Overall diet quality, food groups and mental health disorders among Brazilians older than 15 years old: Brazilian National Health Survey - 2019.

BACKGROUND: Adherence to a nutrient-dense diet can have an impact on depression and other mental health issues. Little is known whether this is attributed to some or all components and how these differ in a country that is known to have a vast diversity of nutrient-dense foods. The aim was to examine whether there is a relationship between individual food groups with depression and other mental health disorders. METHODS: Data was from 89,955 Brazilians from the National Health Survey. Mental health and diet were accessed using a screener questionnaire. Descriptive statistics and regression analyses were calculated. RESULTS: Persons living with depression had significantly lower diet scores for vegetables/fruits (ß = -0.08, 95 % CI -0.13, -0.02), grains/roots (ß = -0.05; 95%CI (-0.07, -0.03)), beans (ß = -0.03; 95%CI (-0.04, -0.01)) and higher scores for sweetened beverages (ß = 0.04; 95%CI (0.01, 0.07)), sweets and sugars (ß = 0.03; 95%CI (0.01, 0.05) and high fat/sodium products (ß = 0.04; 9%CI (0.01, 0.07). Individuals living with other mental disorders showed lower scores for grains/roots (ß = -0.03; 95%CI (-0.06, -0.01)) and higher scores for sweets and sugars (ß = 0.06; 95%CI (0.03, 0.09)) and high fat/sodium products (ß = 0.05; 95%CI (0.01, 0.09)). CONCLUSION: People with mental health disorders are more likely to have an unhealthy diet. Relationships were slightly stronger with depression in particular food groups as other mental disorders. Further studies are needed to help in the prevention of these disorders.

Knowledge and perceptions of the 2019 Canada's Food Guide: a qualitative study with Canadian children.

To support Canadians ages 2 years and older in improving their dietary intake, Health Canada released a revised Canada's Food Guide (CFG) in 2019. This study aimed to explore the knowledge and perceptions of the 2019 CFG among children ages 9-12 years old from Southwestern Ontario. From September-November 2021, interviews were conducted with children by video conference. Thirty-five children (50% girls, 80% White; mean age 9.9 years) participated. Data were analyzed using a hybrid thematic approach with inductive and deductive analyses. Children expressed a lack of knowledge on certain foods (i.e., plant-based proteins, whole grains, and highly processed foods) that are highlighted in the CFG. Children also expressed confusion around food groups, including recommended proportions and categorization of some foods (e.g., dairy products and plant-based proteins). Children generally expressed positive perceptions regarding CFG and its eating habit recommendations, i.e., "Cook more often", "Eat meals with others", and "Enjoy your food", and they suggested strategies to improve adherence to these recommendations, including providing children more responsibility and independence with food preparation tasks and minimizing family time conflicts. Children's perceptions of the CFG can help inform public health policies and programmatic strategies designed to support children's food choices and eating habits.

Association between weight control behaviors and diet quality among Brazilian adolescents and young adults: Health Survey of São Paulo with Focus on Nutrition, 2015.

PURPOSE: Little is known about how behaviors to control weight are associated with diet quality among youth from low- and middle-income countries. The aim of this study was to examine associations between efforts to control weight (ECW) and diet quality among Brazilian adolescents and young adults. METHODS: Data from 731 participants (17.89 ± 4.92 years, 51.1% female) of the 2015 Health Survey of São Paulo were used for this cross-sectional study. Dietary intake was assessed using a 24 h dietary recall and diet quality was calculated using the Brazilian Healthy Eating Index-Revised (BHEI-R). Participants reported their ECW, weight satisfaction, and socio-demographics. Descriptive statistics and linear regressions were calculated to investigate associations between ECW and diet quality. RESULTS: Approximately 47.7% of participants were dissatisfied with their current weight, and 41.0% reported ECW. Reported strategies to control weight included increased physical activity, taking care of what they eat, and dieting (8.2, 3.1, and 2.5%, respectively). After adjusting for age, sex, race/ethnicity, and body mass index, reporting at least one ECW (ß = 0.08; 95% CI 0.02, 0.13), taking care of what to eat (ß = 0.15; 0.08, 0.22) and being satisfied with their weight (0.08; 0.02, 0.13) were all associated with a higher overall BHEI-R score. CONCLUSION: Overall diet quality score showed a small increase in participants reporting ECW. Further studies should be conducted to provide strategies used by adolescents from low- and middle-income countries to control their weight. Thus, developing public health policies, and behavioral-change strategies. LEVEL V: Cross-sectional descriptive study.

Energy, nutrients and food sources in snacks for adolescents and young adults / Energia, nutrientes e fontes alimentares em lanches de adolescentes e jovens adultos

ABSTRACT Objective: To evaluate associations between snacking and energy, nutrients and food source, and to identify the contribution of snacking across age, sex, weight status and lifestyle behaviors among adolescents and young adults. Methods: A sub-sample was calculated from the population-based cross-sectional study 2015-Health Survey of São Paulo (ISA-Capital). The survey "ISA-Nutrição" used a sample of non-institutionalized individuals aged >15 years. For this study, only adolescents (12-18 years old; n=418) and young adults (19-29 years old; n=218) were included. Snacks were identified, and their contribution to energy, nutrients, and food sources were calculated. Descriptive statistics and logistic regressions were used. Results: Participants experienced an average of 2.9±0.6 snacking occasions per day. Young adults consumed more energy from morning and night snacks, and adolescents, from afternoon snacks. The top three food sources on snacking contributed to 30.5% of energy: cookies (11.8%), sugar sweetened beverages (9.4%), sweets and other desserts (9.3%). Although results were non-significant, being a female (Odds Ratio [OR] 0.93; 95% confidence interval [95%CI] 0.36-1.49), meeting the physical activity recommendations (OR 0.75; 95%CI 0.25-1.25), and scoring higher for the healthy eating index (OR 0.88; 95%C 0.24-1.52) were all factors related to increased intake of snacks. Alternatively, overweight individuals (OR -0.54; 95%CI -1.00 to -0.08) consumed less snacks. Conclusions: Improving the quality of snacks should be considered in behavior-change strategies.

RESUMO Objetivo: Avaliar associações entre lanches e consumo de energia, nutrientes e fontes alimentares e identificar seus contribuintes por idade, sexo, status de peso e comportamentos de estilo de vida entre adolescentes e jovens adultos. Métodos: Subamostra calculada a partir do estudo de base-populacional transversal Inquéritos de Saúde de São Paulo (ISA-Capital, 2015). O ISA-Nutrição utilizou amostra de indivíduos não-institucionalizados com idade >15 anos. Para este estudo, apenas adolescentes (12-18 anos; n=418) e jovens adultos (19-29 anos; n=218) foram incluídos. Os "lanches" foram definidos, bem como foram calculadas a contribuição de energia e nutrientes, e as fontes alimentares. Estatística descritiva e regressões logísticas foram utilizadas. Resultados: Em média foram realizados 2,9±0,6 lanches por dia pelos participantes. Jovens adultos consumiram mais energia nos lanches da manhã e noite, enquanto adolescentes, à tarde. As três principais fontes de alimentos nos lanches contribuíram em 30,5% para o total de energia: biscoitos (11,8%), bebidas açucaradas (9,4%), e doces e outras sobremesas (9,3%). Apesar de os resultados não serem significantes, ser do sexo feminino (Odds Ratio [OR] 0,93, intervalo de confiança de 95% [IC95%] 0,36-1,49), atingir as recomendações de atividade física (OR 0,75, IC95% 0,25-1,25), e ter alta pontuação no índice do total da qualidade dieta (OR 0,88, IC95% 0,24-1,52) resultou em aumento na ingestão de lanches. Alternativamente, ter sobrepeso (OR -0.54, IC95% -1.00 a -0.08) está relacionado a menores chances de consumir lanches. Conclusões: Estratégias para melhorar a qualidade dos lanches deveriam ser consideradas nas intervenções de mudança de comportamentos.

Energy, nutrients and food sources in snacks for adolescents and young adults.

OBJECTIVE: To evaluate associations between snacking and energy, nutrients and food source, and to identify the contribution of snacking across age, sex, weight status and lifestyle behaviors among adolescents and young adults. METHODS: A sub-sample was calculated from the population-based cross-sectional study 2015-Health Survey of São Paulo (ISA-Capital). The survey "ISA-Nutrição" used a sample of non-institutionalized individuals aged >15 years. For this study, only adolescents (12-18 years old; n=418) and young adults (19-29 years old; n=218) were included. Snacks were identified, and their contribution to energy, nutrients, and food sources were calculated. Descriptive statistics and logistic regressions were used. RESULTS: Participants experienced an average of 2.9±0.6 snacking occasions per day. Young adults consumed more energy from morning and night snacks, and adolescents, from afternoon snacks. The top three food sources on snacking contributed to 30.5% of energy: cookies (11.8%), sugar sweetened beverages (9.4%), sweets and other desserts (9.3%). Although results were non-significant, being a female (Odds Ratio [OR] 0.93; 95% confidence interval [95%CI] 0.36-1.49), meeting the physical activity recommendations (OR 0.75; 95%CI 0.25-1.25), and scoring higher for the healthy eating index (OR 0.88; 95%C 0.24-1.52) were all factors related to increased intake of snacks. Alternatively, overweight individuals (OR -0.54; 95%CI -1.00 to -0.08) consumed less snacks. CONCLUSIONS: Improving the quality of snacks should be considered in behavior-change strategies.

Contribution of food groups to energy, grams and nutrients-to-limit: the Latin American Study of Nutrition and Health/Estudio Latino Americano de Nutrición y Salud (ELANS).

OBJECTIVE: To quantify the energy, nutrients-to-limit and total gram amount consumed and identify their top food sources consumed by Latin Americans. DESIGN: Data from the Latin American Study of Nutrition and Health (ELANS). SETTING: ELANS is a cross-sectional study representative of eight Latin American countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru and Venezuela. PARTICIPANTS: Two 24-h dietary recalls on non-consecutive days were used to estimate usual dietary intake of 9218 participants with ages between 15-65 years. 'What We Eat in America' food classification system developed by United States Department of Agriculture was adapted and used to classify all food items consumed by the ELANS population. Food sources of energy, added sugars, SFA, Na and total gram amount consumed were identified and ranked based on percentage of contribution to intake of total amount. RESULTS: Three-highest ranked food categories of total energy consumed were: rice (10·3%), yeast breads (6·9%), and turnovers and other grain-based items (6·8 %). Highest ranked food sources of total gram amount consumed were fruit drinks (9·6%), other 100% juice (9·3%) and rice (8·3%). Three highest ranked sources for added sugars were other 100% juice (24·1 %), fruit drinks (16·5%), and sugar and honey (12·4%). SFA ranked foods were turnovers and other grain-based (12·6 %), cheese (11·9%), and pizza (10·3%). Three top sources of Na were rice (13·9%), soups (9·1 %) and rice mixed dishes (7·3 %). CONCLUSION: Identification of top sources of energy and nutrients-to-limit among Latin Americans is critical for designing strategies to help them meet nutrient recommendations within energy needs.

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.

Social determinants, lifestyle and diet quality: a population-based study from the 2015 Health Survey of São Paulo, Brazil.

OBJECTIVE: To investigate the association among social determinants, lifestyle variables and diet quality in São Paulo, Brazil. DESIGN: Cross-sectional study, 2015 Health Survey of São Paulo (Inquérito de Saúde de São Paulo (2015 ISA-Capital)) with Focus on Nutrition Study (2015 ISA-Nutrition). SETTING: Population-based study, with a representative sample of adults living in São Paulo, Brazil. PARTICIPANTS: Adults (aged 20-59 years, n 643) and older adults (aged ≥60 years, n 545). RESULTS: We observed differences in the Brazilian Healthy Eating Index-Revised (BHEI-R) by education, income, occupation, sex and race. Whole grains (0·63 points, 12·6 % of the maximum score), sodium (2·50 points, 25·0 %) and solid fat, alcohol and added sugars (9·28 points, 46·4 %) components had the lowest BHEI-R scores. Factors positively associated with diet quality included the presence of one disease or more (e.g. diabetes mellitus, hypertension, cancer, hypercholesterolaemia: ß = 0·636, P < 0·001), income (middle income: ß = 0·478, P < 0·001; high income: ß = 0·966, P < 0·001) and occupation (other: ß = 1·418, P < 0·001). Energy (ß = -0·001, P < 0·001), alcohol consumption (ß = -0·207, P = 0·027), education level (middle education: ß = -0·975, P < 0·001; high education: ß = -1·376, P < 0·001), races other than white (ß = -0·366, P < 0·001) and being unemployed (ß = -0·369, P < 0·046) were negatively associated with diet quality. CONCLUSIONS: Groups affected by socio-economic inequalities need better diet quality. Governmental actions should be implemented to reduce the consumption of energy-dense and sodium-rich foods, facilitate access and information on healthy eating, and conduct nutritional education.

Changes in diet quality 6 and 12 months post-intervention: the Healthy Habits, Healthy Girls: a Brazilian study / Mudanças na qualidade da dieta em 6 e em 12 meses pós-intervenção: Hábitos Saudáveis, Meninas Saudáveis: estudo brasileiro

ABSTRACT Objective To determine the sustainability of food quality in an obesity-prevention strategy for adolescent girls. Methods The study is a randomized controlled trial with 253 girls (Mean=15.61, 95% Confidence Interval 15.51-15.72) enrolled in 10 vocational schools in São Paulo. The diet intake was determined using a "Food Frequency Questionnaire" and analyzed according to the Brazilian Healthy Eating Index-Revised adequacy, moderation, and overall scores. The adolescents' dietary intake was compared to the baseline 6 months and 12 months post-intervention. Descriptive statistics and analyses of covariance were used, considering a 5% significance level. Results Significant increases were found on the components total fruits (F=6.98, p<0.01), total vegetables (F=5.76, p=0.02), beans (F=5.96, p=0.02), and whole cereals (F=12.35, p<0.001). However, there was also a significant decrease on the scores for milk and dairy (F=6.48, p=0.02), and oils (F=5.98, p=0.02). At 12-month post intervention, improvement on the overall score was found (F=3.89, p=0.05), but there was a decrease on the component whole cereals (F=11.85, p<0.001), as well as in milk and dairies (F=6.38, p=0.02). Despite no significant effect for the SoFAAS component, a moderate effect size was revealed (d=0.56). Conclusion There were significant effects on some diet quality components and for the overall scores at 6-month and 12-month post intervention. Therefore, sustainable dietary changes should be the focus of obesity prevention programs for adolescents. Socio-economic influences on diet behaviors would also need to be acknowledged.

RESUMO Objetivo Determinar a sustentabilidade da qualidade da alimentação presente em uma estratégia de prevenção à obesidade para adolescentes do sexo feminino. Métodos Ensaio randomizado controlado com 253 meninas (Média=15.61, 95% Intervalo de confiança 15.51-15.72) matriculadas em 10 escolas técnicas de São Paulo. Por meio do "Questionário de Frequência Alimentar" a ingestão dietética foi determinada e analisada de acordo com os componentes de adequação, de moderação e de pontuação total do Índice da Qualidade da Dieta-Revisado. A ingestão dietética das adolescentes foi comparada na linha base, em 6 e em 12 meses após a intervenção. Estatística descritiva e análise de covariância foram utilizadas, considerando 5% do nível de significância. Resultados Houve um aumento significativo nos componentes das frutas totais (F=6.98, p<0.01), vegetais totais (F=5.76, p=0.02), feijões (F=5.96, p=0.02) e cereais integrais (F=12.35, p<0.001). Entretanto, houve expressiva redução para a pontuação dos componentes leite e derivados (F=6.48, p=0.02) e óleos (F=5.98, p=0.02). Aos 12 meses de pós-intervenção, foi encontrada melhora na pontuação total do Índice da Qualidade da Dieta-Revisado (F=3.89, p=0.05), porém redução para os componentes cereais integrais (F=11.85, p<0.001) e leites e derivados (F=6.38, p=0.02). Apesar de não haver significância para os componentes gorduras sólidas, açúcar de adição e álcool, o tamanho de efeito moderado foi revelado (d=0.56). Conclusão Foram identificadas mudanças significativas para alguns componentes da qualidade da alimentação e da pontuação total aos 6 e aos 12 meses pós-intervenção. Mudanças dietéticas sustentáveis devem ser o foco de programas de prevenção para adolescentes. Além disso, influências socioeconômicas nos comportamentos dietéticos também devem ser consideradas.

Brazilian Children's Dietary Intake in Relation to Brazil's New Nutrition Guidelines: a Systematic Review.

PURPOSE OF REVIEW: This systematic review reports the latest scientific evidence, from cross-sectional and cohort studies, describing the dietary intake of children and adolescents from Brazil. The goal of the review was to describe intakes according to Brazil's new food classification system (NOVA) which classifies foods according to the degree of processing, i.e., unprocessed/minimally processed, processed culinary ingredients, processed food, and ultra-processed food. Due to a paucity of data using the NOVA classification system, studies with other intake descriptors were included. RECENT FINDINGS: Results using the NOVA system showed a somewhat high intake of (ultra-)processed items, than of minimally processed items. Studies using other methods of dietary assessment showed not only high intake of sources rich in fat, sugar, and sodium, most of them processed items (e.g., savory snacks and sweets) but also intake of fruit, vegetables, and whole grains. Overall, the literature was marred by inconsistencies and variation in study definitions and methods making it hard to make firm conclusions regarding the dietary intake of Brazilian children. The development of tools to evaluate the complexities of dietary intake is much needed. Such a tool needs to be accepted and adopted by numerous study groups, to describe dietary status among Brazilian children and devise the most effective, and to evaluate the success of nutrition education programs.

"Healthy Habits, Healthy Girls-Brazil": an obesity prevention program with added focus on eating disorders.

PURPOSE: To evaluate the immediate post-intervention and 6-month post-intervention effects of a Brazilian school-based randomized controlled trial for girls targeting shared risk factors for obesity and disordered eating. METHODS: Total of 253 girls, mean of 15.6 (0.05) years from 1st to 3rd grades of high school participated in this 6-month school-based cluster randomized controlled trial. "Healthy Habits, Healthy Girls-Brazil (H3G-Brazil)", originally developed in Australia, emphasized 10 key nutrition and physical activity (PA) messages delivered over 6 months. Disordered eating prevention procedures, i.e., prevention of weight-teasing, body satisfaction, and unhealthy weight control behavior, were added to the intervention. Body dissatisfaction, unhealthy weight control behaviors and social cognitive-related diet, and physical activity variables were assessed at baseline, immediate post-intervention, and 6-month post-intervention. Intervention effects were determined by one-way analysis of covariance or logistic regression, after checking for the clustering effects of school. The control group did not receive intervention prior to follow-up assessment. A conservative significance level was set at p < 0.01. RESULTS: Beneficial effects were detected for PA social support (F = 6.005, p = 0.01), and healthy eating strategies (F = 6.08, p = 0.01) immediate post-intervention; and healthy eating social support (F = 14.731, p = 0.00) and healthy eating strategies (F = 5.812, p = 0.01) at 6-month post-intervention. Intervention group was more likely to report unhealthy weight control behaviors (OR = 1.92, 95% CI 1.15-3.21, p = 0.01) at 6-month post-intervention. No other significant immediate or 6-month post effects were detected. CONCLUSION: H3G-Brazil demonstrated positive 6-month effects on some social cognitive variables but an adverse effect on unhealthy weight control behaviors. Thus, this study was not able to achieve synergy by combining obesity and disordered eating prevention procedures in an intervention among low-income girls in Brazil. TRIAL REGISTRATION: Level I: cluster randomized controlled trial.

Sedentary behavior and body composition in children of low-and mid-income countries: a review / Comportamento sedentário e composição corporal em crianças de países de baixa e média renda: uma revisão

This study reviewed the relationship between sedentary behavior (SB) and body composition in children and adolescents from low-and-mid income countries (LMIC). A systematic review was developed through manual and electronic searches in eight databases. Were included observational studies conducted in LMIC, with children and adolescents from three to 19 years. As results, 39 original articles were found (37 cross-sectional, 1 case control study and 1 cohort), which in all presented 75 analyzes, most of them based on screen behaviors (n = 71; 94.7%). At all, 15 of 25 analyses showed risk associations between SB and unfavorable body composition. When focusing on the dose of sedentary behavior, risk associations were verified in distinct cutoff points: 1h/d (3 of 3 analyses); 2h/d (9 of 16); 3h/d (2 of 5); 4h/d (4 of 5) and 5h/d (3 of 6). Television time was the SB type most frequently associated as risk in all categories. In conclusion, recognition of these associa-tions is important both to support future studies and for its dissemination in preventive messages in the population of interest. Also, further longitudinal studies are necessary for narrowing the casual relationships between the variables

Este estudo revisou as relações entre o comportamento sedentário (CS) e composição corporal em crianças e adolescentes de países de renda baixa e média. Uma revisão sistemática foi desenvolvida por meio de buscas manuais e eletrônicas em oito bases de dados eletrônicas. Foram incluídos estudos observacionais conduzidos nos países de renda baixa e média, envolvendo crianças entre três e 19 anos de idade. Como resultados, 39 artigos originais foram encontrados (37 transversais, 1 caso-controle e 1 coorte), que, ao todo, apresentaram 75 análises, sendo a maioria delas baseadas em comportamentos de tela (n = 71; 94,7%). No geral, 15 de 25 análises apresentaram associações de risco entre o CS e composição corporal desfavorável. Quando analisadas doses de comportamento sedentário, associações de risco foram verificadas em distintos pontos de corte: 1h/d (3 de 3 análises encontradas); 2h/d (9 de 16); 3h/d (2 de 5); 4h/d (4 de 5) e 5h/d (3 de 6). O tempo de televisão foi o tipo de CS mais frequentemente associado enquanto risco em todas as categorias. Concluindo, o reconhecimento destas associações é importante tanto para o suporte de futuros estudos, assim como para sua disseminação em mensagens preventivas na população de interesse. Também, estudos longitudinais são necessários para estreitamento das relações causais entre as variáveis

Sustained impact of the "Healthy Habits, Healthy Girls - Brazil" school-based randomized controlled trial for adolescents living in low-income communities.

Pediatric obesity is a major public health concern in low- and middle-income countries, such as Brazil. There is an urgent need for preventive programs for adolescents and, the assessment of their sustained impact. This paper reports the longer-term (6-month post intervention) effects of the "H3G-Brazil" obesity prevention program on weight status and weight-related behaviors. A cluster randomized controlled trial starting with 10 public schools in the city of São Paulo, Brazil involved 253 adolescent girls [mean (se) age = 15.6 (0.87) years]. Body mass index (BMI), waist circumference (WC), dietary intake, physical activity (PA) and sedentary behaviors (SB) were assessed at baseline, immediate post-intervention and 6-month post-intervention (follow-up). ANCOVA was performed using intention to treat principles. There was no effect on BMI, the primary outcome. Although, meaningful increases occurred in waist circumference for both groups, the intervention group presented a lower increase (F = 3.31, p = 0.04). This effect size, however, was lower than the criterion for small (d = 0.102). Unfortunately, significant results favored the control group for time spent on TV/weekdays (F = 5.13, p = 0.01), TV/weekends (F = 5.46, p = 0.01) and sedentary behaviors/weekdays (F = 5.32, p = 0.04). No other significant results were found. This obesity prevention intervention among Brazilian adolescent girls did not have the desire effect on BMI. The significantly lower increase in waist circumference in the intervention groups is inconsistent with the adverse changes detected in sedentary time.

Weight-teasing: does body dissatisfaction mediate weight-control behaviors of Brazilian adolescent girls from low-income communities?

The objective was to examine the mediation hypothesis of body dissatisfaction and analyze their association with weight-teasing and body satisfaction. A total of 253 girls who attended 10 schools from São Paulo, Brazil, participated in this study. Data collection was carried out through a validated and self-reported questionnaire. Study variables were weight-teasing (independent), body satisfaction (mediation), and weight control behavior (outcome). Effect mediation analyses showed a significance level of 5% (p < 0.05). Prevalence of family and peers weight-teasing were 38.5% and 40.6%, respectively. Body dissatisfaction was associated with unhealthy weight control behaviors when controlled by family and peer weight-teasing. Data indicate that family and peers teasing are important aspects that interfere in body satisfaction and weight control behaviors.

Obesity and eating disorders in integrative prevention programmes for adolescents: protocol for a systematic review and meta-analysis.

INTRODUCTION: Obesity and eating disorders are public health problems that have lifelong financial and personal costs and common risk factors, for example, body dissatisfaction, weight teasing and disordered eating. Obesity prevention interventions might lead to the development of an eating disorder since focusing on weight may contribute to excessive concern with diet and weight. Therefore, the proposed research will assess whether integrating obesity and eating disorder prevention procedures ('integrated approach') do better than single approach interventions in preventing obesity among adolescents, and if integrated approaches influence weight-related outcomes. METHODS AND ANALYSIS: Integrated obesity and eating disorder prevention interventions will be identified. Randomised controlled trials and quasi-experimental trials reporting data on adolescents ranging from 10 to 19 years of age from both sexes will be included. Outcomes of interest include body composition, unhealthy weight control behaviours and body satisfaction measurements. MEDLINE/PubMed, PsycINFO, Web of Science and SciELO will be searched. Data will be extracted independently by two reviewers using a standardised data extraction form. Trial quality will be assessed using the Cochrane Collaboration criteria. The effects of integrated versus single approach intervention studies will be compared using systematic review procedures. If an adequate number of studies report data on integrated interventions among similar populations (k>5), a meta-analysis with random effects will be conducted. Sensitivity analyses and meta-regression will be performed only if between-study heterogeneity is high (I2 ≥75%). ETHICS AND DISSEMINATION: Ethics approval will not be required as this is a systematic review of published studies. The findings will be disseminated through conference presentations and peer-reviewed journals.

Weight-teasing: does body dissatisfaction mediate weight-control behaviors of Brazilian adolescent girls from low-income communities? / Provocações em relação ao peso corporal: a insatisfação com o próprio corpo afeta o comportamento de controle de peso de adolescentes brasileiras de comunidades de baixa renda? / Burlas y acoso por el peso: ¿la insatisfacción corporal afecta al comportamiento para el control del peso en adolescentes brasileñas dentro de comunidades con baja renta?

The objective was to examine the mediation hypothesis of body dissatisfaction and analyze their association with weight-teasing and body satisfaction. A total of 253 girls who attended 10 schools from São Paulo, Brazil, participated in this study. Data collection was carried out through a validated and self-reported questionnaire. Study variables were weight-teasing (independent), body satisfaction (mediation), and weight control behavior (outcome). Effect mediation analyses showed a significance level of 5% (p < 0.05). Prevalence of family and peers weight-teasing were 38.5% and 40.6%, respectively. Body dissatisfaction was associated with unhealthy weight control behaviors when controlled by family and peer weight-teasing. Data indicate that family and peers teasing are important aspects that interfere in body satisfaction and weight control behaviors.

O estudo teve como objetivo examinar a hipótese da mediação pela insatisfação com o próprio corpo e analisar as associações com a provocação por terceiros e com a satisfação com o corpo. A amostra incluiu um total de 253 adolescentes do sexo feminino matriculadas em dez escolas na cidade de São Paulo, Brasil. Os dados foram coletados com um questionário validado e auto-preenchido. As variáveis de estudo foram as provocações feitas por outros em relação ao peso da adolescente (independente), a satisfação com o corpo (de mediação) e o comportamento de controle do peso (desfecho). As análises de mediação mostraram um efeito estatisticamente significativo (p < 0,05). As taxas de prevalência de provocações relacionadas ao peso, feitas por familiares e colegas, foram 38,5% e 40,6%, respectivamente. Depois de ajustar para a provocação por familiares e colegas, a insatisfação com o próprio corpo esteve associada a comportamentos prejudiciais de controle de peso. Os dados indicam que as provocações por familiares e colegas são aspectos importantes que interferem na satisfação com o corpo e com os comportamentos de controle de peso.

El objetivo fue examinar la mediación en la hipótesis de la insatisfacción corporal y analiza su asociación con las burlas y acoso por el peso y la satisfacción corporal. Un total de 253 niñas que iban a diez escuelas de São Paulo, Brasil, participaron en este estudio. La obtención de datos se llevó a cabo mediante un cuestionario validado y autoinformado. Las variables de estudio fueron acoso por peso (independiente), satisfacción corporal (mediación), y control de peso comportamiento (resultado). El efecto de los análisis de mediación mostró un nivel de significancia del 5% (p < 0.05). La prevalencia de la familia y las burlas/acoso por el peso entre compañeras fueron de un 38,5% y un 40,6%, respectivamente. La insatisfacción corporal se asoció con comportamientos poco saludables de control de peso, cuando estuvo controlada por la familia y las burlas y acoso por el peso entre colegas. Los datos indican que la familia y las burlas/acoso entre compañeras son aspectos importantes que interfieren en la satisfacción corporal y comportamientos sobre el control de peso.

Home food availability, parents'/caregivers' support, and family meals influence on dietary servings of low-income urban adolescent girls from Brazil

BACKGROUND: There is a striking lack of evidence about parents'/caregivers' influence on their children's dietary intake across Brazil and other middle- and low-income countries. Therefore, the purpose of this study was to identify the associations between adolescents' dietary intake and home environment, family meals and parental support. METHODS: Cross-sectional study with 14­18 years old adolescent girls was conducted in 10 public schools in the city of São Paulo. Girls' dietary intake, home food environment, parental support, and family meals' frequency were self-reported by 253 adolescents. Brazilian Food Pyramid recommendation was used as reference for the dietary intake. Linear regressions were used to verify the associations between home environmental, parental support, and family meal frequency with dietary intake. RESULTS: Girls parents' support for healthy eating was positively associated with the fruits group (mean (95%CI) 0.75 (0.66 to 0.84) ß = 0.26,p= 0.003), and the vegetables group (3.40 (3.08 to 3.72, ß = 0.25,p= 0.006)and negatively associated with the meat and eggs group (2.09 (1.93 to 2.25), ß =−0.14,p= 0.041). Home environment was associated with fruits group (0.73 (0.63 to 0.82), ß = 0.35,p= 0.001). The associations between sharing family meals and food groups were not statistically significant. However, girls demonstrated a positive association with dietary intake and sharing family meals. CONCLUSION: Parental support and home food environment were associated with dietary intake of the adolescent girls. Future studies - mainly from low- and middle-income countries - are needed to provide additional evidence on these associations and the effects of youth home environment

Health behavioral theories used to explain dietary behaviors in adolescents: a systematic review

Background: Health behavior theories are useful to interpret adolescents'dietary behaviors. Evidences show that theories are influenced by social and psychological determinants. So, the purpose of this study is to systematically review studies that tested social cognitive theories (non-integrated) that predict adolescents 'dietary behaviors. METHODS: A structured electronic search of all publication years (through April 2016) was conducted to identify studies in MEDLINE, SciELO, PsycINFO, Scopus, and LILACS with full text. Included publications were cross-sectional and longitudinal (non-intervention) studies involving adolescents (10 to 18 years) that examined the associations between constructs of social-cognitive theories and dietary behaviors. Related strings in titles, abstracts, and indexing fields were searched. RESULTS: Theories used to explain dietary intake were the planned behavior and the social cognitive. It wasobserved evidences of positive associations between the social cognitive constructs and the fruits, the vegetables, the milk groups, and the whole-wheat foods (e.g., bread rich in fiber) and negative associations with sugar- sweetened beverages, soft drinks, snacks high in fat, sugar, and/or sodium, and sweet treats. Theories explained greater proportion of variance for intention to dietary intake. The variance for intention ranged from 3% for pizzas, candy bars, candies, and sugar-sweetened beverages to 68% for whole-wheat food (i.e., bread rich in fiber). CONCLUSION:Longitudinal designs are necessary to comprehend the theories and evaluate the behavioral changes. Finally, the use of food groups should be employed in the studies to help the comparisons and present higher reproducibility. Studies always based on objective, systematic, and rigorous evidences

Preventing obesity among Brazilian adolescent girls: Six-month outcomes of the Healthy Habits, Healthy Girls-Brazil school-based randomized controlled trial.

BACKGROUND: School-based trials to prevent and reduce prevalence of pediatric obesity in low-income countries are necessary. In Brazil, addressing adolescent obesity is a public health priority. OBJECTIVE: To evaluate the impact of a group randomized controlled trial involving a 6-month multicomponent school-based obesity prevention program targeting adolescent girls. METHODS: The Healthy Habits, Healthy Girls-Brazil program recruited participants (n=253; 16.05±0.05 years) from ten eligible public technical schools in São Paulo, Brazil. The program was adapted from an Australian intervention study, which is based on the Social Cognitive Theory. The primary outcome measure was body mass index (BMI), and secondary outcomes included BMI z score, waist circumference, and various sedentary and dietary health-related behaviours. RESULTS: Although changes in BMI were not statistically significant, differences favored the intervention group (adjusted mean difference, -0.26kg/m(2),se SE=0.018, p=0.076). Statistically significant intervention effects were found for waist circumference (-2.28cm; p=, p=0.01), computer screen time on the weekends (0.63h/day, p; p=0.02), total sedentary activities on the weekends (-0.92h/day, p<0.01), and vegetable intake (1.16servings/day, p=0.01). CONCLUSION: These findings provide some evidence for the benefit of a school-based intervention to prevent unhealthy weight gain in adolescent girls living in low-income communities.

The "Healthy Habits, Healthy Girls" randomized controlled trial for girls: study design, protocol, and baseline results.

The purpose of this article is to describe the study design, protocol, and baseline results of the "Healthy Habits, Healthy Girls" program. The intervention is being evaluated through a randomized controlled trial in 10 public schools in the city of São Paulo, Brazil. Data on the following variables were collected and assessed at baseline and will be reevaluated at 7 and 12 months: body mass index, waist circumference, dietary intake, nutrition, physical activity, social cognitive mediators, physical activity level, sedentary behaviors, self-rated physical status, and overall self-esteem. According to the baseline results, 32.4% and 23.4% of girls were overweight in the intervention and control groups, respectively, and in both groups a higher percentage failed to meet daily recommendations for moderate and vigorous physical activity and maximum screen time (TV, computer, mobile devices). There were no significant differences between the groups for most of the variables, except age (p = 0.000) and waist circumference (p = 0.014). The study showed a gap in the Brazilian literature on protocols for randomized controlled trials to prevent obesity among youth. The current study may thus be an important initial contribution to the field.