Percutaneous ethanol injection is an acceptable bridging therapy to hepatocellular carcinoma prior to liver transplantation.

PURPOSE: Locoregional therapies (LRT) are employed for bridging patients with hepatocellular carcinoma (HCC) awaiting orthotopic liver transplantation (OLT). Although the main LRT options include transarterial chemoembolization (TACE) and radiofrequency ablation (RFA), percutaneous ethanol injection (PEI) is an alternative with considerably lower costs. This study is a pioneering evaluation of the natural history of PEI bridging to OLT as compared to TACE. METHODS: All consecutive cirrhotic patients with HCC enlisted for OLT (2011-2020) at a single center were analyzed. Patients were divided into three LRT modality groups: PEI, TACE, and PEI+TACE. The primary study outcome was waitlist dropout due to tumor progression beyond Milan criteria. A comparison of post-transplant outcomes of patients as stratified by LRT modality also was performed. RESULTS: One hundred twenty-nine patients were included (PEI=56, TACE=43, PEI+TACE=30). The dropout rate due to tumor progression was not different among the three groups: PEI=8.9%, TACE=14%, PEI+TACE=16.7% (p=0.54). Thirteen (76.4%) patients underwent OLT after successful downstaging (3 [75%] in the PEI group, 5 [83.3%] in the TACE group, and 5 [71.4%] in the PEI+TACE group). For the 96 patients undergoing OLT, 5-year post-transplant recurrence-free survival was PEI=55.6% vs. TACE=55.1% vs. PEI+TACE=71.4% (p=0.42). Complete/near-complete pathological response rate was similar among groups (p=0.82). CONCLUSION: Dropout rates and post-transplant recurrence-free survivals related to PEI were comparable to those of TACE. This study supports the use of PEI alone or in combination with TACE for HCC patients awaiting OLT whenever RFA is not an option.

Dietary pattern changes, obesity and excess body fat in adults of a Brazilian birth cohort.

BACKGROUND: Few studies have assessed dietary patterns (DPs) and the changes in these patterns over time in adults. The present study aimed to investigate whether possible changes in DPs in two assessments are associated with obesity and excess body fat. METHODS: A prospective study was conducted in which data were collected from 1082 adults of a Brazilian birth cohort during two periods 15 years apart (T1: 2002-2004; T2: 2016-2017). Food consumption was assessed in both periods using validated food frequency questionnaires. Three similar DPs were found in the two assessments, and adherence to these patterns was classified as prudent, risk or mixed. Nine DPs changes were defined. At T2, subjects with a body mass index ≥ 30.0 kg m- ² were classified as obese, and men and women with a body fat (BF) percentage ≥ 25.0 and ≥ 35.0, respectively, were classified as having excess BF. A directed acyclic graph was built to adjust the association for confounding variables. RESULTS: At T2, 34.4% of the subjects were obese and 61.4% had excess BF. In the adjusted analysis, the changes associated with obesity and excess BF were prudent-mixed (prevalence ratio [PR] 1.55; 95% confidence interval [CI] = 1.04-2.29 and PR = 1.35; 95% CI = 1.10-1.65), risk-risk (PR = 1.49; 95% CI = 1.03-2.13 and PR = 1.27; 95% CI = 1.04-1.53), risk-mixed (PR = 1.56; 95% CI = 1.05-2.31 and PR = 1.33; 95% CI = 1.07-1.63) and mixed-risk (PR = 1.61; 95% CI = 1.10-2.35 and PR = 1.29; 95% CI = 1.04-1.58). CONCLUSIONS: A decline in food quality over time or stagnation in an unhealthy DP can lead to obesity and excess BF.

Influence of Paleolithic diet on anthropometric markers in chronic diseases: systematic review and meta-analysis.

BACKGROUND: The Paleolithic diet has been studied in the scope of prevention and control of chronic noncommunicable diseases (CNCD). The objective of this study was to analyze the influence of the Paleolithic diet on the prevention and control of CNCD in humans, specifically on anthropometric markers, through a systematic review with meta-analysis. METHODS: What is the effect of the Paleolithic diet on anthropometric parameters (weight, body mass index and waist circumference) compared to other control diets based on recommendations in adults? We included only randomized studies with humans that used the Paleolithic Diet in the prevention and control of CNCD published in Portuguese, English or Spanish. The search period was until March 2019, in the LILACS, PubMed, Scielo, Science Direct, Medline, Web of Science and Scopus databases. The abstracts were evaluated by two researchers. We found 1224 articles, of which 24 were selected and 11 were included in the meta-analysis. The effect of dietary use on body weight, body mass index and waist circumference was evaluated. RESULTS: The summary of the effect showed a loss of - 3.52 kg in the mean weight (CI 95%: - 5.26; - 1.79; p < 0,001; I2 = 24%) of people who adopted the Paleolithic diet compared to diets based on recommendations. The analysis showed a positive association of adopting the Paleolithic diet in relation to weight loss. The effect was significant on weight, body mass index and waist circumference. CONCLUSION: The Paleolithic diet may assist in controlling weight and waist circumference and in the management of chronic diseases. However, more randomized clinical studies with larger populations and duration are necessary to prove health benefits. TRIAL REGISTRATION: CRD42015027849 .

Healthy dietary pattern is inversely associated with non-alcoholic fatty liver disease in elderly.

The prevalence of non-alcoholic fatty liver disease (NAFLD) is rising, an increase that may be associated with changes in lifestyle such as unhealthy dietary patterns. Although advanced age is a risk factor for NAFLD, no studies reporting this association in the elderly population were found. In the present study, the association between dietary patterns and NAFLD in the elderly was assessed. A study including 229 older adults was conducted. NAFLD diagnosis was defined as individuals whose ultrasound examination disclosed hepatic steatosis at any stage, in the absence of excess intake of alcoholic beverages. Dietary patterns were obtained by principal components analysis. Mean scores and standard errors of each dietary pattern were calculated for the groups with and without NAFLD, and mean scores of the two groups were compared using the Mann-Whitney U test. The prevalence ratios and 95 % CI were estimated for each tertile of the dietary pattern adherence scores using Poisson multiple regression models with robust variance. A total of 103 (45 %) elderly with NAFLD and four dietary patterns were identified: traditional, regional snacks, energy dense and healthy. Mean scores for adherence to the healthy pattern in the groups with and without NAFLD differed. NAFLD was inversely associated with greater adherence to the healthy pattern and directly associated with the regional snacks, after adjustment for confounders. In conclusion, healthy dietary pattern is inversely associated with NAFLD in elderly.

Dietary patterns are associated with excess weight and abdominal obesity in a cohort of young Brazilian adults.

PURPOSE: The objective of the present study was to investigate whether dietary patterns are associated with excess weight and abdominal obesity among young adults (23-25 years). METHODS: A cross-sectional study was conducted on 2061 participants of a birth cohort from Ribeirão Preto, Brazil, started in 1978-1979. Twenty-seven subjects with caloric intake outside ±3 standard deviation range were excluded, leaving 2034 individuals. Excess weight was defined as body mass index (BMI ≥ 25 kg/m(2)), abdominal obesity as waist circumference (WC > 80 cm for women; >90 cm for men) and waist/hip ratio (WHR > 0.85 for women; >0.90 for men). Poisson regression with robust variance adjustment was used to estimate the prevalence ratio (PR) adjusted for socio-demographic and lifestyle variables. Four dietary patterns were identified by principal component analysis: healthy, traditional Brazilian, bar and energy dense. RESULTS: In the adjusted analysis, the bar pattern was associated with a higher prevalence of excess weight (PR 1.46; 95 % CI 1.23-1.73) and abdominal obesity based on WHR (PR 2.19; 95 % CI 1.59-3.01). The energy-dense pattern was associated with a lower prevalence of excess weight (PR 0.73; 95 % CI 0.61-0.88). Men with greater adherence to the traditional Brazilian pattern showed a lower prevalence of excess weight (PR 0.65; 95 % CI 0.51-0.82), but no association was found for women. There was no association between the healthy pattern and excess weight/abdominal obesity. CONCLUSIONS: In this sample, the bar pattern was associated with higher prevalences of excess weight and abdominal obesity, while the energy-dense (for both genders) and traditional Brazilian (only for men) patterns were associated with lower prevalences of excess weight.

Influência da infecção por Helicobacter pylori e de sua erradicação sobre o consumo alimentar e estado nutricional.

Infection by Helicobacter pylori affects over half of the world's population and is a public health issue. Its prevalence is significantly higher in developing countries such as Brazil. It has been suggested that infection by H pylori can impact calorie intake and homeostasis. AIM: Analyze the influence of infection by H pylori and of its eradication on nutritional status and dietary intake. MATERIAL AND METHODS: The study included 124 patients (48 of whom H pylori positive, 45 H pylori negative, and 31 eradicated). Weight and height were measured to calculate the body mass index (BMI). Dietary intake was assessed using a 24-hour diet recall (24hR) in two occasions. RESULTS: Pre-obesity was the highest among the eradicated patients (p = 0.011). Homogenicity was found in the dietary intake for the nutrients studied, except for saccharose, whose intake was the lowest among the eradicated group (p < 0.001). CONCLUSIONS: Patients eradicated for H pylori had a higher rate of pre-obesity. The dietary intake was similar among the groups for nearly all nutrients assessed, except for saccharose, whose intake by eradicated patients was lower. This entails discussions about possibly including the investigation of nutritional status and diet in the routine procedures towards those who seek a diagnosis of infection by H pylori.

Socioeconomic and demographic factors are associated with dietary patterns in a cohort of young Brazilian adults.

BACKGROUND: The aim of the present study was to identify the main dietary patterns among young adults and to investigate the association of socioeconomic and demographic factors, and social mobility with dietary patterns. METHODS: Data from the fourth follow-up of the 1978/79 Ribeirão Preto birth cohort study, Brazil, were used. A total of 2,061 young adults, whose mothers gave sociodemographic information at birth in 1978-79, provided sociodemographic and dietary data through a validated food frequency questionnaire in 2002-2004, when they were aged 23-25 years. Those whose caloric intake was outside of the ±3 standard deviation range were excluded, leaving 2,034 individuals. The dietary patterns were identified by principal component analysis followed by varimax orthogonal rotation. Poisson regression with robust estimation of variance was used to derive prevalence ratios (PR). RESULTS: Four dietary patterns were identified: healthy, traditional Brazilian, energy-dense and bar. In the adjusted analysis, individuals with higher schooling (≥12 years) in adult life (PR = 1.51, 95% CI: 1.07-2.14) showed greater adherence whilst men (PR = 0.79, 95% CI: 0.68-0.93) had lower adherence to the healthy pattern. The highest adherence to the traditional Brazilian pattern was found for men (PR = 2.39, 95% CI: 2.04-2.80), mullatos (PR = 1.41, 95% CI: 1.21-1.64), households with ≥2 members, and for those with children (PR = 1.28, 95% CI: 1.07-1.55) while individuals with higher schooling in adulthood (≥12 years) (PR = 0.47, 95% CI: 0.34-0.65), higher family income in adulthood (≥20 MW) (PR = 0.57, 95% CI: 0.33-0.99) and higher family income at birth (≥6.1 MW) showed lower adherence. The bar pattern was positively associated with male sex (PR = 2.96, 95% CI: 2.47-3.55) and low schooling (≤8 years). The energy-dense pattern was not associated with any of the variables investigated. Social mobility was associated with the traditional Brazilian pattern. Men and women who were not poor at birth and remained so in adulthood showed lower adherence to this pattern (PR = 0.70, 95% CI: 0.53-0.94 for men and PR = 0.40, 95% CI: 0.20-0.80 for women). CONCLUSIONS: Four different dietary patterns were identified among young adults. Socioeconomic and demographic factors, and social mobility were associated with food choices.

Untangle the relationship of muscle mass and bone mineral content on handgrip strength: Results of ELSA-Brasil.

The study aims to investigate the independent association of muscle mass (MM) and bone mineral content (BMC) in the performance of the handgrip strength (HGS) test and whether there is effect modification by sex and age. In 12,491 participants from the ELSA-Brasil we estimated the associations between MM, BMC and HGS using linear regression models. All the analyses were performed for total population, also stratified for sex and age. For total population an interaction term was included between each explanatory variable of interest with sex and age to verify the presence of effect modification. We observed that the higher quintiles of MM and BMC were associated to an increasing in the mean of HGS compared to the first quintile, with greater magnitudes in men compared to women, also adults compared to elderly. When we estimated the independent effect of each exposure of interest, MM showed stronger effect in HGS in women, men and adults then BMC. In conclusion, we observed that higher amounts of MM and BMC are associated with higher HGS, regardless of sociodemographic characteristics, health conditions and lifestyle, with this effect being greater in men and adults.

Sex-Dependent Effects of the Intake of NOVA Classified Ultra-Processed Foods on Syndrome Metabolic Components in Brazilian Adults.

Longitudinal studies evaluating the relationship between UPF consumption and the incidence of Metabolic Syndrome (MetS) and its components are still scarce. This study aimed to evaluate the effect of UPF consumption on the incidence of MetS and its components in adults. A prospective study was conducted with 896 participants from the 1978/79 Ribeirão Preto cohort, São Paulo, Brazil. UPF consumption was evaluated in %kcal and %g at ages 23-25 years. Incidence of MetS and its components were estimated at ages 37-39 years, according to the Joint Interim Statement criteria. Poisson regression was used to assess associations, and interactions with sex were investigated. UPF consumption had no association with MetS (%kcal Adjusted PR: 1.00; 95% CI: 0.99-1.01; %g Adjusted PR: 1.00; 95% CI: 0.99-1.01). However, women with higher UPF consumption, in %kcal and %g, had a higher risk of abdominal obesity (%kcal: p = 0.030; %g: p = 0.003); and women with higher UPF consumption, in %g, had a higher risk of low HDL-cholesterol (p = 0.041). For the other components of MetS, no significant associations were observed in either sex. These findings suggest evidence of no association between UPF consumption and MetS; however, consumption of UPF was associated with increased WC and low HDL-c, but only in women.

Ultra-processed food consumption is associated with increase in fat mass and decrease in lean mass in Brazilian women: A cohort study.

Objective: To investigate the association between ultra-processed food consumption at 23-25 years of age and measurements of body composition-fat mass, fat mass distribution and lean mass at 37-39 years of age in Brazilian adults. Methods: 1978/1979 birth cohort study conducted with healthy adults from Ribeirão Preto, São Paulo, Brazil. A total of 1,021 individuals participated in the fat mass analysis (measured by air displacement plethysmography) and 815 in the lean mass analysis and fat mass distribution (assessed by dual energy X-ray absorptiometry). Food consumption was evaluated by a food frequency questionnaire. Food items were grouped according to the level of processing as per the NOVA classification. Ultra-processed food consumption was expressed as a percentage of total daily intake (g/day). Linear regression models were used to estimate the effect of ultra-processed food consumption (g/day) on body mass index, body fat percentage, fat mass index, android fat, gynoid fat, android-gynoid fat ratio, lean mass percentage, lean mass index and appendicular lean mass index. Marginal plots were produced to visualize interactions. Results: The mean daily ultra-processed food consumption in grams was 35.8% (813.3 g). There was an association between ultra-processed food consumption and increase in body mass index, body fat percentage, fat mass index, android fat and gynoid fat and decrease in lean mass percentage, only in women. Conclusion: A high ultra-processed food consumption is associated with a long-term increase in fat mass and a decrease in lean mass in adult women.

Barriers to Physical Exercise and Associated Factors in the Pre- and Postoperative Periods of Bariatric Surgery.

BACKGROUND: To compare the barriers to exercise and its associated factors among patients in the pre- and postoperative periods of bariatric surgery. METHODS: Cross-sectional study with patients who were split into preoperative (n = 81) and postoperative (n = 209) groups. It was collected sociodemographic characteristics, and the Exercise Benefits Barriers Scale was adopted in order to identify the barriers related to exercise practice. Chi-square, Mann-Whitney, and Poisson regression were applied for comparisons and associations. RESULTS: The postoperative group had a lower score on the barrier scale, except for the lack of time subdimension. In the preoperative, the subjects were considered physically active (p = 0.03), and those over 42 years old (p < 0.001) had the lowest score in lack of time subdimension. Those with a body mass index (BMI) higher than 36.89 kg/cm2 had a higher overall score on the scale (p < 0.001), also in the lack of time (p = 0.003) and physical effort subdimensions (p < 0.001). Those with higher education scored more in the lack of time (p = 0.014) and family discouragement subdimensions (p = 0.034). In the postoperative, the participants considered active had the lowest score on the general scale, as well as in all subdimensions (p < 0.001), and the ones with higher education presented better scores in physical effort subdimension (p = 0.041). CONCLUSIONS: The preoperative group had a higher score of barriers to practice exercises related to physical effort, environment, and family discouragement, when compared to the postoperative. The factors associated were physical inactivity, BMI over 36.89 kg/cm2, age 42 years old or under, and higher education.

Association between Eating Patterns and Excess Body Weight in Adolescents.

Background: Excess body weight is a risk factor for the development of diseases. Adolescence is a nutritionally vulnerable age group that suffers due to influences on food intake. We aimed to identify the main dietary patterns of adolescents to investigate their association with excess body weight. Methods: This was a cross-sectional study. Anthropometric measurements (weight and height) were collected to calculate the BMI. Nutritional statuses were classified according to World Health Organization classification. Food consumption data were obtained through a 24-hour recall and food patterns were identified through factor analyses of the main components. The patterns were categorized into quintiles and dichotomized into greater (fourth and fifth quintile) and lower (first to third quintile) adherences. Binomial regression was used to assess the association between food patterns and excess body weight. The study was conducted in a capital city in Northeast Brazil from adolescents aged between 10 and 19 years in 826 public schools. Results: Three main food patterns were identified in women and men: coffee with bread (white bread, coffee, fat, and eggs), common Brazilian (white rice, beans, meat, pasta, with negative factor load for regional foods), and mixed pattern (sweets, fruits, biscuits and cakes, vegetables, and dairy products). Adolescents with a greater adherence to the coffee and bread pattern [odds ratio (OR) = 0.68; 95% confidence interval (95% CI): 0.50-0.93] and the common Brazilian pattern (OR = 0.72; 95% CI: 0.53-0.99) had a lower chance of being excess body weight than those with lower adherence. Conclusions: Three main eating patterns were identified among adolescents, and greater adherence to the coffee with bread and common Brazilian patterns implied a lower chance of excess body weight.

[Factors associated with inflammatory biomarkers in adolescents: analysis by structural equation modeling]. / Fatores associados aos biomarcadores inflamatórios em adolescentes: análise por modelagem de equações estruturais.

The study aimed to analyze factors associated with inflammatory biomarkers in adolescents. This was a cross-sectional study in 391 adolescents 17-18 years of age in public schools in São Luís, Maranhão State, Brazil. Three-stage random cluster sampling was performed in schools, classes, and students. Food consumption was studied with a food frequency questionnaire, and dietary patterns were extracted by principal components factor analysis. Assessment of factors associated with inflammatory biomarkers used structural equation modeling. Latent variables were constructed: socioeconomic status, which included maternal schooling, family income, and economic class; and inflammation, consisting of interleukin-1ß, interleukin-6, and interleukin-8. A theoretical model was developed to assess factors associated with inflammatory biomarkers, indicating direct and indirect effects between the latent and observed variables. Three dietary patterns were identified (Western, basic Brazilian, and healthy), with 31% explained variance and the Western pattern with the largest share. No associations were found between the patterns and the latent variable inflammation (standardized coefficients = 0.281; p = 0.002). Extraction of the three patterns evidenced higher consumption of foods high in carbohydrates and fats, which are nutrients associated directly with the increase in chronic noncommunicable diseases. Excess weight was associated with higher levels of inflammatory biomarkers.

O objetivo foi avaliar os fatores associados aos biomarcadores inflamatórios em adolescentes. Trata-se de estudo transversal com 391 adolescentes entre 17 e 18 anos de escolas públicas em São Luís, Maranhão, Brasil. Realizou-se amostragem aleatória com conglomeração em três estágios: escola, turma e aluno. O consumo alimentar foi investigado por meio do Questionário de Frequência Alimentar, e os padrões alimentares foram extraídos por análise fatorial por componentes principais. Para avaliar os fatores associados aos biomarcadores inflamatórios, foi utilizada modelagem de equações estruturais. Foram construídas variáveis latentes: condição socioeconômica, que incluiu escolaridade materna, renda familiar e classe econômica; e inflamação, constituída pela interleucina-1ß, interleucina-6 e interleucina-8. Um modelo teórico foi elaborado para avaliar fatores associados aos biomarcadores inflamatórios, indicando os efeitos diretos e indiretos entre as variáveis latentes e observadas. Três padrões alimentares foram identificados (ocidental, básico brasileiro e saudável), com variância explicada de 31%, e padrão ocidental o de maior contribuição. Não foram encontradas associações dos padrões com a variável latente inflamação. O excesso de peso foi positivamente associado com a variável latente inflamação (coeficientes padronizados = 0,281; p = 0,002). A extração dos três padrões evidencia maior consumo de alimentos ricos em carboidratos e gorduras que são nutrientes diretamente relacionados ao aumento das doenças crônicas não transmissíveis. O excesso de peso foi associado com maiores níveis de biomarcadores inflamatórios.

El objetivo fue evaluar los factores asociados con biomarcadores inflamatorios en adolescentes. Se trata de un estudio transversal con 391 adolescentes entre 17 e 18 años de escuelas públicas en São Luís, Maranhão, Brasil. Se realizó una muestra aleatoria por conglomerados en tres etapas: escuela, grupo y alumno. El consumo alimentario fue investigado mediante el cuestionario de frecuencia alimentaria, y los patrones alimentarios fueron extraídos por análisis factorial por componentes principales. Para evaluar los factores asociados a los biomarcadores inflamatorios se utilizó un modelado de ecuaciones estructurales. Se construyeron variables latentes: condición socioeconómica, que incluyó escolaridad materna, renta familiar y clase económica; e inflamación, constituida por la interleucina-1ß, interleucina-6 e interleucina-8. Un modelo teórico se elaboró para evaluar factores asociados a los biomarcadores inflamatorios, indicando los efectos directos e indirectos entre las variables latentes y observadas. Se identificaron tres patrones alimentarios (occidental, básico brasileño y saludable), con variancia explicada de un 31% y patrón occidental o de mayor contribución. No se encontraron asociaciones de los patrones con la variable latente inflamación. El exceso de peso estuvo positivamente asociado con la variable latente inflamación (coeficientes estandarizados = 0,281; p = 0,002). La extracción de los tres patrones evidencia mayor consumo de alimentos ricos en carbohidratos y grasas que son nutrientes directamente relacionadas con el aumento de las enfermedades crónicas no transmisibles. El exceso de peso estuvo asociado con mayores niveles de biomarcadores inflamatorios.

MELD EXCEPTION POINTS PROVIDE AN ENOURMOUS ADVANTAGE FOR RECEIVING A LIVER TRANSPLANT IN BRAZIL.

BACKGROUND: Current policy for listing to liver transplant (LT) may place cirrhotic patients without MELD exception points (CIR) in a disadvantageous position if compared to patients enlisted with appealed MELD scores - patients with hepatocellular carcinoma (HCC) or special conditions other than hepatocellular carcinoma (SPE). Transplant rates, delisting, and waitlist mortality of CIR, HCC, and SPE candidates were compared. OBJECTIVE: The aim of this study is to counterweight the listing rate and speed of listing of HCC, SPE, and CIR patients. To the best of our knowledge, this is the first study comparing the outcomes of patients enlisted for SPE to those of HCC and CIR. In several countries worldwide, SPE patients also receive appealed MELD scores in a similar way of HCC patients. METHODS: Two cohorts of patients listed for LT in a single institution were evaluated. The first cohort (C1, n=180) included all patients enlisted on August 1st, 2008, and all additional patients listed from this date until July 31st, 2009. The second cohort (C2, n=109) included all patients present on the LT list on October 1st, 2012, and all additional patients listed from this date until May 2014. RESULTS: In both cohorts, HCC patients had a higher chance of receiving a LT than CIR patients (C1HR =2.05, 95%CI=1.54-2.72, P<0.0001; C2HR =3.17, 95%CI =1.83-5.52, P<0.0001). For C1, 1-year waiting list mortality was 21.6% (30.0% for CIR vs 9.5% for HCC vs 7.1% for SPE) (P<0.001). For C2, 1-year waiting list mortality was 13.3% (25.7% for CIR, 8.3% for HCC, and 4.0% for SPE) (P<0.001). Post-transplant survival was similar among the three groups. CONCLUSION: Compared to CIR, SPE and HCC patients had lower wait list mortality. CIR patients had the highest waitlist mortality and the lowest odd of LT. Current LT allocation system does not allow equitable organ allocation.

[Cross-cultural adaptation and evaluation of the psychometric properties of the Emotional Appetite Questionnaire among Portuguese-speaking women]. / Adaptação transcultural e avaliação de propriedades psicométricas do Emotional Appetite Questionnaire em mulheres de língua portuguesa.

Obesity and its determinants have been the topic of broad research. Emotional appetite, defined as the tendency to overeat in response to negative emotions, is among these determinants. Some instruments were created to measure this construct, the Emotional Appetite Questionnaire (EMAQ) being one of them. The objective of this study was to perform cross-cultural adaptation and evaluation of psychometric properties of EMAQ among Portuguese-speaking women. Methodological research was carried out by translation, back-translation and cross-cultural adaptation of the instrument. A study was conducted with 450 women, through cross-cultural adaptation and evaluation of the instrument's psychometric properties (validity and reliability). The internal consistency of the instrument was measured using Cronbach's Alpha and stability was checked by means of test-retest. The instrument showed good internal consistency and intraclass correlation. The interviewees did not mention changes in food consumption linked to positive emotions and situations. There was a tendency towards reduction in emotional appetite when subjected to negative emotions and situations. The Portuguese EMAQ (QUEAPEM) was considered a reliable instrument, easy to apply and administer, to assess emotional appetite in the Portuguese language.

A obesidade e seus determinantes são foco de amplas pesquisas, dentre tais determinantes, encontra-se o apetite emocional, definido como a tendência a comer em excesso em reposta às emoções negativas. Alguns instrumentos foram criados para mensurar esse constructo, dentre eles o "Emotional Appetite Questionnaire" (EMAQ). O objetivo deste estudo foi realizar adaptação transcultural e avaliação de propriedades psicométricas do EMAQ em mulheres de língua portuguesa. Realizou-se uma pesquisa com 450 mulheres, mediante a adaptação transcultural e avaliação de propriedades psicométricas do instrumento (validade e confiabilidade). A consistência interna do instrumento foi medida pelo Alfa de Cronbach e a estabilidade foi feita por meio do teste-reteste. O instrumento demonstrou boa consistência interna e correlação intraclasse. As entrevistadas não referiram alteração do consumo alimentar frente às emoções e situações positivas. Houve tendência a redução do apetite emocional quando submetidas a emoções e situações negativas. O Questionário de Apetite Emocional (QUEAPEM) apresentou-se como um instrumento confiável, de fácil aplicação e administração, para avaliação do apetite emocional na língua portuguesa.

[Socioeconomic, demographic and lifestyle factors associated with eating patterns of shift workers]. / Fatores socioeconômicos, demográficos e de estilo de vida associados a padrões alimentares de trabalhadores em turnos.

The scope of this paper was to identify the main eating patterns of shift workers and to associate them with socioeconomic, demographic and lifestyle variables. Men between 20 and 60 years of age, workers of a metallurgical company in the state of Ceará, were studied. Eating patterns were identified by factorial analysis by major components, followed by varimax orthogonal rotation. Poisson regression was used to estimate the prevalence ratios (PR) of the variables in relation to dietary patterns. Three patterns were identified: standard northeastern, popular and western. Employees of the night shift and those who smoke or have smoked showed less adherence to the common northeastern pattern, while those who consume or have consumed alcoholic beverages showed greater adherence. For the popular, the highest adherence was of employees with higher education, residents in the company's headquarter city and who only consumed alcoholic beverages in the past, while individuals with better Brazilian economic classification showed lower adherence. Older men and smokers had lower adherence to the western standard. Knowledge of these variables associated with the eating patterns identified may support the planning of healthy eating practices in the group studied.

O objetivo foi identificar os principais padrões alimentares de trabalhadores em turnos e associá-los às variáveis socioeconômicas, demográficas e de estilo de vida. Foram estudado homens entre 20 a 60 anos, trabalhadores de uma metalúrgica do Ceará. Os padrões alimentares foram identificados por análise fatorial por componentes principais, seguida de rotação ortogonal varimax. Utilizou-se Regressão de Poisson para estimar as razões de prevalências (RP) das variáveis em relação aos padrões alimentares. Três padrões foram identificados: comum nordestino, popular e ocidental. Os funcionários do turno da noite e os que fumam ou já fumaram apresentaram menor adesão ao padrão comum nordestino, enquanto aqueles que consomem ou já consumiram bebidas alcoólicas mostraram maior adesão. Para o popular, a maior adesão foi de funcionários com maior escolaridade, residentes na cidade sede da empresa e que já consumiram bebidas alcoólicas apenas no passado, enquanto indivíduos com melhor classificação econômica brasileira mostraram menor adesão. Os homens com idade mais elevada e que fumam apresentaram menor adesão ao padrão ocidental. O conhecimento dessas variáveis associadas aos padrões alimentares identificados poderá orientar o planejamento das ações de práticas alimentares saudáveis no grupo estudado.

[Eating patterns among children aged 13 to 35 months and association with maternal characteristics]. / Padrões alimentares de crianças de 13 a 35 meses de idade e associação com características maternas.

This study sought to identify eating patterns among children and to verify their association with maternal characteristics. We studied 1,185 children aged 13 to 35 months. Food consumption was investigated using the 24h dietary recall and the eating patterns were identified using principal components factor analysis, followed by orthogonal varimax rotation. We carried out a hierarchical modeling using poisson regression with robust variance estimates in order to estimate prevalence ratios. We identified four eating patterns: common Brazilian, dairy/porridge, healthy and unhealthy. The variance explained by these factors was of 34.3% and the common Brazilian pattern was the one that most contributed to proportional variance. We highlight the dairy/porridge pattern, in which breast milk had negative factorial loading, suggesting its substitution by cow and modified milk. The data reveal that the characterization of children's eating patterns diverges according to maternal characteristics, such as age, educational level and number of children. Three of the four patterns we found are represented by foods rich in starch, saturated fat and simple sugar and poor in vitamins, minerals and fibers. Multiparity, lower educational levels and maternal age under 20 years were associated with a lower consumption of foods considered to be healthy and important in child development.

O objetivo foi identificar os padrões alimentares em crianças e verificar a sua associação com características maternas. Foram estudadas 1.185 crianças de 13 a 35 meses de idade. O consumo alimentar foi investigado por meio do recordatório alimentar de 24 horas e os padrões alimentares identificados pela análise fatorial por componentes principais, seguida de rotação ortogonal varimax. Utilizou-se a modelagem hierarquizada por meio da regressão de Poisson com estimativa robusta da variância para calcular as razões de prevalências. Quatro padrões alimentares foram identificados: comum brasileiro, lácteo/mingau, saudável e não saudável. A variância explicada por esses fatores foi de 34,3%, sendo que o padrão comum brasileiro foi o que mais contribuiu com a variância proporcional. Destaca-se o padrão lácteo/mingau, em que o leite materno apresentou carga fatorial negativa, apontando para a sua substituição pelos leites de vaca e modificados. Os dados revelam que a caracterização dos padrões alimentares das crianças diverge segundo as características maternas, como a idade, escolaridade e número de filhos. Três dos quatro padrões encontrados são representados por alimentos ricos em amido, gordura saturada e açúcar simples, e pobres em vitaminas, minerais e fibras. Multiparidade, menor escolaridade materna e idade materna menor que 20 anos foram associadas ao menor consumo de alimentos considerados saudáveis e importantes para o desenvolvimento infantil.

El objetivo fue identificar los estándares alimentarios en niños y verificar su asociación con características maternas. Se estudiaron a 1.185 niños de 13 a 35 meses de edad. El consumo alimentario se investigó mediante un recordatorio alimentario de 24 horas, y los estándares alimentarios se identificaron mediante un análisis factorial por componentes principales, seguidos de una rotación ortogonal varimax. Se utilizó un modelado jerarquizado mediante la regresión de Poisson con estimativa robusta de la variancia para estimar razones de prevalencias. Se identificaron cuatro estándares alimentarios: brasileño común, lácteo/papillas, saludable y no saludable. La variancia explicada por esos factores fue 34,3%, donde el estándar común brasileño fue el que más contribuyó a la variancia proporcional. Se destaca el estándar lácteo/papilla, donde la leche materna presentó una carga factorial negativa, apuntando su sustitución por leches de vaca y modificadas. Los datos revelan que la caracterización de los estándares alimentarios de los niños diverge según las características maternas, como la edad, escolaridad y número de hijos. Tres de los cuatro estándares encontrados se representan por alimentos ricos en almidón, grasa saturada y azúcar común y pobre en vitaminas, minerales y fibras. Multiparidad, menor escolaridad materna y edad materna inferior a 20 años se asociaron a un menor consumo de alimentos considerados saludables e importantes para el desarrollo infantil.

Untangle the relationship of muscle mass and bone mineral content on handgrip strength: Results of ELSA-Brasil / Desvendando a relação entre massa muscular e conteúdo mineral ósseo na força de preensão palmar: Resultados do ELSA-Brasil

Abstract The study aims to investigate the independent association of muscle mass (MM) and bone mineral content (BMC) in the performance of the handgrip strength (HGS) test and whether there is effect modification by sex and age. In 12,491 participants from the ELSA-Brasil we estimated the associations between MM, BMC and HGS using linear regression models. All the analyses were performed for total population, also stratified for sex and age. For total population an interaction term was included between each explanatory variable of interest with sex and age to verify the presence of effect modification. We observed that the higher quintiles of MM and BMC were associated to an increasing in the mean of HGS compared to the first quintile, with greater magnitudes in men compared to women, also adults compared to elderly. When we estimated the independent effect of each exposure of interest, MM showed stronger effect in HGS in women, men and adults then BMC. In conclusion, we observed that higher amounts of MM and BMC are associated with higher HGS, regardless of sociodemographic characteristics, health conditions and lifestyle, with this effect being greater in men and adults.

Resumo O estudo tem como objetivo investigar a associação independente da massa muscular (MM) e conteúdo mineral ósseo (CMO) na realização do teste de força de preensão manual (FPM) e se há modificação do efeito por sexo e idade. Em 12.491 participantes do ELSA-Brasil estimamos as associações entre MM, CMO e FPM usando modelos de regressão linear. Todas as análises foram realizadas para a população total, também estratificada por sexo e idade. Para a população total foi incluído um termo de interação entre cada variável explicativa de interesse com sexo e idade para verificar a presença de modificação de efeito. Observamos que os maiores quintis de MM e BMC estiveram associados a um aumento na média da FPM em relação ao primeiro quintil, com maiores magnitudes em homens em relação a mulheres, também em adultos em relação a idosos. Quando estimamos o efeito independente de cada exposição de interesse, MM mostrou efeito mais forte na FPM em mulheres, homens e adultos do que BMC. Em conclusão, observamos que maiores quantidades de MM e BMC estão associadas a maior FPM, independentemente das características sociodemográficas, condições de saúde e estilo de vida, sendo esse efeito maior em homens e adultos.

Metodologias de identificação de padrões alimentares a posteriori em adultos: uma revisão integrativa / Methods of a posteriori identification of food patterns in adults: an integrativereview / Métodos de identificación posteriori de patrones alimentarios en adultos: una revisión integradora

Introdução:São poucos os estudos que identificaram os padrões alimentares em adultos sem patologias associadas utilizando metodologias de abordagem a posteriori, o que representa um grande e importante campo de pesquisa na epidemiologia nutricional a ser explorado para melhor entender o hábito alimentar das diferentes populações no mundo e suas relações com demais fatores.Objetivo:Analisar as metodologias deidentificação dos padrões alimentares em adultos saudáveis que utilizaram a abordagem a posteriori.Metodologia:Trata-se de uma revisão integrativa. Foram incluídos somente artigos originais publicados em português ou inglês que identificaram padrão alimentar de adultos saudáveis por meio de abordagem a posteriori, de 2013 a 2018. Os artigos foram selecionados por meio de busca em 4 bases de dados, sendo resgatadas 328 publicações.Resultados:Apenas 9 artigos identificaram padrões alimentares por meio de abordagem a posteriori em adultos, sendo 7 do tipo transversal e 2 longitudinal.O método de abordagem exploratória mais utilizado foi a análise fatorial, abordada em sete estudos. Um artigo utilizou o método de análise de agrupamento, enquanto outros dois utilizaram o método RRR, sendo um deles associado ao método ACP. Conclusões:As metodologias de avaliação do padrão alimentar possuem limitações, o que torna absolutamente importante que os estudos sejam bem delineados, com escolha de inquéritos alimentares mais convenientes, tamanho e seleção da amostra relevantes e testes estatísticos que orientem as decisões do pesquisador da melhor forma possível, para que os resultados retratem padrões e agrupamentos bem fidedignos (AU).

Introduction:There are few studies that have identified dietary patterns in adults without associated pathologies using a posteriori approach methodologies, which represents a large and important field of research in nutritional epidemiology to be explored to better understand the eating habits of different populations in the world and their relationships with other factors. Objective:To analyze the methodologies for identifying dietary patterns in healthy adults who used the a posteriori approach. Methodology:This is an integrative review. Only original articles published in Portuguese or English that identified the dietary pattern of healthy adults through an a posteriori approach, from 2013 to 2018, were included. Results:Only 9 articles identified eating patterns through a posteriori approach in adults, 7 of which were transverse and 2 were longitudinal.The most used exploratory approach method was factor analysis, addressed in seven studies. One article used the cluster analysis method, while two others used the RRR method, one of them associated with the ACP method. Conclusions:The dietary pattern assessment methodologies have limitations, which makes it absolutely important that the studies are well designed, with the choice of more convenient food surveys, relevant sample size and selection, and statistical tests that guide the researcher's decisions in the best possible way, so that the results depict very reliable patterns and groupings (AU).

Introducción: Existen pocos estudios que hayan identificado patrones alimentarios en adultos sin patologías asociadas utilizando metodologías de abordaje a posteriori, lo que representa un amplio e importante campo de investigación en epidemiología nutricional a explorar para comprender mejor los hábitos alimentarios de diferentes poblaciones en el mundo y sus relaciones con otros factores. Objetivo: Analizar las metodologías para la identificación de patrones dietéticos en adultos sanos que utilizaron el enfoque a posteriori.Metodología:Esta es una revisión integradora. Se incluyeron solo artículos originales publicados en portugués o inglés que identificaron el patrón dietético de adultos sanos a través de un enfoque a posteriori, de 2013 a 2018. Resultados: Solo 9 artículos identificaron patrones de alimentación mediante abordaje a posteriori en adultos, 7 de los cuales fueron transversales y 2 longitudinales.El método de abordaje exploratorio más utilizado fue el análisis factorial, abordado en siete estudios. Un artículo utilizó el método de análisis de conglomerados, mientras que otros dos utilizaron el método RRR, uno de ellos asociado al método ACP.Conclusiones: Las metodologías de evaluación del patrón dietético tienen limitaciones, por lo que es absolutamente importante que los estudios estén bien diseñados, con la elección de encuestas alimentarias más convenientes, tamaño y selección de muestras relevantes y pruebas estadísticas que guíen las decisiones del investigador de la mejor maneraposible, para que que los resultados representan patrones y agrupaciones muy fiables (AU).