Pragmatic Carbohydrate Quality Metrics in Relation to Glycemic Index, Glycemic Load, and Front-of-Pack Warning Labels in Grain Foods.

The challenges in the characterization of the nutritional quality of grain foods comprise obstacles to public health actions toward promotion of healthier grain-based foods. The present study investigated how carbohydrate metrics related to glycemic index (GI), glycemic load (GL), and warning labels of grain foods consumed by individuals living in São Paulo, Brazil. Information on intake of grain foods at individual level was obtained using 24 h recalls within a cross-sectional population-based survey conducted in 2015. There were 244 unique grain products reported by individuals in the survey, assessed through four metrics of carbohydrate quality, considering contents per 10 g of total carbohydrate: (1) ≥1 g fiber, (2) ≥1 g fiber and <1 g free sugars, (3) ≥1 g fiber and <2 g free sugars, and (4) ≥1 g fiber, and <2 g free sugars per 1 g of fiber. Outcomes included GI, GL, and inclusion of warning labels proposed by the Brazilian National Health Surveillance Agency (ANVISA), the Chilean Ministry of Health (1st and 3rd stages), and the Pan American Health Organization (PAHO). Metrics identified products with lower mean GI (-12.8 to -9.0 [p-values < 0.001]), and GL (-12.5 to -10.3 [p-values < 0.001]). Warning systems showed a certain degree of discrimination between products according to the metrics (p-value < 0.01 each); however, >50% of products with good nutritional quality according to the carbohydrate metrics still would receive warnings. Findings suggest that carbohydrate metrics identified products with lower GI and GL, and current warning labels may not adequately capture overall nutritional quality of grain foods.

Body composition affects the accuracy of predictive equations to estimate resting energy expenditure in older adults: An exploratory study.

BACKGROUND: To investigate the accuracy of ten different predictive equations to estimate resting energy expenditure (REE) in a sample of Brazilian older adults and develop a predictive equation for estimating REE based on body composition data. METHODS: A cross-sectional study with thirty-eight Brazilian older adults aged 60-84 years, who had their REE measured by indirect calorimetry (IC) and BC assessed by dual-energy x-ray absorptiometry (DXA). REE was compared to the estimation of ten predictive equations, and the differences between BC and anthropometric-based equations were investigated using Bland-Altman plots and Lin's concordance correlation. Accuracy was evaluated considering ±10% of the ratio between estimated and measured REE. RESULTS: The sample was composed of 57.9% men, with a mean age of 68.1 (5.8) years, and a mean REE by IC of 1528 (451) kcal. The highest accuracy was 47.4% obtained by Luhrmann and Fredrix equations, and the lowest accuracy was 13.2% reached by Weigle equation. In general, the proportion of underestimation was higher than overestimation. All anthropometric-based equations presented a good agreement with REE from IC. For those equations derived from BC, however, three of them reached only a moderate agreement. In terms of accuracy, all equations presented lower than 50% of accurate prediction of REE. CONCLUSIONS: In this sample of older adults, previous predictive equations to estimate REE did not show good accuracy, and those based on BC presented even worse results, showing that changes in BC related to aging could impact the accuracy of these equations.

Misreporting of dietary energy intake obtained by 24 h recalls in older adults: a comparison of five previous methods using doubly labeled water.

BACKGROUND/OBJECTIVE: To test five different methods to detect misreporting in comparison to doubly labeled water in a sample of older adults. SUBJECTS/METHODS: A cross-sectional study with thirty-eight Brazilian community-dwelling older adults aged 60-84 years, who had their total energy expenditure measured by doubly labeled water (TEEDLW). Dietary data were collected by two 24 h recalls. Misreporting was compared with estimates obtained by the methods proposed by: Goldberg et al. [1, 2], Black [3], McCrory et al. [4], Huang et al [5], and Rennie et al [6]. Bland-Altman plots with 95% limits of agreement were constructed to assess the agreement between rEI and TEEDLW. Weighted kappa coefficients, sensitivity and specificity analyses, and area under the receiving operator characteristic curve (AUC) were used to test the performance of each method. RESULTS: The prevalence of under-reporters (UR) and over-reporters (OR) obtained by the reference (DLW) were 57.9% (n = 22) and 5.3% (n = 2), respectively. Black [3] presented the worst agreement and McCrory et al. [4] the best one to accurately classify individuals in the three categories of energy reporting. McCrory et al. [4] had the best performance in the sensitivity and specificity analyses detecting UR and plausible reporters. CONCLUSIONS: There was a high prevalence of misreporting, especially underreporting, in this sample of community-dwelling Brazilian older adults. The study showed a wide variation in the accuracy of predictive methods to handle misreporting, with none of the equations showing outstanding agreement with the reference. When DLW is not available, a valid method should be chosen to address energy intake reporting.

Estimating total daily energy requirements in community-dwelling older adults: validity of previous predictive equations and modeling of a new approach.

BACKGROUND/OBJECTIVES: Accurate estimation of energy requirements is crucial for health maintenance and prevention of malnutrition in older adults. This study aimed to assess the accuracy of predictive equations for estimating energy requirements in older adults and to test the validity of new predictive equations for this age group. SUBJECTS/METHODS: This is a cross-sectional study including 38 Brazilian community-dwelling older adults aged 60-84 years, who had their total energy expenditure measured by doubly labeled water (TEEDLW). The energy expenditure was compared to the Institute of Medicine (Dietary Reference Intake (DRI)) and Vinken et al. previous predictive equations and three predictive models developed in a modeling sample. The agreement was assessed using intra-class correlation coefficient, Bland-Altman plots, and Lin's concordance correlation. Accuracy was evaluated considering ±10% of the ratio between estimated and measured energy expenditure. RESULTS: The mean (standard deviation) TEEDLW was 2656.7 (405.6) kcal/day for men and 2168.9 (376.9) for women. Vinken et al. and both DRI equations presented moderate to good degree of agreement, while the developed models vary from fair to very good agreement in comparison to DLW. The accuracy rate was the same for both DRI equations and Vinken et al. equation (60.53%). The new equations developed in this study had accuracy in predicting TEE for Brazilian older adults varying from 43.11% to 73.68%. CONCLUSIONS: The results corroborate the use of previous predictive equations for estimating energy requirements in Brazilian older adults. Further studies have the potential to explore the use of the developed models to assess energy needs in this population.

Increased sugar-sweetened beverage consumption is associated with poorer dietary quality: A cross-sectional population-based study / Aumento no consumo de bebidas açucaradas é associado à pior qualidade da dieta: um estudo transversal de base populacional

ABSTRACT Objective To evaluate the association between sugar-sweetened beverages consumption and dietary quality in adolescents, adults, and older adults living in São Paulo, Brazil. Methods Data were drawn from a cross-sectional population-based study conducted in 2008 in a representative urban city sample involving 1494 consumers of sugar-sweetened beverages. Dietary intake was evaluated through two 24-Hour Dietary Recalls, and the usual sugar-sweetened beverages consumption was estimated using the Multiple Source Method. Dietary quality was evaluated using the Brazilian Healthy Eating Index - Revised. The association between total score of the revised index and components with sugar-sweetened beverages consumption tertiles was assessed using multiple linear regression models for each age group, considering the sample design. Results Regardless of age group, the increase of sugar-sweetened beverages consumption was associated with a decrease in the total Healthy Eating Index - Revised score and in the components "total fruit"; "whole fruit"; "meat, eggs and legumes", and the "solid fat, alcohol and added sugar". Conclusion The results of our study suggest that higher sugar-sweetened beverages consumption was associated with poorer dietary quality. Planning public health policies aimed at decreasing sugar-sweetened beverages consumption is essential to increase dietary quality and reduce the incidence of noncommunicable diseases.

RESUMO Objetivo Avaliar a associação entre a qualidade da dieta e o consumo de bebidas açucaradas em adolescentes, adultos e idosos residentes da cidade de São Paulo, Brasil. Métodos Foram utilizados dados provenientes do Inquérito de Saúde de São Paulo de 2008, estudo transversal de base populacional, com amostra composta por 1494 consumidores de bebidas açucaradas. O consumo alimentar foi avaliado por meio de dois Recordatórios Alimentares de 24 Horas e o consumo habitual de bebidas açucaradas foi estimado por meio do Multiple Source Method. A qualidade da dieta foi determinada usando o Índice de Qualidade da Dieta Revisado. A associação entre o índice revisado e a ingestão de bebidas açucaradas foi avaliada por meio de modelos de regressão linear para cada grupo etário, considerando o desenho amostral. Resultados Independente da faixa etária, o aumento do consumo de bebidas açucaradas foi associado à diminuição da pontuação total do Índice de Qualidade da Dieta-Revisado e dos componentes "frutas integrais", "frutas totais", "carne, ovos e leguminosas" e "gordura sólida, álcool e açúcar de adição". Conclusão A maior ingestão de bebidas açucaradas está associada à pior qualidade da dieta. O planejamento de políticas públicas visando à diminuição do consumo de bebidas açucaradas é essencial para aumentar a qualidade da dieta e reduzir a incidência de doenças crônicas não transmissíveis.

Implausibilidade no relato da ingestão energética de idosos: comparação de dados de consumo e gasto energético por meio de marcador biológico / Implausibility of the reported energy intake in older adults: comparison of energy intake and energy expenditure using a biomarker

Introdução: Estudos que avaliam o consumo alimentar da população por meio de métodos baseados no relato do indivíduo são recorrentes. Todavia, a implausibilidade no relato da ingestão energética pode comprometer a validade das associações entre dieta e saúde, prejudicando a interpretação dos resultados. Nesse contexto, a água duplamente marcada (ADM) destaca-se como marcador biológico de recuperação utilizado para validar as estimativas de ingestão energética dos indivíduos. Objetivos: Avaliar a validade de equações preditivas para estimativa de gasto energético total (GET) e do relato implausível da ingestão de energia em idosos. Métodos: Foram utilizados dados de 38 idosos, de ambos os sexos, que tiveram o GET mensurado pela ADM. Uma base de dados composta por 41 idosos com características semelhantes a população desse estudo foi utilizada para modelagem de novas equações preditivas para determinação do GET em idosos. Para a estimativa da ingestão energética foram aplicados dois recordatórios alimentares de 24 horas em dias não consecutivos. A implausibilidade no relato da ingestão energética foi determinada comparando-se a razão entre consumo médio reportado de energia e o gasto energético total, calculando-se o intervalo de 95% de confiança. O relato implausível obtido pelo método de referência foi comparado com as equações preditivas de Goldberg et al., Black, McCrory et al., Huang et al. e Rennie et al. Regressão linear múltipla foi utilizada para a modelagem das novas equações preditivas do GET. Acurácia foi avaliada considerando ±10% da razão entre GET mensurado pela ADM e estimado pelas equações. Concordância entre métodos foi avaliada usando coeficiente de correção intraclasse e gráficos de Bland-Altman. Análises de sensibilidade e especificidade foram realizadas para testar o desempenho das equações preditivas em determinar sub-relato. Resultados: O GET médio pela ADM foi de 2.656,7 (405,6) kcal/dia para homens e 2.168,9 (376,9) para mulheres. Vinken et al. e ambas as equações das Dietary Reference Intake (DRIs) apresentaram concordância moderada a boa, enquanto os modelos desenvolvidos variaram de concordância moderada a muito boa em comparação com a ADM. A acurácia foi a mesma para as equações das DRIs e Vinken et al. (60,53%). As novas equações desenvolvidas neste estudo tiveram acurácia variando de 43,11% a 73,68% na predição do GET de idosos. A prevalência de sub-relato e super-relato foi de 57,9% (n = 22) e 5,3% (n = 2), respectivamente. A equação de Black apresentou a pior concordância enquanto o método proposto por McCrory et al. a melhor concordância em classificar os indivíduos nas três categorias de relato implausível. O método de McCrory et al. também teve o melhor desempenho nas análises de sensibilidade e especificidade para detecção de sub-relato. Conclusão: O estudo mostrou uma grande variação na precisão dos métodos preditivos para determinar relato implausível, com nenhum dos protocolos mostrando concordância excelente comparada a classificação obtida pela ADM. Os resultados deste estudo ressaltam a importância de se considerar o relato implausível da ingestão de energia em estudos que investigam o consumo alimentar de indivíduos, de modo a se obter dados mais acurados e fidedignos em estudos que relacionam alimentação e saúde.

Introduction: Studies assessing the population's food intake using methods based on the individual's report are recurrent. However, the implausibility in the reported energy intake can compromise the validity of the associations between diet and health, impairing the interpretation of results. In this context, doubly labeled water (DLW) stands out as a biological recovery marker used to validate individuals' energy intake estimates. Objectives: To evaluate the validity of predictive equations for estimating total energy expenditure (TEE) and the implausible report of energy intake in older adults. Methods: Data from 38 older people of both sexes, who had TEE measured by DLW were used. A database composed of 41 older adults with characteristics similar to the population of this study was used to model new predictive equations for determining TEE. To estimate energy intake, two 24-hour food records were applied on non-consecutive days. The implausibility in reporting energy intake was determined by comparing the ratio between mean reported energy intake and total energy expenditure, calculating the 95% confidence interval. The implausible report obtained by the reference method was compared with the predictive equations of Goldberg et al., Black, McCrory et al., Huang et al., and Rennie et al. Multiple linear regression was used to model the new predictive equations for TEE. Accuracy was assessed considering ± 10% of the ratio between TEE measured by DLW and estimated by the equations. Agreement between methods was assessed using intraclass correction coefficient and Bland-Altman plots. Sensitivity and specificity analyze were performed to test the performance of predictive equations in determining underreporting. Results: The average TEE by DLW was 2,656.7 (405.6) kcal/day for men and 2,168.9 (376.9) for women. Vinken et al. and both Dietary Reference Intake (DRIs) equations showed moderate to good agreement, while the developed models ranged from moderate to very good agreement compared to DLW. The accuracy was the same for the DRI equations and Vinken et al. (60.53%). The new equations developed in this study had accuracy ranging from 43.11% to 73.68% in the prediction of TEE in the elderly. The prevalence of underreporting and overreporting was 57.9% (n = 22) and 5.3% (n = 2), respectively. Black's equation showed the worst agreement while the method proposed by McCrory et al. the best agreement in classifying individuals in the three categories of implausible reporting. The McCrory et al. also had the best performance in the sensitivity and specificity analysis for detecting underreporting. Conclusion: The study showed a wide variation in the accuracy of predictive methods to determine implausible reporting, with none of the protocols showing excellent agreement compared to the classification obtained by the DLW. The results of this study highlight the importance of considering the implausible report of energy intake in studies that investigate the individuals' dietary intake, to obtain more accurate and reliable data in studies that relate food and health.