The global diet quality score as an indicator of adequate nutrient intake and dietary quality - a nation-wide representative study.

BACKGROUND: The Global Diet Quality Score (GDQS) was developed to be a simple, timely and cost-effective tool to track, simultaneously, nutritional deficiency and non-communicable disease risks from diet in diverse settings. The objective was to investigate the performance of GDQS as an indicator of adequate nutrient intake and dietary quality in a national-representative sample of the Brazilian population. METHODS: Nationally-representative data from 44,744 men and non-pregnant and non-lactating women aging ≥ 10 years, from the Brazilian National Dietary Survey were used. Dietary data were collected through two 24-h recalls (24HR). The GDQS was calculated and compared to a proxy indicator of nutrient adequate intake (the Minimum Dietary Diversity for Women-MDD-W) and to an indicator of high-risk diet for non-communicable diseases (caloric contribution from ultra-processed foods-UPF). To estimate the odds for overall nutrient inadequacy across MDD-W and GDQS quintiles, a multiple logistic regression was applied, and the two metrics' performances were compared using Wald's post-test. RESULTS: The mean GDQS for Brazilians was 14.5 (0-49 possible range), and only 1% of the population had a low-risk diet (GDQS ≥ 23). The GDQS mean was higher in women, elderly individuals and in higher-income households. An inverse correlation was found between the GDQS and UPF (rho (95% CI) = -0.20(-0.21;-0.19)). The odds for nutrient inadequacy were lower as quintiles of GDQS and MDD-W were higher (p-trend < 0.001), and MDD-W had a slightly better performance than GDQS (p-diff < 0.001). Having a low-risk GDQS (≥ 23) lowered the odds for nutrient inadequacy by 74% (95% CI:63%-81%). CONCLUSION: The GDQS is a good indicator of overall nutrient adequacy, and correlates well with UPF in a nationally representative sample of Brazil. Future studies must investigate the relationship between the GDQS and clinical endpoints, strengthening the recommendation to use this metric to surveillance dietary risks.

Which blood cutoff value should be used for vitamin A deficiency in children aged 3-10 years? A systematic review.

CONTEXT: Blood cutoff values for vitamin A deficiency in children aged 3-10 years have not been addressed in the literature. OBJECTIVE: To identify blood retinol concentrations for determining severe vitamin A deficiency in children aged 3-10 years. DATA SOURCES: The MEDLINE, Web of Science, Embase, and Scopus databases were searched. DATA EXTRACTION: Two reviewers independently extracted article data and assessed quality. DATA ANALYSIS: The hierarchical summary receiver operating characteristic models were applied for the diagnostic accuracy meta-analysis. This review is registered at PROSPERO (identifier: CRD42020149367). RESULTS: A total of 15 articles met the eligibility criteria, and 9 were included in the diagnostic accuracy meta-analysis. The summary estimates (95%CI) were: Sensitivity, 0.39 (0.20-0.62); specificity, 0.79 (0.65-0.88); positive likelihood ratio, 1.85 (1.33-2.57); and negative likelihood ratio, 0.77 (0.60-0.99). The area under the curve of the overall analysis was 0.68 (95%CI 0.63-0.72). CONCLUSIONS: Blood retinol concentrations have low diagnostic accuracy for severe vitamin A deficiency in children aged 3-10 years. Therefore, there is unclear evidence about the preferable cutoff point for determining severe vitamin A deficiency in children in this age group.

A posteriori dietary patterns and their association with systemic low-grade inflammation in adults: a systematic review and meta-analysis.

CONTEXT: A posteriori dietary patterns are promising ways of uncovering potential public health strategies for the prevention of systemic, low-grade, inflammation-related, chronic noncommunicable diseases. OBJECTIVE: To investigate and summarize the current evidence on the association between a posteriori dietary patterns and systemic, low-grade inflammation in adults. DATA SOURCES: MEDLINE, EMBASE, Web of Science, and LILACS were searched. DATA EXTRACTION: Data screening, extraction, and quality assessment were performed independently by 2 investigators. Meta-analysis with random effects was conducted. Differences and similarities between reduced rank regression-derived dietary patterns were assessed. RESULTS: Healthy dietary patterns are inversely and the Western dietary pattern is positively associated with inflammation (r = -0.13, 95% confidence interval -0.20 to -0.06; and r = 0.11, 95% confidence interval, 0.09-0.12, respectively). Reduced rank regression-derived anti-inflammatory dietary patterns are consistently characterized by high intake of fresh fruits and inflammatory dietary patterns are consistently characterized by high intake of red and processed meat and low intake of vegetables. CONCLUSION: Favoring the substitution of a Westernized diet for a healthy diet may lower inflammation, which might improve the prevention of some chronic noncommunicable diseases.

Validation and adaptation of the empirical dietary inflammatory pattern across nations: A test case.

OBJECTIVE: The empirical dietary inflammatory pattern (EDIP) assesses the inflammatory potential of diet in the US population. The aim of this study was to assess the applicability of the EDIP to a Brazilian population. METHODS: Data from 19- to 75-y-old participants of two editions of the cross-sectional population-based Health Survey of Sao Paulo (HS-SP) were used to validate the EDIP (n = 269; HS-SP 2008), develop an EDIP adapted to a Sao Paulo population, the EDIP-SP (n = 441; HS-SP 2008), and replicate EDIP-SP results in an independent sample (n = 501; HS-SP 2015). Dietary data was assessed through two 24-h recalls and one validated food frequency questionnaire. Plasma C-reactive protein (CRP), and nine other inflammatory biomarkers were determined. EDIP was tested for its association with the 10 inflammatory biomarkers. For development of the EDIP-SP, 21 food groups and their contributions to plasma CRP levels were modeled using a stepwise multiple linear regression adjusted for age and sex. RESULTS: The EDIP was not associated with concentrations of inflammatory biomarkers in a Brazilian population. The components of EDIP-SP were processed meats (ß = 0.27; P = 0.082), fruits and vegetables (ß = -0.12; P = 0.018), and rice and beans (ß = -0.27; P = 0.007). EDIP-SP significantly predicted dietary quality (ß = -6.1; P < 0.001) and its inflammatory potential was replicated among men (ß = 0.36; P = 0.01), but not among women (ß = 0.05; P = 0.82). CONCLUSION: EDIP was adapted to the Sao Paulo population. EDIP-SP, composed of high processed meat intake and low intake of fruits and vegetables, and rice and beans, constitutes an important tool to investigate dietary quality based on its inflammatory potential, in Brazilian populations.

Systemic low-grade inflammation-associated lifestyle, diet, and genetic factors: A population-based cross-sectional study.

OBJECTIVES: Systemic low-grade inflammation (SLGI) is an intermediary common condition to the physiopathology of chronic noncommunicable diseases and targeting its determinants could lead to more efficient public health strategies. We aimed to investigate SLGI-independent associations with lifestyle, diet, and genetic factors in a population-based sample of adults using a systemic low-grade inflammation score (SIS). METHODS: The study sample is composed of 269 participants from the cross-sectional population-based Health Survey of Sao Paulo (2008-2010), ages 20 to 59 y, whose data on socioeconomic variables, lifestyle, health parameters, and blood samples were available. Diet was assessed by two 24-h recalls, and the Brazilian Health Eating Index-Revised (BHEI-R) was scored. From blood samples, 30 single nucleotide polymorphisms on inflammatory genes were genotyped, and plasma eleven inflammatory biomarkers levels that composed the SIS were determined. A multiple, stepwise, linear regression was used to investigate SIS-independent associated factors. RESULTS: Factors independently associated with SIS were BHEI-R score (partial R²â€¯= 5.1; ß = -0.13; P = 0.003), body mass index (partial R²â€¯= 3.4; ß = 0.19; P = 0.001), TLR4 rs5030728 GA + AA genotype (partial R²â€¯= 3.1; ß = -1.37; P = 0.008), age 50 to 59 y (partial R²â€¯= 2.5; ß = 1.93; P = 0.029) in comparison with the reference category (20 to 29 y), and commuting physical activity >150 min/wk (partial R²â€¯= 2.2; ß = -1.29; P = 0.043) after adjustment for current smoking status, medication use, and dietary misreporting. CONCLUSIONS: Eating a lower quality diet, having a higher body mass index score and age, being GG homozygous for TLR4 rs5030728, and spending <150 min/wk in transportation physical activity are independent determinants of SLGI.

Association between 25-hydroxyvitamin D and inflammatory biomarker levels in a cross-sectional population-based study, São Paulo, Brazil.

Besides the classic vitamin D function on bone homeostasis, there are bodies of evidence showing that adequate status of vitamin D can modulate inflammation. We hypothesized that higher plasma levels of 25-hydroxyvitamin D (25[OH]D) would correlate with lower plasma levels of proinflammatory cytokines, acute-phase proteins, and soluble adhesion molecules and higher plasma levels of anti-inflammatory cytokines. We included all adults (age, 20-59 years) of the population-based, cross-sectional study, Health Survey-São Paulo, conducted in São Paulo (Brazil) in the study (n = 281). Anthropometric parameters, blood pressure measurements, and a fasting blood sample were collected by trained fieldworkers. Serum 25(OH)D concentration, plasma inflammatory biomarker levels (C-reactive protein, interleukin [IL]-1ß, IL-6, IL-8, IL-10, tumor necrosis factor [TNF] α, IL-12p70, adiponectin, monocyte chemoattractant protein-1, soluble intercellular adhesion molecule-1, and soluble vascular cell adhesion molecule-1), and plasma blood lipid parameters were evaluated. The prevalence of vitamin D inadequacy (<50 nmol/L) was 65.5%. Inadequate participants were younger, with lower body mass index (BMI), systolic and diastolic blood pressures, triglyceride, and total cholesterol levels as well as low-density lipoprotein cholesterol, compared with individuals adequate for vitamin D status. After adjustment, plasma concentration of soluble intercellular adhesion molecule-1 was statistically higher among adequate participants. Stratifying for BMI categories, a negative association was observed between plasma IL-6 and TNF-α levels and serum 25(OH)D concentration in normal-weight participants, whereas a negative association was detected between plasma adiponectin level and serum 25(OH)D concentration in overweight participants. The present findings suggest that BMI interacts with serum 25(OH)D levels, modulating inflammatory response and affecting plasma IL-6, TNF-α, and adiponectin levels. These data indicate that BMI plays a determinant role in the vitamin D-inflammation axis.

Interaction of SNP in the CRP gene and plasma fatty acid profile in inflammatory pattern: A cross-sectional population-based study.

OBJECTIVE: To assess the interaction of three single nucleotide polymorphisms in the C-reactive protein (CRP) gene and plasma fatty acid (FA) levels in modulating inflammatory profile. METHODS: A total of 262 subjects, aged >19 y and <60 y, participated in a cross-sectional, population-based study performed in Brazil. Three single nucleotide polymorphisms (rs1205, rs1417938, and rs2808630) spanning the CRP gene were genotyped. Eleven plasma inflammatory biomarkers and plasma FA profile were determined. Cluster analysis was performed to stratify individuals based on eleven inflammatory biomarkers into two groups: an inflammatory (INF) and a noninflammatory group. RESULTS: The INF cluster had higher age, waist circumference, systolic blood pressure, and diastolic blood pressure; higher levels of triacylglycerol, high-sensitivity CRP, tumor necrosis factor-α, interleukin (IL)-8, IL-6, IL-1ß, IL-12, IL-10, soluble monocyte chemoattractant protein-1, soluble intercellular adhesion molecule-1, C16:0, polyunsaturated fatty acid, and omega (n)-6 polyunsaturated fatty acid; and greater C20:4n-6, C18:1/18:0, and C20:4/20:3 ratios than the noninflammatory group. Statistically significant gene-plasma C16:1n-7 interaction was detected for rs1417938 (P = 0.047). Those with a dominant homozygous rs2808630 had a lower risk of belonging to the INF group with the upper 50th percentile of C20:4n-6, n-3 highly unsaturated FA, and C20:4/20:3 ratio. Regarding rs1205, A allele carriers had lower risk of being in the INF group when C20:5n-3 and n-3 highly unsaturated FA levels were greater than the median. CONCLUSIONS: The INF group exhibited changes in metabolic parameters that predispose this group to chronic disease, where polymorphisms in the CRP gene modulated the risk of being in the INF group depending on individual plasma fatty acid and lipid profile.