Tools developed in Brazil for the promotion and assessment of adequate and healthy eating habits: A scoping review. / Ferramentas para promoção e avaliação da alimentação adequada e saudável desenvolvidas no Brasil: uma revisão de escopo.

The objective of this study was to identify and discuss the tools for the promotion and evaluation of adequate and healthy eating based on the Food Guide for the Brazilian Population. The scoping review was conducted according to the JBI Manual for Evidence Synthesis via the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and by searching PubMed/MEDLINE, EMBASE, SciELO and LILACS. Sixteen studies on relevant tools, based on the food guide for individuals of all age groups, were thus included: two descriptive studies, two randomized clinical trial protocols, eleven methodological analyses, and one psychometric paper, aimed at either a focal population (n=12) or health professionals (n=4). Six studies addressed tools for promoting adequate and healthy eating, and ten developed tools for evaluating dietary practices or the knowledge and activities of health professionals. This review can therefore assist health professionals in choosing instruments for the implementation and/or dissemination of food guide recommendations, contributing to the promotion of adequate and healthy eating habits.

O objetivo deste estudo foi identificar e discutir as ferramentas de promoção e avaliação da alimentação adequada e saudável baseadas no Guia Alimentar para a População Brasileira. A revisão de escopo foi conduzida de acordo com o JBI Manual for Evidence Synthesis, utilizando para relatório de revisão de escopo o guia Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews, com busca nas bases de dados PubMed/MEDLINE, EMBASE, SciELO e LILACS. Dezesseis estudos sobre ferramentas baseadas no guia alimentar para indivíduos de todas as faixas etárias, foram incluídos: dois descritivos, dois de protocolo de estudo clínico randomizado, onze metodológicos e um psicométrico, direcionados à população (n=12) ou à profissionais de saúde (n=4). Seis estudos abordaram ferramentas para promoção da alimentação adequada e saudável e dez desenvolveram ferramentas para avaliação de práticas alimentares ou de conhecimento e atividades de profissionais da saúde. Esta revisão auxiliará os profissionais de saúde na escolha dos instrumentos para o processo de implementação e, ou, divulgação das recomendações do guia alimentar, contribuindo para a promoção da alimentação adequada e saudável.

Ferramentas para promoção e avaliação da alimentação adequada e saudável desenvolvidas no Brasil: uma revisão de escopo / Tools developed in Brazil for the promotion and assessment of adequate and healthy eating habits: A scoping review

Resumo O objetivo deste estudo foi identificar e discutir as ferramentas de promoção e avaliação da alimentação adequada e saudável baseadas no Guia Alimentar para a População Brasileira. A revisão de escopo foi conduzida de acordo com o JBI Manual for Evidence Synthesis, utilizando para relatório de revisão de escopo o guia Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews, com busca nas bases de dados PubMed/MEDLINE, EMBASE, SciELO e LILACS. Dezesseis estudos sobre ferramentas baseadas no guia alimentar para indivíduos de todas as faixas etárias, foram incluídos: dois descritivos, dois de protocolo de estudo clínico randomizado, onze metodológicos e um psicométrico, direcionados à população (n=12) ou à profissionais de saúde (n=4). Seis estudos abordaram ferramentas para promoção da alimentação adequada e saudável e dez desenvolveram ferramentas para avaliação de práticas alimentares ou de conhecimento e atividades de profissionais da saúde. Esta revisão auxiliará os profissionais de saúde na escolha dos instrumentos para o processo de implementação e, ou, divulgação das recomendações do guia alimentar, contribuindo para a promoção da alimentação adequada e saudável.

Abstract The objective of this study was to identify and discuss the tools for the promotion and evaluation of adequate and healthy eating based on the Food Guide for the Brazilian Population. The scoping review was conducted according to the JBI Manual for Evidence Synthesis via the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and by searching PubMed/MEDLINE, EMBASE, SciELO and LILACS. Sixteen studies on relevant tools, based on the food guide for individuals of all age groups, were thus included: two descriptive studies, two randomized clinical trial protocols, eleven methodological analyses, and one psychometric paper, aimed at either a focal population (n=12) or health professionals (n=4). Six studies addressed tools for promoting adequate and healthy eating, and ten developed tools for evaluating dietary practices or the knowledge and activities of health professionals. This review can therefore assist health professionals in choosing instruments for the implementation and/or dissemination of food guide recommendations, contributing to the promotion of adequate and healthy eating habits.

Acute effect of a beverage containing Brazil and cashew nuts on oxidative stress, lipemia, and blood pressure of women with cardiometabolic risk (Brazilian Nuts Study): a randomized clinical trial.

Nuts are important sources of antioxidants that combat oxidative stress and improve lipid profile as well as vascular function. However, the intake of typical Brazilian nuts and its acute effect on cardiovascular health needs to be better understood. Thus, the present study aimed to evaluate the acute effect of a beverage containing cashew (Anacardium occidentale L.) and Brazil nuts (Bertholletia excelsa H.B.K.) on postprandial oxidative stress, lipemia, and blood pressure of adult women aged 20 to 55 years with cardiometabolic risk. This was an acute, randomized, parallel arm, controlled clinical trial. The participants received either a beverage containing nuts (30 g Brazil nuts + 15 g cashew nuts) or a beverage without nuts with similar macronutrient composition. Oxidative stress markers and lipid profiles were evaluated at fasting and 4 h after beverage consumption. Blood pressure was measured during fasting and after beverage intake (1, 2, 3, and 4 h). In the postprandial state, there was a greater reduction in malondialdehyde levels in the intervention group compared to the control group (-12.3 ± 0.59 vs. -10.7 ± 0.43 µmol/mL; p < 0.05), which was positively correlated with the concentrations of TG (r = 0.399; p < 0.05), VLDL (r = 0.399; p < 0.05), TG/HDL (r = 0.380; p < 0.05), and blood pressure (iAUC SBP r = 0.391; p < 0.05, iAUC DBP r = 0.409; p < 0.05). The remaining oxidative stress markers showed similar postprandial changes between groups. In women with cardiometabolic risk, a beverage containing Brazilian nuts promoted a significant acute reduction on postprandial malondialdehyde levels. The study was registered in the Brazilian Clinical Trials Registry-ReBEC (protocol: RBR-3ntxrm).

Urate-lowering effect of calcium supplementation: Analyses of a randomized controlled trial.

OBJECTIVE: To investigate if the gout-protective effect of low-fat dairy products could be attributed to the urate-lowering effect of calcium. METHODS: This is a placebo-controlled trial in which thirty-five adult (aged 18-42 years) female low-calcium consumers (<800 mg/d) were randomized to one of three treatment groups: low calcium breakfast (control, ∼70 mg of calcium/d) -C or high-calcium breakfast (∼770 mg/d) from calcium citrate - CIT or from skim milk - SM, during 45 consecutive days. Breakfasts were matched for potential confounders and were provided as part of an energy-restricted normoprotein diet containing an additional 800 mg of calcium/d. Dual-energy X-ray absorptiometry measurements (body fat assessment) and fasting blood samples (urate, ionic calcium, PTH, and 1,25-(OH)2-D3) were taken at baseline and the end of the experiment. CLINICAL TRIAL REGISTRATION: http://www.ensaiosclinicos.gov.br/ (RBR-7Q2N33). RESULTS: Despite no significant changes in total body weight/fat, CIT and SM led to a significant reduction in serum urate and ionic calcium, but did not affect PTH and vitamin D concentrations compared to C. CIT and SM reduced baseline serum urate by ∼14% and ∼17%, respectively. There was a trend to a positive correlation between changes in serum urate and changes in ionic calcium on day 45 (r = 0.327, P = 0.055). CONCLUSIONS: Calcium supplementation (770 mg/d from dairy or calcium citrate) reduced serum urate concentrations, suggesting that the gout-protective effect of low-fat dairy consumption is at least partly due to a urate-lowering effect of calcium.

Brazil and cashew nuts intake improve body composition and endothelial health in women at cardiometabolic risk (Brazilian Nuts Study): a randomized controlled trial.

Several mechanisms have been proposed for the beneficial effect of nuts on health. However, Brazil and cashew nuts remain the least studied. We aim to evaluate the effect of these nuts within an energy-restricted diet on body weight, body composition, cardiometabolic markers, and endothelial function in cardiometabolic risk women. Brazilian nuts study is a randomized controlled parallel 8-week dietary intervention trial. Forty women were randomly allocated to 1) Control group: Energy-restricted diet without nuts, n= 19 or, 2) Brazil and cashew nuts group (BN-Group): Energy-restricted diet containing daily 45 g of nuts (15 g of Brazil nuts + 30g of cashew nuts), n= 21. At the beginning and final intervention, anthropometry, body composition, and blood pressure were measured. Fasting blood sampling was obtained to evaluate lipid profile, glucose homeostasis, and endothelial function markers. After 8-week, plasma selenium concentration increased in BN-group (∆ = + 31.5 ± 7.8 µg/L; p= 0.001). Brazil and cashew nuts intake reduced total body fat (-1.3 ± 0.4 %) parallel to improvement of lean mass percentage in BN-group compared to the control. Besides, the soluble adhesion molecule VCAM-1 decreased (24.03 ± 15.7 pg/mL vs. -22.2 ± 10.3 pg/mL; p= 0.019) after Brazil and cashew nuts intake compared to the control. However, lipid and glucose profile markers, apolipoproteins, and blood pressure remained unchanged after the intervention. Thus, the addition of Brazil and cashew nuts to an energy-restricted diet can be a healthy strategy to improve body composition, selenium status, and endothelial inflammation in cardiometabolic risk women.

Visceral adiposity index is positively associated with blood pressure: A systematic review.

PURPOSE: This systematic review aimed to investigate the association between VAI and blood pressure. METHODS: The study was according to the PRISMA standards and the bibliographic search in the PubMed, EMBASE and Cochrane Library databases. RESULTS: This review included 32 articles, with 60,482 individuals - children to elderly people between 7 and 102 years old - of different age groups, most of them female (54.9%; n = 26,478). The year of publication ranged from 2010 to 2020, indicating that it is a recent theme, applied in almost all continents (America, Europe, Africa and Asia). The authors used data as continuous or into quantiles; blood pressure data also varied, with different cutoff points for the classification of arterial hypertension or continuously. The vast majority of studies have shown a positive association between VAI and blood pressure, both the sexes, in different age groups. The evaluation of the quality of the articles used by the Tool of the Joanna Briggs Institute according to their design. CONCLUSION: Individuals with increased VAI have higher blood pressure levels. Registration (PROSPERO: CRD42020205965).

Can resveratrol modulate sirtuins in obesity and related diseases? A systematic review of randomized controlled trials.

PURPOSE: Human sirtuins can be a powerful therapeutic target in preventing and treating obesity and age-related diseases. Some dietary components can modulate sirtuins' activity, such as resveratrol. This systematic review aimed to assess whether resveratrol (RSV), without other interventions, can stimulate sirtuins in the treatment of excess weight and its comorbidities. METHODS: MEDLINE/Pubmed, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) were used for search eligible articles. Randomized clinical trials assessing RSV supplementation on changes in the sirtuins' gene expression/protein levels was the primary outcome. Other possible changes in cardiometabolic markers were considered the second outcome. Following PRISMA guidelines and using predefined inclusion and exclusion criteria, two reviewers independently and in parallel screened, assessed the studies' quality, and compiled data. Disagreements were resolved by consensus or consulting a third author. RESULTS: This review included seven randomized control trials. Four articles demonstrated a significant increase in SIRT-1 with different RSV dosages and interventions time. The secondary outcomes showed improvements in insulin sensitivity, lipid profile, metabolic flexibility, total antioxidant capacity, energy expenditure changes, and reduction of ectopic accumulation of fat. CONCLUSION: Data from RCTs studies showed that RSV supplementation could stimulate SIRT-1 in humans, and therefore contribute to the treatment of excess weight and its comorbidities. However, more research is needed because it was not possible to confirm this effect truly. [PROSPERO registration number: CRD42020205571].

Acute consumption of a shake containing cashew and Brazil nuts did not affect appetite in overweight subjects: a randomized, cross-over study.

PURPOSE: Evidence from epidemiological and clinical studies suggests that nut consumption provides satiety and may contribute to the management of obesity. However, the effect of acute intake of nuts on appetite responses remains unclear. The objective of this study was to evaluate the acute effect of a shake containing 30 g of cashew nuts (Anacardium occidentale L.) and 15 g of Brazil nuts (Bertholletia excelsa H.B.K) on appetite responses in overweight subjects. METHODS: This was a clinical, randomized, controlled, single-blind, cross-over, pilot study. On two non-consecutive test days, 15 subjects received a shake containing nuts, and a shake absent of nuts matched for energy and macronutrient content. Subjective appetite sensation was evaluated by visual analogue scales (VAS). Food intake was measured by weighing the lunch served at the end of each morning-test, which subjects ate ad libitum. Total energy intake was estimated by food records. This study is registered on the Brazilian Registers of Clinical Trials-ReBEC (protocol: U1111-1203-9891). RESULTS: We observed no significant difference in subjective appetite sensations between the groups. Food intake at lunch, as well as energy intake throughout the day also did not differ between the treatments. CONCLUSION: Our results suggest that the acute intake of a shake containing nuts was not able to enhance satiety, compared to a shake matched for energy and macronutrient content. Further studies are warranted to elucidate the satiety mechanisms of nuts intake.

Triglyceride-glucose index predicts independently type 2 diabetes mellitus risk: A systematic review and meta-analysis of cohort studies.

OBJECTIVE: Our objective was to perform a systematic review and meta-analysis of cohort studies evaluating the triglyceride-glucose (TyG) index as a tool for type 2 diabetes (T2D) prediction in adults and older adults. METHODS: Studies were identified in PubMed, Cochrane, Scopus, and Lilacs. Studies with cohort design, which evaluated the T2D incidence through the hazard ratio (HR) or relative risk (RR) or odds ratio values were included. Were included both studies that evaluated the incidence of T2D from tertiles, quartiles, quintiles, or single TyG index values. First, a meta-analysis only for studies that reported data in HR values was performed. Additionally, given the different association measurements used, the number of T2D cases, non-T2D cases, and the total number of participants were extracted from exposed and non-exposed groups when available. Then the risk ratio was calculated. A meta-analysis using the inverse variance method and the random-effects model was performed. Heterogeneity was assessed by I2 statistics and by inspecting funnel plots. RESULTS: Thirteen cohort studies with a total of 70,380 subjects, both sexes, adults, and older adults were included in the meta-analysis. Ten studies showed a significant association of the TyG index with T2D risk through HR estimative (overall HR: 2.44, 95% CI: 2.17-2.76). After estimating RR for nine studies, we also observed a significant association of the TyG index with T2D risk (RR: 3.12, 95 CI: 2.31-4.21). For all analyses, high heterogeneity was verified by I2 and visual inspection of funnel plots. CONCLUSIONS: TyG index has a positive and significant association with T2D risk, suggesting that the TyG index may become an applicable tool to identify subjects with T2D risk. However, due to the high heterogeneity observed in overall HR and RR analysis, more studies could be necessary to confirm these results.

Personalized Nutrition Using PROCARDIO to Reduce Cardiometabolic Risk in the Academic Community: A Study Protocol with Preliminary Results.

Background: Strategies of promotion, prevention and health care of individuals with cardiometabolic risk are necessary to control cardiovascular diseases.Objective: To describe a study design and present partial results of nutritional counseling in the Cardiovascular Health Care Program (PROCARDIO).Methods: PROCARDIO is a nutritional intervention program for students and workers or dependents of the Brazilian university academic community who are at risk of or have a cardiovascular disease (Brazilian Registry of Clinical Trials n° RBR-5n4y2g). Patients are submitted to nutritional clinical assessments involving anthropometry, biochemical analysis, sociodemographic and clinical, lifestyle and dietary data. Patients are provided with nutritional counseling, dietetic workshops and educational materials. In addition, nutritional following-ups are performed monthly.Results: The sample consisted of 296 patients (171 F/125 M, 27-56 years). The prevalence of individuals with excess body weight, dyslipidemia, diabetes and hypertension in the sample were 74.7% (n = 222), 79.1% (n = 235), 18.2% (n = 54) and 25.3% (n = 75), respectively. After three months of nutritional counseling, PROCARDIO users had decreased body fat, waist circumference, fasting blood glucose, total cholesterol and LDL-C (p < 0.05). Specifically, patients with diabetes exhibited reduced glycated hemoglobin concentrations (p < 0.05); those with dyslipidemia showed a reduction in total cholesterol, LDL-C and LDL/HDL (p < 0.05) concentrations; and those with excess body weight reduced waist circumference, waist-to-hip ratio, body fat, uric acid and total cholesterol/HDL-C ratios (p < 0.05).Conclusion: PROCARDIO patients concluded with a clinical-metabolic improvement regardless of chronic diseases after receiving nutritional counseling, thus highlighting the importance of individual actions and strategies to be based on personalized nutrition for achieving proposed therapeutic targets.

Effects of blueberry and cranberry consumption on type 2 diabetes glycemic control: A systematic review.

The metabolic effects of cranberry and blueberry consumption on glycemic control have been evaluated in vitro and in animal models as well as in human studies, although findings have not been systematically reviewed yet. Therefore, a systematic review was carried out of relevant randomized clinical trials (RCTs) in order to assess the effect of berries (blueberry and cranberry) consumption on type 2 diabetes (T2DM) glycemic control. Some evidences were also discussed on the anti-diabetic mechanisms exerted by berries polyphenols. Studies were identified by searching electronic databases: LILACS, PubMed/MEDLINE, Scopus, The Cochrane Library and Web of Science. Three authors independently searched and extracted RCTs in which the effect of berries (cranberry or blueberry) consumption on T2DM glycemic control was assessed. A total of 7 RCTs, involving 270 adults with type 2 diabetes were included. Despite the heterogeneity of the administration forms (in natura, dried, extract, preparations - juice), dosage, duration of the intervention and type of population of the studies involving these two berries some studies highlight the potential benefit of berries, especially of blueberry, on glucose metabolism in T2DM subjects. Daily cranberry juice (240 mL) consumption for 12 weeks and blueberry extract or powder supplementation (9.1 to 9.8 mg of anthocyanins, respectively) for 8 to 12 weeks showed a beneficial effect on glucose control in T2DM subjects. Those results indicate a promising use of these berries in T2DM management; although more studies are required to better understand the mechanisms involved.

Impact of dietary fat on gut microbiota and low-grade systemic inflammation: mechanisms and clinical implications on obesity.

Dietary fat strongly affects human health by modulating gut microbiota composition and low-grade systemic inflammation. High-fat diets have been implicated in reduced gut microbiota richness, increased Firmicutes to Bacteroidetes ratio, and several changes at family, genus and species levels. Saturated (SFA), monounsaturated (MUFA), polyunsaturated (PUFA) and conjugated linolenic fatty acids share important pathways of immune system activation/inhibition with gut microbes, modulating obesogenic and proinflammatory profiles. Mechanisms that link dietary fat, gut microbiota and obesity are mediated by increased intestinal permeability, systemic endotoxemia, and the activity of the endocannabinoid system. Although the probiotic therapy could be a complementary strategy to improve gut microbiota composition, it did not show permanent effects to treat fat-induced dysbiosis. Based upon evidence to date, we believe that high-fat diets and SFA consumption should be avoided, and MUFA and omega-3 PUFA intake should be encouraged in order to regulate gut microbiota and inflammation, promoting body weight/fat control.

Polyunsaturated fatty acids and type 2 diabetes: Impact on the glycemic control mechanism.

There is a growing mortality related to co-morbidities associated with diabetes mellitus. Intake of polyunsaturated fatty acids (PUFA) has been associated with low cardiometabolic risk and reduction of inflammatory process. The objective of this paper is to review the impact of PUFA intake on glycemic control in diabetic patients as well as to elucidate the possible mechanisms involved. Medline/PubMed electronic database was searched to identify studies published within last five years regarding the effect of PUFA intake on glucose metabolism in type 2 diabetics. The search terms used were "polyunsaturated fatty acid(s)," "PUFA," and "diabetes." We included only interventional studies that assessed the effects of PUFA intake on glucose metabolism - fasting glucose, serum insulin, HbA1c, and HOMA-IR assessment- in type 2 diabetics. Initially, 48 articles were identified, of which one was not available and 41 did not match the inclusion criteria. Within the selected studies, three articles showed an improvement in fasting blood glucose, two showed an increase in fasting glycemia, and there was no effect of intervention in one article only. Based on the analyzed clinical interventional studies, supplementation of 0.42-5.2-g PUFA/day for at least eight weeks may become an alternative treatment for type 2 diabetes mellitus, particularly in Asian subjects.

Consumo de carotenoides e polifenóis em indivíduos com risco cardiometabólico / Carotenoid and polyphenol consumption in subjects with cardiometabolic risk

Introdução: Os compostos bioativos possuem um importante papel antioxidante e proporcionam um tratamento adjuvante no combate às Doenças Crônicas Não Transmissíveis. Objetivo: Determinar o consumo atual de compostos bioativos (carotenoides e polifenóis) em indivíduos com risco cardiometabólico. Metodologia: Estudo transversal com 227 sujeitos participantes do Programa de Atenção à Saúde Cardiovascular da Universidade Federal de Viçosa. Foram coletados dados de ingestão alimentar atual para determinação do consumo de carotenoides, polifenóis, micro e macronutrientes utilizando um recordatório 24 horas. Dados antropométricos, de composição corporal, sociodemográficos e de estilo de vida também foram avaliados. O teste de Mann Whitney e correlação de Spearman foram realizados no SPSS v.20.0, com significância de p2,52 mg/dia) obtiveram menores valores de gordura corporal total (p<0,001). Conclusão: Nossos resultados indicam que um maior consumo de quempferol esteve relacionado com menores valores de indicadores de adiposidade total. Porém, mais estudos são necessários para se estabelecer os mecanismos envolvidos em seus potenciais benefícios em relação à adiposidade e resposta metabólica (AU)

Introduction: The bioactive compounds play an important antioxidant role and provide an adjuvant treatment to fight Chronic Noncommunicable Diseases. Objective: To determine the current intake of bioactive compounds (carotenoids and polyphenols) in subjects with cardiometabolic risk. Methods: Cross-sectional study of 227 subjects who participated in the Cardiovascular Health Care Program of the Federal University of Viçosa. Data of current dietary intake were collected for the determination of carotenoids, polyphenols, micronutrients and macronutrients consumption using a 24-hour recall. Data of anthropometry, body composition, sociodemographic conditions and lifestyle were also evaluated. The Mann Whitney test and Spearman correlation were performed using SPSS v.20.0, with significance of p 2.52 mg / day) had lower values of total body fat (p< 0.001). Conclusion: Our results indicate that a higher intake of kaempferol was associated with lower values of total adiposity indicators. However, more studies are necessary to establish the mechanisms involved in their potential benefits regarding adiposity and metabolic response (AU)