Predictors for papillary thyroid cancer persistence and recurrence: a retrospective analysis with a 10-year follow-up cohort study.

OBJECTIVE: We aimed to determine outcome predictors of papillary thyroid cancer (PTC) persistence and recurrence, separately. CONTEXT: The factors contributing to either persistence or recurrence of PTC are poorly defined, as both outcomes are usually evaluated together. DESIGN AND PATIENTS: In this 10-year follow-up cohort study, 190 PTC patients were evaluated (18-85 years old; registered from 1 January 1990 to31 December 1999 at a Brazilian Cancer Care referral Hospital). After initial surgery, we examined persistence (disease detected up to 1 year), recurrence (disease detected after 1 year) and PTC-free status (disease absence during follow-up). MEASUREMENTS: Outcome predictors were modelled using multinomial logit regression analysis. RESULTS: The univariate analysis showed that persistence and recurrence were significantly associated with lymph node metastasis (OR = 12·33; OR = 2·84, respectively), local aggressiveness (OR = 5·22; OR = 3·35) and extrathyroidal extension (OR = 5·07; OR = 7·11). Persistence was associated with male sex (OR = 3·49), age above 45 years old at diagnosis (OR = 1·03), macroscopic lymph node metastasis (OR = 5·85), local aggressiveness (OR = 5·22), each 1-cm tumour size increase (OR = 1·34), a cancer care referral hospital as the place of initial surgery (OR = 2·3), thyroidectomy or near total thyroidectomy(OR = 3·03) and neck dissection (OR = 3·19). Recurrence was associated with the time of radioactive iodine ((131) I) therapy (OR = 3·71). After data modelling, persistence was associated with macroscopic lymph node metastasis (OR = 6·17), 1-cm increases in tumour size (OR = 1·30) and thyroidectomy or near total thyroidectomy (OR = 3·82), while recurrence was associated with surgery at referral hospital (OR = 3·79). CONCLUSIONS: The best predictors of persistence were tumour size and macroscopic lymph node metastasis; when the initial surgery is of quality, the recurrence depends more on tumour's biology aspects.

Leprosy in Brazilian counties bordering Paraguay: Mato Grosso do Sul State, 2001-2011.

BACKGROUND: In Mato Grosso do Sul state, Brazil, the dry border shared with Paraguay is a territory marked by facilities in the flow of goods, services and people, bringing difficulties for surveillance of communicable diseases. PURPOSE: The purpose of this study is to characterise leprosy epidemiologically in dry border municipalities of Mato Grosso do Sul in Brazil with contiguous urban areas with neighbouring Paraguayan counties, in the period 2001-2011. METHODS: This is an exploratory descriptive investigation that includes the four dry border municipalities of Mato Grosso do Sul (Coronel Sapucaia, Paranhos, Ponta Porã, and Sete Quedas) in Brazil whose urban areas are contiguous with Paraguay. Data comprised the period 2001-2011. RESULTS: The rates of leprosy detection and prevalence oscillated along the study period, increasing in the last 2 years investigated. The detection rate was 3.3/10,000 in 2011, up from 1.7/10,000 in 2009. Prevalence was 5.3/10,000 in 2011, up from 2.5/10,000 in 2009. The Virchowian disease form was predominant in 8 of the 11 years investigated. Most patients were male, with limited formal education (44.2% with less than 4 years of study). CONCLUSION: In the border of Brazil, most (greater than 70%) of the cases detected were classified as multibacillary. The higher coefficient found in Brazilian municipalities was the Virchowian clinical form, which can influence the operational classification in multibacillary. The predominance of the Virchowian clinical form, larger number of patients in rural areas and children under 15 years of age provides new information on the manifestations of the disease in the border territories. The study revealed that municipalities with contiguous cross-border urban areas with Paraguay have unique epidemiological features that need to be addressed by policies focusing leprosy as a public health priority.

Early Abortions and Congenital Malformations: A Comparison Between Agricultural and Nonagricultural Areas in the State of São Paulo/Brazil.

INTRODUCTION: Areas with higher agricultural production have higher rates of abortion and malformation, probable related to pesticides. OBJECTIVE: To compare the rates of early abortion and fetal malformation in agricultural and nonagricultural areas. METHOD: A survey was carried out on fetal deaths in children weighing less than 500 g or gestational age less than 22 weeks and fetal malformations in live births. RESULTS: From 1996 to 2018, there was an increase in the rates of abortion and, albeit to a lesser extent, malformation. The areas of greater agricultural production have higher rates of fetal mortality and malformation than the others. CONCLUSIONS: The study suggests that areas with higher use of pesticides have higher rates of abortion and fetal malformations than the others, requiring further observational studies, reducing confounders inherent to the ecological study.

Can living in the surroundings of a petrochemical complex be a risk factor for autoimmune thyroid disease?

BACKGROUND: Based on a suspicion raised by a health professional and due to a subsequent legal request, a cross-sectional study was made with a comparison group to investigate a possible excess of Hashimoto's thyroiditis-HT and antibodies-ATA in the surroundings of a Petrochemical Complex. METHODS: People of both sexes aged over 20 years were investigated in a random sample of residents in the area surrounding the Petrochemical Complex. Controls were investigated in an area with steel industries. In the areas searched, participants were chosen randomly and stratified a priori by sex and age group. As a result, 90.5% of the expected sample was obtained, totaling 1533 individuals. HT and ATA prevalences were compared by the chi-square test. Logistic regression was used to control the possible confounding factors for HT and ATA. RESULTS: Both TH (9.3%) and ATA (17.6%) prevalences were higher in the Petrochemical Complex area than in the control area (3.9% and 10.3%, respectively). After controlling the possible confounding factors, the POR for living in the surroundings of the Complex and presenting HT was 2.39 (CI95%: 1.42-4.03). According to the ATA criterion, the POR for living in the surroundings of the Complex was 1.78 (CI95%: 1.23-2.60). CONCLUSIONS: The authors have found higher prevalence and risk of developing thyroiditis and anti-thyroid antibodies among residents of areas surrounding the Petrochemical Complex and think these findings need to be further studied in similar areas.

[Reliability of a questionnaire to assess food safety knowledge, perceptions, and practices among outpatients with human immunodeficiency virus]. / Reprodutibilidade de um questionário para avaliação de conhecimentos, percepções e práticas em segurança sanitária alimentar de portadores de HIV/AIDS ambulatoriais.

HIV-positive patients are at increased risk of acquiring infections, particularly those related to water and food. The risk could be reduced by educational interventions in the clinical setting related to food safety for the prevention of food-borne diseases. The current study aimed to analyze food safety knowledge, perceptions, and practices among HIV-positive outpatients. A questionnaire was organized with five behavioral areas (cross contamination; personal hygiene; household hygiene; temperature control; and control of unsafe foods). The test-retest procedure demonstrated the questionnaire's reliability. Kappa values varied among the questions: high for 84.6% (33); moderate for 12.8% (5); and low for 2.5% (1). Based on the results, the instrument showed good reliability for most of the questions and can be used for surveys on food safety in HIV-positive outpatients.

Occupational exposure and effects on the male reproductive system.

A significant increase in the incidence of male infertility has been described in the international literature, raising questions about its causes. Part of this effect may result from synthetic toxic substances acting on the endocrine system (endocrine disruptors), many of which are routinely used in work processes. We provide a critical review of the specialized literature on work-related chemical substances capable of causing male infertility. Pesticides such as DDT, linuron, and others, heavy metals like mercury, lead, cadmium, and copper, and substances from various industrial uses and residues such as dioxins, polychlorinated biphenyls (PCBs), ethylene dibromide (EDB), phthalates, polyvinyl chloride (PVC), and ethanol are among the main endocrine disruptors that can cause male infertility. Based on the literature, gonadal dysfunction and congenital malformation are the main alterations caused by these substances in the male reproductive system. We conclude that despite the relative lack of studies on this issue, the relevance of such risk calls for further studies as well as measures to prevent workers' exposure to the various substances.

Apgar, diagnósticos de malformação fetal e condições de parto em São Paulo / Apgar, fetal malformation diagnoses and delivery conditions in São Paulo

Objetivo: Determinar a correlação entre vias de parto, locais de parto e prognóstico neonatal por meio do índice de Apgar e a capacidade de diagnosticar malforma- ções. Métodos: A pesquisa foi realizada no Sistema de Informação de Nascidos Vivos para variáveis de parto e malformações. Também correlacionamos o Apgar com ou sem malformação fetal e local do parto. Resultados: Houve uma quantidade considerável de dados de Apgar indefinidos, especialmente em partos domiciliares. Os partos domiciliares com malformações fetais com Apgar 0-2 e 3-5 no primeiro minuto também apresentaram piores taxas de recuperação no quinto minuto em comparação a cesárea e parto vaginal intra-hospitalar. O registro do diagnóstico das malformações fetais ocorre em ambiente hospitalar e é mais frequente do que no domiciliar. Recém-nascidos com malformações fetais apresentaram maiores taxas de Apgar ao nascer em ambiente hospitalar. As anomalias associadas aos piores prognósticos foram neurológicas e cardiológicas, enquanto as menos associadas foram as de pés e quadris. Conclusão: Esta pesquisa sugere que a cesárea e o parto hospitalar estão correlacionados a um melhor prognóstico do recém-nascido com malformação, bem como a capacidade de diagnosticar doenças congênitas que potencialmente requerem intervenção médica imediata.(AU)

Objective: To determine the correlation between delivery routes, delivery sites and neonatal prognosis through Apgar score and the ability to diagnose malformations. Methods: Research was carried out in the Live Birth Information System for delivery variables and malformations. We also correlated Apgar with or without fetal malformation and delivery site. Results: There was a considerable amount of undefined Apgar data, especially in home births. Home births with fetal malformations with Apgar 0-2 and 3-5 in the first minute also showed worse recovery rates in the fifth minute compared to cesarean section and intra-hospital vaginal delivery. Registration of the diagnosis of fetal malformations occurs in a hospital environment and is more frequent than at home. Newborns with fetal malformations had higher Apgar rates when born in a hospital environment. The abnormalities associated with the worst prognoses were neurological and cardiological, while the least associated were those of the feet and hips. Conclusion: This research suggests that caesarean section and hospital births are correlated with a better prognosis of the newborn with malformation, as well as ability to diagnose congenital diseases that potentially require immediate medical intervention.(AU)

The context of leprosy in Brazil-Paraguay border.

In Brazil, leprosy is endemic in three regions: the North, Northeast, and Mid-West. Counties with contiguous binational urban areas are characterized by a constant flow of people, goods, and services, which facilitates the transmission of diseases and influences the epidemiological profile of leprosy. The purpose of this study was to examine territorial differences in relation to the incidence of leprosy, focusing on border counties with contiguous binational urban areas or otherwise. Each county was taken as an information unit for leprosy cases reported during 2001-2011, based on data from original notification records of the state's Department of Health. In counties with contiguous binational urban areas detection rates showed tendency to increase, Virchowian (lepromatous) disease and disability grade II predominated when compared with Groups II and III: 0.64 and 0.54/100,000 inhabitants for Virchowian disease and 0.14 and 0.27/100,000 inhabitants for disability grade II respectively, and were associated with higher transmission rates. The findings demonstrate the role of border areas in maintaining the endemicity of leprosy.

Health, sleep and lack of time: relations to domestic and paid work in nurses.

OBJECTIVE: To assess whether reported morbidity and complaints of lack of time and sleep are associated with the burden of professional work and housework among nurses. METHODS: A cross-sectional exploratory study was carried out among female nurses and nurse assistants (N=206) of a public hospital in Rio de Janeiro, Brazil. Data were collected by means of a questionnaire. The prevalence ratio and 95% confidence intervals were estimated. RESULTS: Mean duration of professional work and housework time was 40.4 and 31.6 hours/week, respectively. Long professional working time (over 44 hours/week) were associated with mild emotional disorders (PR=1.37; 95% CI: 1.05-1.80), complaints of lack of time for resting/leisure (PR=1.61; 95% CI: 1.31-1.97), housework (PR=1.48; 95% CI: 1.12-1.97), and childcare (PR=1.99; 95% CI: 1.51-2.63). Long housework time (over 28 hours/week) was associated with lower prevalence of lack of time for childcare (PR=0.62; 95% CI: 0.46-0.84). High housework load was associated with lack of personal time and complaints of varicose veins (PR=1.31; 95% CI: 1.14-1.50 and PR=1.31; 95% CI: 1.08-1.58, respectively). Complaints of varicose veins were also frequent among female nurses with a total work load above 84 hours (PR=1.30; 95% CI: 1.05-1.61), though this group has shown a lower prevalence of arterial hypertension and recurrent headaches (PR=0.35; 95% CI: 0.15-0.83 and PR=0.53; 95% CI: 0.32-0.89, respectively). CONCLUSIONS: Results suggest that both professional and home environments are relevant in the evaluation of work overload on nurses' health and their family and social life. It is stressed the need for instruments for analyzing total workload among female populations.

Self-reported health and sleep complaints among nursing personnel working under 12 h night and day shifts.

This cross-sectional exploratory study involved health care workers of various skill types and levels. We tested the hypothesis that the prevalence of diseases, sleep complaints, and insufficient time for nonprofessional activities (family, leisure, and rest) are higher among night than day workers. Data collection was carried out in two public hospitals using questionnaires and other forms. Night work was explored as a risk factor, considering a night worker as one who had at least one night job on the occasion of the research. Data were assessed by a univariate analysis. The association between work schedule and the dependent variables--health conditions, sleep complaints, and insufficient time for nonprofessional activities--was evaluated through the estimation of the prevalence ratio, with a confidence interval of 95%. Two hundred and fifty-eight female nursing personnel participated; 41.5% were moonlighters, and only 20 worked a shift of less than 12h in length. Reports of migraine and need of medical care the 2 weeks before the survey were more prevalent among day than night workers (PR=0.71; CI=0.55-0.92 and PR=0.71; CI=0.52-0.95, respectively). Migraine headaches occurred less frequently among night than day workers as confirmed by comparing the reports of the night workers and day workers whose work history was always day shifts (PR = 0.74; CI = 0.57-0.96). Reports of mild emotional disorders (mild depression, tension, anxiety, or insomnia) were less frequent among night (PR=0.76; CI=0.59-0.98) and ex-night workers (PR=0.68; CI=0.50-0.91) than day workers who never had worked a night job. The healthy worker effect does not seem to explain the results of the comparisons between day and night workers. The possible role of exposure by day workers to some risk factors, such as stress, was suggested as an explanation for these results. No significant difference was observed between night and day workers as to sleep complaints, a result that may have been influenced by the nature of the shift-work schedule (no successive night shifts) and possibly nap taking during the night shift. Moreover, the long work hours and moonlighting of the healthcare workers, which is common in Brazil, may have masked other possible differences between the day and night workers. Among night workers, a significant relation was found between years working nights (more than 10 yrs) and high cholesterol values (PR = 2.58; CI = 1.07-6.27), a result that deserves additional study. Working nights more than four times per 2-week span was related to complaints about insufficient time for children (PR= 1.96; CI = 1.38-2.78) and rest/leisure (PR= 1.54; CI = 1.20-1.99). These results can be related to the "social value of time," as evenings and nights are when families usually spend time together. The complexity of the professional life and the consequent heterogeneity of the group of workers under shift-work schemes confound the results. More in-depth study of the questions raised here demands a more sophisticated epidemiological treatment and larger sample size.

Health surveillance and endocrine disruptors.

The author discusses the extreme relevance of research on the presence of endocrine disruptors (EDs) in products of interest to health surveillance (HS). Focusing on EDs, the author highlights the urgency of changes already under way in the direction of HS. The shift should be from product and product-registration approaches to the productive process and its realization in consumption, generation of contaminants, and alterations in the health of workers and the overall population. He briefly describes: regulatory gaps for dealing with EDs; difficulty in evaluating risk and suspension of the production and use of products with its characteristics and the need, as exemplified by such products, to enhance the inter-relationship among all stakeholders and to turn HS into a state-of-the-art technological setting, associated with the academic community and accountable to the public. The author reports on measures already taken in relation to EDs, including the establishment of a reference laboratory for analyzing persistent organic pollutants (POPs), interruption of the use of various POPs in Brazil and an initial review of requirements for registering pesticides under the Brazilian National Health Surveillance Agency (ANVISA).

Production of iodine-124 and its applications in nuclear medicine.

Until recently, iodine-124 was not considered to be an attractive isotope for medical applications owing to its complex radioactive decay scheme, which includes several high-energy gamma rays. However, its unique chemical properties, and convenient half-life of 4.2 days indicated it would be only a matter of time for its frequent application to become a reality. The development of new medical imaging techniques, especially improvements in the technology of positron emission tomography (PET), such as the development of new detectors and signal processing electronics, has opened up new prospects for its application. With the increasing use of PET in medical oncology, pharmacokinetics, and drug metabolism, (124)I-labeled radiopharmaceuticals are now becoming one of the most useful tools for PET imaging, and owing to the convenient half-life of I-124, they can be used in PET scanners far away from the radionuclide production site. Thus far, the limited availability of this radionuclide has been an impediment to its wider application in clinical use. For example, sodium [(124)I]-iodide is potentially useful for diagnosis and dosimetry in thyroid disease and [(124)I]-M-iodobenzylguanidine ([(124)I]-MIBG) has enormous potential for use in cardiovascular imaging, diagnosis, and dosimetry of malignant diseases such as neuroblastoma, paraganglioma, pheochromocytoma, and carcinoids. However, despite that potential, both are still not widely used. This is a typical scenario of a rising new star among the new PET tracers.

[Reproducibility, relative validity, and calibration of a food-frequency questionnaire for adults in Greater Metropolitan Porto Alegre, Rio Grande do Sul State, Brazil]. / Reprodutibilidade, validade relativa e calibração de um questionário de frequência alimentar para adultos da Região Metropolitana de Porto Alegre, Rio Grande do Sul, Brasil.

This study tested the relative validity and estimated calibration factors of a food-frequency questionnaire (FFQ) with 120 food items in 128 adults. We applied one FFQ and three 24h recalls. Validity was tested by the Bland-Altman method, intraclass correlation coefficient (ICC), classification in quartile categorization, and weighted kappa. Calibration factors were estimated by linear regression, with 24h recall of food intake as the dependent variable and the FFQ values as the independent variable. FFQ underestimated the nutrient intake when compared to 24h recall. The energy-adjusted and de-attenuated ICC ranged from 0.19 (zinc) to 0.82 (calcium). 37% of subjects were classified in the same quartile, with mean kappa of 0.28 (zinc: 0.08; calcium: 0.49). The highest calibration factors were 0.48 (calcium), 0.47 (potassium), and 0.44 (carbohydrates), and the lowest was 0.10 (retinol). FFQ showed satisfactory relative validity and calibrated energy and nutrient intake values similar to 24h recall.

Cobertura vacinal em declínio: hora de agir!

A cobertura vacinal está em queda no Brasil. Os dados são oficiais. O Ministério da Saúde (MS) adverte que mais de 300 municípios têm cobertura menor do que 50% para a poliomielite, até 1 ano de idade...

Seasonal variation of food intake of adults from Niterói, Rio de Janeiro, Brazil.

The measurement of usual food intake (FI) is necessary to accurately establish the relationship between diet and disease. In most studies data are collected at one particular time of the year, which may influence the interpretation of the results. The purpose of this study was to investigate the effect of seasonality on FI in a sample of adults from Niterói, RJ, Brazil. A total of 102 healthy subjects (69 women) aged between 20 and 69 years were interviewed to obtain six 24-hour dietary recalls, three in summer and three in winter. In both seasons, the intake of energy (EI) and 23 nutrients was determined and the percent of subjects who met the recommendations for the nutrients were computed. The data of FI were deattenuated considering the within-person variability and adjusted for energy. The intake of energy and some nutrients were significantly different between men and women. EI did not differ between seasons, for both sexes, but the intake of macro and micronutrients was different. The results of this study suggest that the seasonality in the measurement of FI should be considered in order to improve the methods and instruments used in population dietary surveys.

The context of leprosy in Brazil-Paraguay border / O contexto da hanseníase na fronteira Brasil/Paraguai

Abstract In Brazil, leprosy is endemic in three regions: the North, Northeast, and Mid-West. Counties with contiguous binational urban areas are characterized by a constant fow of people, goods, and services, which facilitates the transmission of diseases and influences the epidemiological profile of leprosy. The purpose of this study was to examine territorial differences in relation to the incidence of leprosy, focusing on border counties with contiguous binational urban areas or otherwise. Each county was taken as an information unit for leprosy cases reported during 2001-2011, based on data from original notification records of the state's Department of Health. In counties with contiguous binational urban areas detection rates showed tendency to increase, Virchowian (lepromatous) disease and disability grade II predominated when compared with Groups II and III: 0.64 and 0.54/100,000 inhabitants for Virchowian desease and 0.14 and 0.27/100,000 inhabitants for disability grade II respectively, and were associated with higher transmission rates. The findings demonstrate the role of border areas in maintaining the endemicity of leprosy.

Resumo A hanseníase no Brasil é endêmica em três regiões: norte, nordeste e centro-oeste. As cidades com áreas urbanas contíguas entre o Brasil e Paraguai têm como característica intenso fluxo de pessoas, bens e serviços, cuja mobilidade favorece a transmissão de doenças e influencia no perfil epidemiológico da hanseníase. O objetivo do estudo é analisar as diferenças territoriais relacionadas aos casos de hanseníase, considerando os municípios da linha de fronteira com e sem áreas urbanas contiguas e demais municípios de Mato Grosso do Sul. Cada município foi tratado como unidade de informação para os casos de hanseníase notificados no período de 2001 a 2011, sendo os dados obtidos a partir da base de dados composta pelas fichas de notificação originais da Secretaria de Estado de Saúde. Em municípios com áreas urbanas contiguas, a detecção de casos mostra tendência de aumento, maior coeficientes da forma clínica virchowiana e grau de incapacidade II, em relação aos grupos II e III, que apresentaram 0,64 e 0,54/100.000 da forma clínica virchowiana, respectivamente, e 0,14 e 0,27/100.000, respectivamente, para o grau II de incapacidade. Situação que implica no aumento da transmissão da doença e configura o território de fronteira como cidade urbana contigua importante na manutenção da hanseníase como endêmica.

Development of a food frequency questionnaire in a probabilistic sample of adults from Niterói, Rio de Janeiro, Brazil.

With the purpose of generating a list of foods for a food-frequency questionnaire, data from 24h dietary recalls on a typical day from a probabilistic sample of 1,724 adults of Niterói, Rio de Janeiro, Brazil, were analyzed. The frequency of food intake, the total intake of energy and macronutrients and the relative contribution of each food item to total energy and macronutrient intake were calculated. The most frequently reported food items (> 50% of adults) were rice, coffee, beans, refined canesugar, and bread. Whole milk was consumed more frequently then skimmed milk or semi-skimmed milk. Beef was consumed by more adults than chicken, pork or fish. Approximately 90% of energy and macronutrients intake was explained by 65 food items. The list of food items generated in the present analysis is similar to those found in other samples of adults from urban areas in Brazil. It may be possible to generate a core list of common foods with addition of regional foods to be used nationally in urban areas of the country.

Nanotecnología. El impacto potencial de las nanotecnologías y las nanopartículas para la salud humana / Nanotechnology. The potential impact of nanotechnologies and nanoparticles to human health

Los nanomateriales pueden tener diferentes propiedades a las del mismo material en mayor escala. Esto permite el uso en diversas ramas de la producción, con un papel especial en la industria de la salud, como en sensores para el diagnóstico y recubrimiento de fármacos para drug delivery. Diferentes propiedades del mismo material, determinadas por la escala, podrán determinar diferentes toxicidades. De hecho, ya conocemos algunos efectos tóxicos celulares, tales como la producción de radicales libres y en los sistemas cardiovascular y respiratorio, en la piel y otros órganos por ciertos nanomateriales, incluyendo nanopartículas presentes en el smog. En este trabajo, una revisión integradora tiene como objetivo presentar estos temas en general, destacando que los nanomateriales están cada vez más presentes en los productos utilizados en la vida cotidiana.

Nanomaterials may have different properties than the same materials at larger scales. This allows use in various branches of production, with a special role in the healthcare industry, such as sensors for diagnosis and drug coating for drug delivery. Different properties of the material depend on the scale, may determine different toxicities. In fact, we already know some cellular toxic effects such as the production of free radicals, and in cardiovascular, respiratory, skin and other systems and organs by certain nanomaterials, including nanoparticles in smog. In this work integrative review aims to present these issues in general, noting that nanomaterials are increasingly present in products used in everyday life.

Reprodutibilidade, validade relativa e calibração de um questionário de frequência alimentar para adultos da Região Metropolitana de Porto Alegre, Rio Grande do Sul, Brasil / Reproducibility, relative validity, and calibration of a food-frequency questionnaire for adults in Greater Metropolitan Porto Alegre, Rio Grande do Sul State, Brazil / Reproducibilidad, validez relativa y calibración de un cuestionario de frecuencia alimentaria para adultos de la región metropolitana de Porto Alegre, Río Grande do Sul, Brasil

Este estudo testou reprodutibilidade e validade relativa, e estimou fatores de calibração de um QFA (questionário de frequência alimentar) com 120 itens alimentares, em 128 adultos. Aplicou-se um QFA e três inquéritos recordatórios de 24hs (IR24h). A validade foi testada pelo método de Bland-Altman, correlação intraclasse (CCI), classificação em quartos de ingestão e kappa ponderado. Os fatores de calibração foram estimados por meio de regressão linear, com os valores de ingestão alimentar do IR24h como variável dependente e os valores do QFA como variável independente. O QFA subestimou a ingestão da maioria dos nutrientes em relação ao IR24h. O CCI corrigido para energia e deatenuado variou de 0,19 (zinco) a 0,82 (cálcio). Trinta e sete por cento dos indivíduos foram classificados no mesmo quarto, com valor médio de kappa de 0,28 (zinco: 0,08; cálcio: 0,49). Os maiores fatores de calibração foram 0,48 (cálcio), 0,47 (potássio) e 0,44 (carboidratos), e o menor fator foi 0,10 (retinol). Esse QFA demonstrou validade relativa satisfatória e valores de ingestão de energia e nutrientes calibrados semelhantes ao IR24h.

This study tested the relative validity and estimated calibration factors of a food-frequency questionnaire (FFQ) with 120 food items in 128 adults. We applied one FFQ and three 24h recalls. Validity was tested by the Bland-Altman method, intraclass correlation coefficient (ICC), classification in quartile categorization, and weighted kappa. Calibration factors were estimated by linear regression, with 24h recall of food intake as the dependent variable and the FFQ values as the independent variable. FFQ underestimated the nutrient intake when compared to 24h recall. The energy-adjusted and de-attenuated ICC ranged from 0.19 (zinc) to 0.82 (calcium). 37% of subjects were classified in the same quartile, with mean kappa of 0.28 (zinc: 0.08; calcium: 0.49). The highest calibration factors were 0.48 (calcium), 0.47 (potassium), and 0.44 (carbohydrates), and the lowest was 0.10 (retinol). FFQ showed satisfactory relative validity and calibrated energy and nutrient intake values similar to 24h recall.

Se evaluó la validez relativa y se obtuvieron los factores de calibración de un cuestionario de frecuencia alimentaria (CFA) con 120 alimentos en 128 adultos. Se aplicó un CFA y tres recuerdos de 24 horas (R24h). La validez se evaluó mediante el método de Bland-Altman, correlación intraclase (CCI), clasificación en cuartil de ingesta, y kappa ponderado. Los factores de calibración se estimaron por regresión lineal, con los valores del R24h como la variable dependiente y los valores de los CFA como la variable independiente. El CFA subestimó la ingesta de nutrientes en relación con R24h. El CCI corregido para la energía y desatenuado osciló entre 0,19 (zinc) y 0,82 (calcio). Un 37% de los sujetos fueron clasificados en el mismo cuartil de ingesta, con un valor promedio de kappa de 0,28 (zinc: 0,08; calcio: 0,49). Los mayores factores de calibración fueron 0,48 (calcio), 0,47 (potasio) y 0,44 (carbohidrato), y el factor más bajo fue de 0,10 (retinol). Este CFA demostró validez satisfactoria y los valores relativos de la ingesta de energía y nutrientes similares al R24h calibrado.

Variacao sazonal na ingestao alimentar de adultos de Niteroi, Rio de Janeiro / Seasonal variation of food intake of adults from Niteroi, Rio de Janeiro, Brazil

A aferição da ingestão alimentar (IA) usual é necessária para estabelecer, com acurácia, a relação entre a dieta e o aparecimento de doenças. Na maioria dos estudos, os dados de IA usual são coletados referentes ao período de um ano, sem considerar a estação do ano em que o estudo ocorre. O objetivo do presente estudo foi verificar o efeito da sazonalidade na IA de adultos de Niterói, RJ. Um total de 102 sujeitos (69 mulheres) saudáveis, com idade entre 20 e 69 anos, responderam a seis recordatórios dietéticos de 24 horas, três no verão e três no inverno. Em ambas as estações do ano, foi determinada a ingestão energética (IE) e de 23 nutrientes, além do percentual de indivíduos que alcançavam as recomendações dos mesmos. Os dados finais foram deatenuados pela variabilidade intraindividual e ajustados pela energia. A IE e de alguns nutrientes foram significativamente diferentes entre os homens e as mulheres. A IE não se diferenciou entre as estações, para ambos os sexos, porém a ingestão de proteínas, fibras, magnésio, tiamina, piridoxina e niacina foi diferente entre as estações para ambos os sexos. Os resultados do presente estudo sugerem que a sazonalidade seja considerada na aferição da IA, servindo de base para a adequação dos métodos e instrumentos utilizados nos inquéritos dietéticos populacionais.

The measurement of usual food intake (FI) is necessary to accurately establish the relationship between diet and disease. In most studies data are collected at one particular time of the year, which may influence the interpretation of the results. The purpose of this study was to investigate the effect of seasonality on FI in a sample of adults from Niterói, RJ, Brazil. A total of 102 healthy subjects (69 women) aged between 20 and 69 years were interviewed to obtain six 24-hour dietary recalls, three in summer and three in winter. In both seasons, the intake of energy (EI) and 23 nutrients was determined and the percent of subjects who met the recommendations for the nutrients were computed. The data of FI were deattenuated considering the within-person variability and adjusted for energy. The intake of energy and some nutrients were significantly different between men and women. EI did not differ between seasons, for both sexes, but the intake of macro and micronutrients was different. The results of this study suggest that the seasonality in the measurement of FI should be considered in order to improve the methods and instruments used in population dietary surveys.