Healthful grain foods consumption by São Paulo residents: a 12-year analysis and future trends.

OBJECTIVE: Understanding trends in grain consumption is essential to tackle the low consumption of healthful grain foods. This study aimed to evaluate trends and determinants of grain foods meeting the ≤10:1 carbohydrate:fibre ratio (≤10:1 ratio) in Brazil and to estimate this intake for the next years. DESIGN: Three editions of the cross-sectional, population-based study Health Survey of São Paulo (2003, 2008 and 2015). SETTING: Urban area of São Paulo, Brazil. PARTICIPANTS: The sample included 5801 participants aged 12 years or more. RESULTS: A growing trend in the intake of these foods (0·9 percentage of energy (%E) in 2003 to 1·5 %E in 2015) was observed. Also, the proportion of the population consuming at least one grain food meeting the ≤10:1 ratio increased from 8·7 % in 2003 to 15·8 % in 2015, and 20·3 % of the population would be consuming some kind of healthful grain food by 2030. Sociodemographic factors associated with the consumption of grain foods meeting the ≤10:1 ratio changed according to study edition, but overall, older individuals (+79 %), females (+28 %), those with higher education (+138 %) and higher family income (+135 %) were more likely to consume grain foods meeting the ratio, whereas participants who self-reported black, brown or indigenous ethnicity were less likely to consume these foods (-30 %). CONCLUSIONS: There was a growing trend to consume grain foods meeting the ≤10:1 ratio from 2003 to 2015, but this consumption continues to be far from recommended levels. Intersectoral changes are urgently needed in order to increase the intake of healthful grain foods.

Nutritional breakfast quality and cardiometabolic risk factors: Health Survey of São Paulo, a population-based study.

OBJECTIVE: To evaluate the association between nutritional quality of breakfast and cardiometabolic risk factors. DESIGN: Cross-sectional study, 2015 Health Survey of São Paulo (2015 ISA-Capital) with Focus on Nutrition Study (2015 ISA-Nutrition). SETTINGS: Population-based study, with a representative sample of adults and elderlies living in São Paulo, Brazil. PARTICIPANTS: The sample included 606 adults (aged 20-59 years) and 537 elderlies (aged ≥60 years) from the 2015 Health Survey of São Paulo. Dietary intake was assessed by at least one 24-h recall. Breakfast quality was evaluated using the proposed Brazilian Breakfast Quality Index (BQI), ranging scores from 0 to 10. BQI associations with sociodemographic, lifestyle, dietetic and cardiometabolic variables were estimated using survey-weighted multiple logistic regression models. RESULTS: Being ≥60 years of age, self-identifying as White or Asian, having a per capita family income with ≥1 minimum wage, being sufficiently active at leisure time and non-smoker were associated with better scores of BQI. A higher BQI score was inversely associated with elevated blood pressure (OR 0·81, 95 % CI 0·70, 0·94), fasting glucose (OR 0·85, 95 % CI 0·73, 0·98), HOMA-IR (OR 0·86, 95 % CI 0·74, 0·98), total cholesterol (OR 0·87, 95 % CI 0·76, 0·99), LDL-C (OR 0·85, 95 % CI 0·74, 0·97), metabolic syndrome (OR 0·82, 95 % CI 0·72, 0·93) and being overweight (OR 0·87, 95 % CI 0·76, 0·99). CONCLUSIONS: Breakfast quality of Brazilian adults needs improvement with disparities across some sociodemographic factors. BQI was associated with lower odds of cardiometabolic risk factors, suggesting a beneficial effect in this population and emphasising the role of breakfast in reducing the risk of CVD.

Eating behaviours and dietary intake associations with self-reported sleep duration of free-living Brazilian adults.

Sleep duration in modern societies has been decreasing over the past decades and many environmental and behaviour factors contribute with. Evidence have shown that individuals with short sleep duration have worse eating behaviours and dietary intakes than those with adequate sleep. This study aimed to describe eating behaviours and dietary intakes of Brazilian adults and investigate their associations with self-reported sleep duration encompassing aspects of chrono-nutrition. Demographic, socioeconomic, anthropometric, lifestyle, sleep duration and dietary data were obtained from an interviewer-administered structured questionnaire of the cross-sectional population-based study, 2015 ISA-Capital, (n = 1081 adults, ≥20y). The independent associations between sleep duration (categories: ≤6 h, 7-8 h, and ≥9 h) and dietary variables were assessed after adjustment for covariates. Employment status, physical activity, number of chronic diseases and day of recalled intake were significantly associated with sleep duration categories (p < 0.05). Short duration sleepers (≤6 h) showed the largest probabilities of eating breakfast and snacks. Snacks contributed to 23% of total energy intake and provided the largest amounts of total and added sugar than other eating occasions among short duration sleepers. Long duration sleepers (≥9 h) exhibited lower probability of consumption of the three main meals, lower energy and nutrient intakes in the morning, lower eating frequency and shorter eating period. Irrespective of sleep duration, the largest contribution to total energy intake was in the afternoon (43-46%), followed by the evening (30-32%) and morning (22-25%) periods. In conclusion, sleep duration was associated with different dietary intakes and eating behaviours among Brazilian adults. The largest energy intakes in the afternoon and evening periods signalize the relevance to consider the timing of food consumption aside sleep duration as a target to nutritional counseling for prevention of circadian misalignment and related metabolic disturbances.

Proposal for a breakfast quality index for brazilian population: Rationale and application in the Brazilian National Dietary Survey.

Breakfast has been related to positive nutrition and health outcomes, but criteria for an optimal composition of this meal are not well established. The aim of this study was to propose a breakfast quality index (BQI) for the Brazilian population, and to describe the relationship between breakfast quality, socio-demographic factors, dietary intake at breakfast and for the total day. BQI was constructed based on individual dietary data of 22,279 breakfast consumers, aged 20+ years from the Brazilian National Dietary Survey, a population-based cross-sectional study. The BQI was comprised of food components (cereals, fruit/vegetables, dairy products), and nutrient criteria (energy, fiber, free sugar, saturated fat, calcium and sodium). Mean, percentage and 95% CIs were estimated for variables according to BQI categories. The mean BQI was 4.2, with 71% of individuals falling into medium BQI category and 6% in high category. Individuals in urban areas, in higher categories of income and education and women had higher BQI means. Consumers with high BQI had higher intake of fruits/vegetables and higher breakfast and total daily intake of energy, carbohydrates, fiber, total sugar, sodium, potassium, phosphorus, thiamin, riboflavin, niacin, folate and vitamins B6, A, C, and D, and lower trans fatty acids compared to those in low and medium BQI groups. Promoting a high-quality breakfast may contribute to a better nutrient intake and achievement of daily requirements.

Examining associations between dietary patterns and metabolic CVD risk factors: a novel use of structural equation modelling.

The association between dietary patterns and metabolic cardiovascular risk factors has long been addressed but there is a lack of evidence towards the effects of the overall diet on the complex net of biological inter-relationships between risk factors. This study aimed to derive dietary patterns and examine their associations with metabolic cardiovascular risk factors following a theoretic model for the relationship between them. Participants included 417 adults of both sexes, enrolled to the cross-sectional population-based study performed in Brazil. Body weight, waist circumference, high-sensitivity C-reactive protein, blood pressure, total cholesterol:HDL-cholesterol ratio, TAG:HDL-cholesterol ratio, fasting plasma glucose and serum leptin were evaluated. Food consumption was assessed by two non-consecutive 24-h dietary recalls adjusted for the within-person variation of intake. A total of three dietary patterns were derived by exploratory structural equation modelling: 'Traditional', 'Prudent' and 'Modern'. The 'Traditional' pattern had a negative and direct effect on obesity indicators (serum LEP, body weight and waist circumference) and negative indirect effects on total cholesterol:HDL-cholesterol ratio, TAG:HDL-cholesterol ratio and fasting plasma glucose. The 'Prudent' pattern had a negative and direct effect on systolic blood pressure. No association was observed for the 'Modern' pattern and metabolic risk factors. In conclusion, the 'Traditional' and 'Prudent' dietary patterns were negatively associated with metabolic cardiovascular risk factors among Brazilian adults. Their apparent protective effects against obesity and high blood pressure may be important non-pharmacological strategies for the prevention and control of obesity-related metabolic disorders and CVD.

Dietary glycemic index, glycemic load, and nutritional correlates in free-living elderly Brazilians: a population-based survey.

OBJECTIVES: To investigate the association of dietary glycemic index (GI) and glycemic load (GL) with nutrient intake and to describe the foods that contribute to dietary GI and GL in elderly subjects. METHODS: This is a cross-sectional population-based survey performed in 2003, which enrolled 804 free-living Brazilian subjects aged 60 years or older. Dietary intake was measured by a single 24-hour dietary recall applied at the subjects' homes. The usual dietary GI and GL as well as the usual energy and nutrient intakes were estimated using external variance components. Dietary GI and GL were categorized in tertiles and the usual mean of nutrient intake was described accordingly. Linear association between dietary GI and GL and nutrient intake was investigated before and after energy adjustment. Foods that contributed with at least 1% of dietary GI and GL were described. RESULTS: Dietary GI was positively associated with starch, total fat, monounsaturated fatty acids (MUFA), and polyunsaturated fatty acids (PUFA) and inversely associated with total sugar, protein, fiber, and calcium. Dietary GL was strongly and positively associated with total and available carbohydrates, starch, and total sugar and inversely associated with protein, total fat, MUFA, PUFA, and cholesterol. White breads and white rice were the major contributors to dietary GI and GL in the studied population. CONCLUSION: Dietary GI and GL are important indicators of overall quality and quantity of carbohydrates from elderly Brazilians diet and are also associated with other macronutrients such as protein, fat, and fiber. The overall dietary GI and GL reflects other dietary aspects, such as composition of the diet and combination of foods consumed.

Measuring Cannabis Reinforcement among Young Adults: A Mixed Methods Examination.

Introduction: Increasing reinforcement received from cannabis-free activities, relative to reinforcement from cannabis-related activities, is one way to reduce harmful cannabis use. Thus, accurate measurement of cannabis reinforcement is important. Using convergent mixed methods, we developed the Adolescent Reinforcement Survey Schedule-Cannabis Use Version (ARSS-CUV). ARSS-CUV, adapted from the alcohol use version, measures cannabis reinforcement by asking individuals how frequently they engaged in, and how much they enjoyed, different activities when using and not using cannabis. Method: Young adults (N = 65; M age = 20.4 years [SD = 1.8]) completed measures of cannabis use, the ARSS-CUV, and provided feedback on included activities, via focus groups. Following Standards for Educational and Psychological Testing framework, this study examined evidence of measurement validity based on item content. Results: Quantitative findings revealed that peer interactions were the most reinforcing activities, whereas activities related to family were least reinforcing. Qualitative findings indicated some confusion with question wording. Participants also indicated the importance of environmental context when using cannabis and noted who they use cannabis with may be more important than the activity they are doing. Changes were made to survey flow and response choices after participant feedback. Conclusions: ARSS-CUV includes revisions in activities solicited and response format. The revised ARSS-CUV provides opportunities to advance measurement of an important construct (i.e., reinforcement) in the study of cannabis use. Psychometric properties of the ARSS-CUV across different populations and contexts of use (e.g., polysubstance use) should be examined.

Are plasma homocysteine concentrations in Brazilian adolescents influenced by the intake of the main food sources of natural folate?

BACKGROUND: Folate, a B vitamin, has been associated with a reduced concentration of plasma homocysteine (phcy), a marker of cardiovascular disease. The contribution of fruits and vegetables (FV) and other natural folate-rich foods to folate intake and folate status in Brazilian adolescents has hardly been determined. OBJECTIVES: To investigate the intake of FV and beans and its association with the concentration of phcy in adolescents. METHODS: This was a cross-sectional population-based study with a complex sample survey, with 198 adolescents who completed two 24-hour dietary recalls, a food frequency questionnaire, and a fasting blood draw. Usual dietary intake estimates were derived applying the Multiple Source Method. Three different generalized linear models with a gamma distribution were developed for each sex to evaluate the relationship between phcy and tertiles of FV intake as well as to evaluate the relationship between phcy and tertiles of FV and bean intake. RESULTS: No association was found between phcy concentration and FV intake or between phcy and FV and beans. Serum folate and female sex were inversely related to phcy. CONCLUSION: Phcy was not related to FV or FV and beans; this may be attributable to a low intake of these food groups.

Single- and Cross-Commodity Delay Discounting of Cannabis.

OBJECTIVE: Despite extensive literature that has identified high rates of delay discounting as a behavioral correlate of substance misuse, associations of cannabis use measures and delay discounting are less consistent. Furthermore, there is very limited research examining cannabis use using cross-commodity delay discounting tasks, where the immediate and delayed outcomes are different commodities. METHOD: Using conventional single-commodity delay discounting tasks for money and cannabis outcomes as well as cross-commodity delay discounting tasks (i.e., cannabis now vs. money later, money now vs. cannabis later), we examined associations of delay discounting rates with cannabis use frequency, cannabis use disorder symptom count, cannabis-related problems, and craving among young adult cannabis users (N = 115; M age = 20.7, SD = 2.6; M cannabis use days per month = 15.5, SD = 10.0). RESULTS: Although associations between cannabis use measures and rates of delay discounting in single-commodity conditions were modest, significant associations were observed with delay discounting rates in cross-commodity conditions. Of note, regression and model comparison analyses generally showed positive associations of cannabis measures with immediate cannabis versus delayed money delay discounting rates, and negative associations of cannabis measures with immediate money versus delayed cannabis delay discounting rates. CONCLUSIONS: The results suggest that problematic cannabis use may not be strictly associated with the inability to wait for delayed outcomes, as suggested by previous research implementing single-commodity delay discounting tasks, but also with a willingness to wait for delayed access to cannabis.

Comparison and convergent validity of five Mediterranean dietary indexes applied to Brazilian adults and older adults: data from a population-based study (2015 ISA-Nutrition).

Different dietary indexes are proposed to investigate adherence to the Mediterranean diet (MD). However, they are based on different methodologies, and limited research has compared them to each other, particularly in non-Mediterranean populations. We aimed to compare five indexes intended to measure adherence to the MD. The sample was composed of adults and older adults (n 1187) from 2015 ISA-Nutrition, a cross-sectional population-based study in São Paulo, SP, Brazil. Dietary data obtained through two 24-h dietary recalls (24HDR) from which the Mediterranean diet scale (MDS), Mediterranean diet Score (MedDietscore), Mediterranean dietary pattern (MDP), Mediterranean Adequacy Index (MAI) and Mediterranean-Style Dietary Pattern Score (MSDPS) were calculated. The correlations and agreements between them were analysed by Spearman's correlation and linearly weighted Cohen's Kappa coefficients, respectively. Confirmatory factor analyses (CFAs) were applied to investigate their convergent validity. The highest correlations were found between MDP and MAI (r = 0⋅76; 95% CI 0⋅74-0⋅79) and between MDP and MDS (r = 0⋅72; 95% CI 0⋅69-0⋅75). The greatest agreements observed were moderate, between MDP v. MAI (κ = 0⋅57, P < 0⋅001) and MDP v. MDS (κ = 0⋅48, P < 0⋅001). The goodness-of-fit of CFA for MedDietscore (RMSEA = 0⋅033, 90% CI 0⋅02-0⋅042; SRMR = 0⋅042) and MSDPS (RMSEA = 0⋅028, 90% CI 0⋅019-0⋅037; SRMR = 0⋅031) had acceptable values for absolute fit indices. Vegetables, olive oil, MUFA:SFA ratio and cereals with legumes were more relevant to characterise the MD (factor loadings ≥0⋅50). The MDS, MAI and MDP classified the population similarly, but the MedDietscore showed better performances in evaluating adherence to the MD. These results provided guidance for the most appropriate Mediterranean dietary index to be applied in non-Mediterranean populations.

Food Insecurity Reduces the Chance of Following a Nutrient-Dense Dietary Pattern by Brazilian Adults: Insights from a Nationwide Cross-Sectional Survey.

Dietary patterns derived by data-driven techniques are still scarce in the food security context and may be a useful tool to inform policymakers to promote adequate and healthy diets for vulnerable populations. We investigated the association between food security status and dietary patterns among 28,127 Brazilian adults using data from the 2017-2018 Household Budget Survey. Food security status was measured by the Brazilian Food Insecurity Scale. Food items reported in two 24 h dietary recalls were combined into food groups. Dietary patterns were derived from exploratory factor analysis, and participants were grouped according to their factor scores by K-means cluster analysis. Multiple logistic regression models were fitted to investigate the association between food security status and clusters of adherence to dietary patterns. Four dietary patterns were derived: 'Brazilian breakfast style' (cluster 3), 'Brazilian Traditional staple foods' (cluster 2), 'Beverages, ready-to-eat and convenience foods' (cluster 4), and 'Fruits, vegetables, and whole grains' (cluster 1). After adjustments, food insecurity was inversely associated with adherence to the 'Fruits vegetables, and whole grains' pattern (OR = 0.75, 95% CI: 0.63-0.89). Findings suggest food insecurity negatively impact the adoption of a nutrient-dense dietary pattern and highlight the critical role of policy actions in a scenario of increasing food insecurity.

Prevalence of Excess Sodium Intake and Their Corresponding Food Sources in Adults from the 2017-2018 Brazilian National Dietary Survey.

Excessive sodium intake has been related to high blood pressure, a central risk factor for cardiovascular disease. In the present work, updated estimates of sodium intake, the main food sources, and the prevalence of excessive intakes in a nationwide multi-ethnic sample of Brazilian adults (2017-2018 Brazilian National Dietary Survey) were presented. Based on two 24-h recalls adjusted for the within-person variation, the overall median of sodium intake was 2432 mg. The prevalence of adults exceeding the recommended limits (tolerable upper limit, UL, and the chronic disease risk reduction cut-off point, CDRR) was 61% and 56%, respectively. The median sodium intake and proportion of individuals above the limits varied according to the subgroups evaluated. Males and adults (20-29 years) presented the highest excessive sodium intakes, and consequently, lowest adherence rates to UL and CDRR recommendations. The top food sources of sodium were white bread and toast (12.3%), beans (11.6%), white rice (10.6%), beef (7.7%), and poultry meat (5.5%). Given the health benefits of dietary sodium reduction, it would be advisable to enhance the current national initiatives of awareness and educational campaigns' combined efforts to reduce sodium in processed foods to effectively decrease this micronutrient intake across the Brazilian population.

A chrononutrition perspective of diet quality and eating behaviors of Brazilian adolescents in associated with sleep duration.

It is well recognized that sleep and food intake exhibit 24-h patterns and disturbances of these patterns can lead to health problems. Cross-sectional and prospective studies suggest that diet quality and eating behaviors are negatively affected by short sleep duration. Adolescence is a particularly vulnerable period for the emergence of inadequate sleep and diet patterns. The aim of the study was to investigate associations, from a chrononutrition perspective, of diet quality, nutrients intake, and eating behaviors (eating frequency, eating period, and time-interval between eating occasions) in relation to sleep duration among a multi-ethnic cohort of Brazilian adolescents. Data were collected by the 2015 ISA-Capital survey, a population-based cross-sectional study comprising 419 adolescents of both sexes (12-19 years old) of São Paulo, Brazil. Demographic, socioeconomic, anthropometric, and lifestyle, including sleep duration, data were obtained from an interviewer-administered structured questionnaire. Dietary data were obtained by 24-h dietary recall (24-HDR), and diet quality was assessed by the Brazilian Healthy Eating Index - Revised (BHEI-R), validated for the Brazilian population. The independent associations between sleep duration categories (i.e., <8 h as short sleep and 8-10 h as adequate sleep), and dietary variables were assessed after adjustments for covariates. Multiple linear, logistic, and Poison regression models were used, depending on the variable. Diet quality, nutrients intake, and eating behaviors differed according to adolescents' sleep duration. Approximately 36% of adolescents were sleep deprived. They presented poorer diet quality (53 points, p = .034) and eating behaviors characterized by lower probability of having lunch (88%, p < .001) and dinner (71%, p < .001) and higher probabilities of eating breakfast (87%, p < .001) and morning snack (26%, p = .001). These adolescents compared to those with adequate sleep duration also had, from snacks and in the 24-h cycle, higher contribution of available carbohydrates (8%, p < .001; 50%, p = .024) and total sugar (6%, p < .001; 21%, p < .001) and added sugar (3%, p < .001; 15%, p < .001). The chrononutrition characteristics of sleep-deprived adolescents were marked by longer eating periods (12 h, p < .001) and time-interval between eating occasions (3 h, p < .001) than adolescents with adequate sleep duration. These differences point to the relevance of the interrelation between sleep and diet, i.e., disruption of circadian cycles and consequent metabolic health problems, to inform public health policies and clinical interventions.

Psychosocial Aspects of Gestational Grief in Women Undergoing Infertility Treatment: A Systematic Review of Qualitative and Quantitative Evidence.

Women undergoing assisted reproduction treatment without being able to become pregnant, and experiencing pregnancy loss after assisted reproduction, are triggering factors for prolonged grief and mourning. This review aims to investigate the psychosocial aspects of gestational grief among women who have undergone infertility treatment. We searched the databases of MEDLINE/PubMed, EMBASE, CINAHL, Scopus, ScienceDirect, and Lilacs for works published up to 5 March 2021. The outcomes analyzed were negative and positive psychosocial responses to gestational grief among women suffering from infertility and undergoing assisted human reproduction treatment. Eleven studies were included, which yielded 316 women experiencing infertility who were undergoing treatment. The most frequently reported negative psychosocial manifestations of grief response were depression (6/11, 54.5%), despair or loss of hope/guilt/anger (5/11, 45.5%), anxiety (4/11, 36.4%), frustration (3/11, 27.3%), and anguish/shock/suicidal thoughts/isolation (2/11, 18.2%). Positive psychosocial manifestations included the hope of becoming pregnant (4/6, 66.6%) and acceptance of infertility after attempting infertility treatment (2/6, 33.3%). We identified several negative and positive psychosocial responses to gestational grief in women experiencing infertility. Psychological support before, during, and after assisted human reproduction treatment is crucial for the management of psychosocial aspects that characterize the grief process of women experiencing infertility who become pregnant and who lose their pregnancy. Our results may help raise awareness of the area of grief among infertile women and promote policy development for the mental health of bereaved women.

Comparing Methods from the National Cancer Institute vs Multiple Source Method for Estimating Usual Intake of Nutrients in the Hispanic Community Health Study/Study of Latino Youth.

BACKGROUND: The Multiple Source Method (MSM) and the National Cancer Institute (NCI) method estimate usual dietary intake from short-term dietary assessment instruments, such as 24-hour recalls. Their performance varies according to sample size and nutrients distribution. A comparison of these methods among a multiethnic youth population, for which nutrient composition and dietary variability may differ from adults, is a gap in the literature. OBJECTIVE: To compare the performance of the NCI method relative to MSM in estimating usual dietary intakes in Hispanic/Latino adolescents. DESIGN: Data derived from the cross-sectional population-based Hispanic Community Health Study/Study of Latino Youth, an ancillary study of offspring of participants in the adult Hispanic Community Health Study/Study of Latino Youth cohort. Dietary data were obtained by two 24-hour recalls. PARTICIPANTS/SETTING: One thousand four hundred fifty-three Hispanic/Latino youth (aged 8 to 16 years) living in four urban US communities (Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA) during 2012 through 2014. MAIN OUTCOME MEASURES: The NCI method and the MSM were applied to estimate usual intake of total energy, macronutrients, minerals and vitamins, added sugar, and caffeine. STATISTICAL ANALYSES: Mean, standard deviation, minimum and maximum values, coefficient of variation, variance ratio, and differences between NCI and MSM methods and the 2-day mean were estimated in several percentiles of the distribution, as well as concordance correlation coefficients and Bland-Altman plot analysis. RESULTS: The distributions of all nutrients studied were very similar between NCI and MSM. The correlation between NCI and MSM was >0.80 for all nutrients (P<0.001), except dietary cholesterol, vitamin C, and n-3 fatty acids. In individual estimations, NCI method predicted higher estimates and lower variance than the MSM. The lowest level of agreement was observed in the values at the tails of the distribution, and for nutrients with high variance ratio. CONCLUSIONS: Overall, both MSM and NCI method provided acceptable estimates of the usual intake distribution using 24-hour recall, and they better represented the usual intake compared with 2-day mean, correcting for intraindividual variability.

Principal Component Analysis and Factor Analysis: differences and similarities in Nutritional Epidemiology application.

INTRODUCTION: Statistical methods such as Principal Component Analysis (PCA) and Factor Analysis (FA) are increasingly popular in Nutritional Epidemiology studies. However, misunderstandings regarding the choice and application of these methods have been observed. OBJECTIVES: This study aims to compare and present the main differences and similarities between FA and PCA, focusing on their applicability to nutritional studies. METHODS: PCA and FA were applied on a matrix of 34 variables expressing the mean food intake of 1,102 individuals from a population-based study. RESULTS: Two factors were extracted and, together, they explained 57.66% of the common variance of food group variables, while five components were extracted, explaining 26.25% of the total variance of food group variables. Among the main differences of these two methods are: normality assumption, matrices of variance-covariance/correlation and its explained variance, factorial scores, and associated error. The similarities are: both analyses are used for data reduction, the sample size usually needs to be big, correlated data, and they are based on matrices of variance-covariance. CONCLUSION: PCA and FA should not be treated as equal statistical methods, given that the theoretical rationale and assumptions for using these methods as well as the interpretation of results are different.

Prevalence of consumption and nutritional content of breakfast meal among adolescents from the Brazilian National Dietary Survey.

OBJECTIVE: To estimate the prevalence of breakfast consumption and describe the foods and nutrients consumed at this meal and throughout the day by Brazilian adolescents. METHOD: A total of 7276 adolescents aged 10-19 years were evaluated in the Brazilian National Dietary Survey 2008-9, a population-based cross-sectional study. Individuals' information was collected at home. Dietary data were obtained by two food records. Breakfast was defined as the first eating occasion of the day that occurred between 6 and 9:59am. Differences between breakfast consumers, occasional consumers, and skippers were tested through Pearson's chi-squared test or F-test of regression analysis. RESULTS: Breakfast was consumed by 93% of adolescents and it was associated with age, income, geographic region and household area. The most frequently consumed foods at breakfast were white bread, coffee, butter/margarine, refined cookies and crackers, and whole milk. The mean daily intakes of total energy, sugar, and calcium were higher among occasional consumers and skippers. Breakfast consumers had higher intake of vitamins B12, C, and D. Breakfast contributed more to total intake of calcium, phosphorus, thiamin, riboflavin, and vitamins A, B6, and D (17-32%), trans fat and sodium (about 30%) and less to folate, vitamin C, iron, zinc, and fiber (8-12%) and energy intake (16%). CONCLUSIONS: Although the prevalence of breakfast consumption among Brazilian adolescents was high, the overall nutritional quality of this meal is suboptimal, highlighting the need to support adolescents and their families to make more nutrient-dense food choices.

Nutritional quality of dietary patterns of children: are there differences inside and outside school?

OBJECTIVES: To describe the dietary patterns of children inside and outside school and investigate their associations with sociodemographic factors and nutritional status. METHODS: This was a multicenter cross-sectional study in which children of both sexes, aged 1-6 years, attending private and public daycare centers and preschools in Brazil, were evaluated (n=2979). Demographic, socioeconomic and dietary data (weighed food records and estimated food records) were collected. Dietary patterns were derived by factor analysis from 36 food groups. RESULTS: Four dietary patterns were identified inside school, and three outside. Inside school, the "traditional" pattern was associated to low income and presented high nutritional quality. The "dual" pattern was associated with low income and with high intake of added sugar and glycemic load. The "snack" pattern was associated with children enrolled at private schools and with high intake of added sugar and glycemic load. The "bread and butter" pattern was associated with high intake of added sugar and trans fat. Outside school, the "traditional" pattern was associated with high intake of saturated fat, trans fats, sodium, and total fiber. The "bread and butter" pattern was associated with high intake of trans fats and glycemic load, whereas the "snack" pattern was associated with overweight, private schools, high income, and high intake of trans fats, sodium, and total fiber. CONCLUSION: There are differences in the nutritional quality of dietary patterns inside and outside school, and heterogeneity in adherence to these patterns were observed across regions and socioeconomic classes.