.

BACKGROUND: Worldwide we are facing a serious demographic challenge due to the dramatic growth of the population over 60 years. It is expected that the proportion of this population will nearly double from 12 to 22 %, between 2015 and 2050. This demographic shift comes with major health and socio-economic concerns. Nutrition is a fundamental determinant of both health and disease and its role in extending a healthy lifespan is the object of considerable research. Notably, malnutrition is one of the main threats to health and quality of life among the elderly. Therefore, knowledge about nutritional status among the elderly is essential for the promotion and maintenance of healthy ageing and to support the development of health protection policies and equity in elderly health care. METHODS: This is a nationwide nutrition survey of the Portuguese population over 65 years old, with data collection through face-to-face interviews. A representative and random sample of community dwelling elderly and nursing homes residents will be obtained by multistage sampling stratified per main Portuguese regions, sex and age groups. Minimum sample size was estimated to be 2077 elderly (979 in the community and 1098 in nursing homes). Data will be collected on food habits and eating patterns, nutritional status, food insecurity, lifestyle, self-rated general health status and self-reported diseases, functionality, loneliness, cognitive function, emotional status and demographic and socio-economic characterization. DISCUSSION: This is the first national survey to evaluate the prevalence of nutritional risk and malnutrition of the Portuguese population above 65 years old, including those living in nursing homes. It will allow the identification of population subgroups of elderly with increased odds of malnutrition and nutritional risk. In addition, this survey will contribute to the identification of psychosocial and clinical predictors of malnutrition among elderly, which is an important risk factor for other devastating medical conditions.

Social and health behavioural determinants of maternal child-feeding patterns in preschool-aged children.

Parental child-feeding attitudes and practices may compromise the development of healthy eating habits and adequate weight status in children. This study aimed to identify maternal child-feeding patterns in preschool-aged children and to evaluate their association with maternal social and health behavioural characteristics. Trained interviewers evaluated 4724 dyads of mothers and their 4-5-year-old child from the Generation XXI cohort. Maternal child-feeding attitudes and practices were assessed through the Child Feeding Questionnaire and the Overt/Covert Control scale. Associations were estimated using linear regression [adjusted for maternal education, body mass index (BMI), fruit and vegetables (F&V) intake and child's BMI z-score]. Principal component analysis defined a three-factor structure explaining 58% of the total variance of maternal child-feeding patterns: perceived monitoring - representing mothers with higher levels of monitoring, perceived responsibility and overt control; restriction - characterizing mothers with higher covert control, restriction and concerns about child's weight; pressure to eat - identifying mothers with higher levels of pressure to eat and overt control. Lower socioeconomic status, better health perception, higher F&V intake and offspring cohabitation were associated with more 'perceived monitoring' mothers. Higher maternal F&V intake and depression were associated with more 'restrictive' mothers. Younger mothers, less educated, with poorer health perception and offspring cohabiting, were associated with higher use of 'pressure to eat'. Maternal socioeconomic indicators and family environment were more associated with perceived monitoring and pressure to eat, whereas maternal health behavioural characteristics were mainly associated with restriction. These findings will be helpful in future research and public health programmes on child-feeding patterns.

Dietary patterns among 13-y-old Portuguese adolescents.

OBJECTIVE: The aim of this study was to identify dietary patterns in 13-y-old adolescents and to evaluate their association with socioeconomic and behavioral factors. METHODS: Data from 1489 adolescents born in 1990 and enrolled in schools of Porto, Portugal, in 2003-2004 (EPITeen study) were analyzed, after excluding those without information on the food frequency questionnaire and the outliers. The questionnaire items were grouped into 14 food groups and dietary patterns were identified by cluster analysis (k-means). Their association with participants' characteristics was computed using multinomial logistic regression. RESULTS: Four dietary patterns were identified. The pattern healthier (16.1%) was characterized by the highest consumption of seafood, soup, vegetables/legumes, fruit, and added fats. The dairy products pattern (29.7%) showed the highest consumption of dairies. The pattern fast food and sweets (14.2%) presented the highest intake of fast food, sweets and pastry, soft drinks and coffee or tea. The lower intake pattern (40%) was characterized by a lower consumption of the majority of food groups. A higher odds of belonging to the fast food and sweets pattern, compared with the lower intake pattern was found among adolescents spending more time watching TV on the weekends (>360 min: odds ratio [OR], 2.09; 95% confidence interval [CI], 1.23-3.57) and among those consuming four to seven fried meals per week (OR, 3.96; 95% CI, 2.27-6.90). Adolescents with highly educated parents were less likely to belong to the fast food and sweets group. CONCLUSION: Unhealthier behaviors and lower socioeconomic position were the main factors associated with the unhealthier dietary pattern (fast food and sweets). This information should be considered in the development of health-promotion interventions.