Intake of Table Sugar and Their Corresponding Food Sources in Adults from the 2017-2018 Brazilian National Dietary Survey.

Excessive intake of free sugars is associated with adverse health outcomes. Table sugar is one of the main dietary sources of free sugars; however, the amount added by Brazilian consumers in their culinary preparations is unknown. The aims were to estimate the daily intake of table sugar (g/day), its contribution to total energy intake (E%) and the main food groups that contribute to the intake of this sugar in a nationwide multi-ethnic sample of Brazilian adults (2017-2018 Brazilian National Dietary Survey). Based on two 24-h recalls adjusted for the within-person variation, the overall median table sugar intake was 14.3 g/day, corresponding to 3.2 E%. Males, individuals living in rural areas, with low income, low education and experiencing food insecurity had a higher intake of table sugar. The main food sources of table sugar were coffee (55.8%), juice (33.9%), milk-based preparations and smoothies (3.1%), powdered and processed juice (2.7%), whole milk (1.9%), and tea (1.6%). There are no recommendations regarding the limit of table sugar intake, but considering that the WHO limits the intake of free sugars to <10 E%, it is concluded that table sugar intake by Brazilians corresponds to about 30% of the upper recommended daily intake of free sugars.

Associations between Four Diet Quality Indexes and High Blood Pressure among Adults: Results from the 2015 Health Survey of Sao Paulo.

Several dietary quality indexes (DQIs) have been proposed to investigate adherence to a healthy diet. However, only a few studies have been conducted to investigate their association with high blood pressure (BP) in Brazil. In the present work, we examine the association between four established DQIs-2020 Healthy Eating Index (HEI-2020), Dietary Approaches to Stop Hypertension (DASH), Alternative Healthy Eating Index (AHEI), and Brazilian Healthy Eating Index (BHEI)-and high BP in a cross-sectional sample of Brazilian adults from the 2015 Health Survey of São Paulo with Focus on Nutrition. Based on two 24 h recalls adjusted for the within-person variation, higher HEI-2020 and BHEI total scores were inversely related to elevated BP (HEI-2020: OR 0.94, BHEI: OR 0.95). Individuals at the second quartile (OR 0.33) and the fourth quartile of BHEI (OR 0.35), as well as individuals with higher scores on dairy components (HEI-2020: OR 0.80, BHEI: OR 0.83, DASH: OR 0.75), and fruit components (AHEI: OR 0.82, HEI-2020: OR 0.72, BHEI: OR 0.77, DASH: OR 0.79) also presented lower odds for the occurrence of elevated BP. In conclusion, healthier diet quality using the HEI-2020 and BHEI indexes and the fruit and dairy components were identified as protective factors for high BP.

The environmental impact of beef and ultra-processed food consumption in Brazil.

OBJECTIVE: This study evaluated the independent and combined environmental impacts of the consumption of beef and ultra-processed foods in Brazil. DESIGN: Cross-sectional study. SETTING: Brazil. PARTICIPANTS: We used food purchases data from a national household budget survey conducted between July 2017 and July 2018, representing all Brazilian households. Food purchases were converted into energy, carbon footprints and water footprints. Multiple linear regression models were used to assess the association between quintiles of beef and ultra-processed foods in total energy purchases and the environmental footprints, controlling for sociodemographic variables. RESULTS: Both beef and ultra-processed foods had a significant linear association with carbon and water footprints (P < 0·01) in crude and adjusted models. In the crude upper quintile of beef purchases, carbon and water footprints were 47·7 % and 30·8 % higher, respectively, compared to the lower quintile. The upper quintile of ultra-processed food purchases showed carbon and water footprints 14·4 % and 22·8 % higher, respectively, than the lower quintile. The greatest reduction in environmental footprints would occur when both beef and ultra-processed food purchases are decreased, resulting in a 21·1 % reduction in carbon footprint and a 20·0 % reduction in water footprint. CONCLUSIONS: Although the environmental footprints associated with beef consumption are higher, dietary patterns with lower consumption of beef and ultra-processed foods combined showed the greatest reduction in carbon and water footprints in Brazil. The high consumption of beef and ultra-processed foods is harmful to human health, as well as to the environment; thus, their reduction is beneficial to both.

Fatores sociodemográficos e comportamentais da obesidade: um estudo longitudinal / Obesity sociodemographic and behavioral factors: a longitudinal study / Factores sociodemográficos y conductuales de la obesidad: un estudio longitudinal

Resumo: O objetivo foi investigar a associação entre fatores sociodemográficos e comportamentais e a ocorrência da obesidade entre 2014 e 2021 em adultos da cidade de São Paulo, Brasil. Realizou-se estudo prospectivo com 1.241 adultos paulistanos, com 18 anos ou mais, participantes da coorte Inquérito de Saúde de São Paulo (ISA) - Atividade Física e Ambiente. O desfecho foi obesidade (sim/não), classificada por meio do índice de massa corporal e com pontos de corte específicos para cada faixa etária. As variáveis de exposição foram: sexo, idade, escolaridade, cor da pele, estado marital, coordenadoria regional de saúde, atividade física nos quatro domínios e comportamentos sedentários. Foram utilizados modelos de regressão logística multinível para a análise longitudinal. Houve aumento significativo de 27,7% na prevalência de obesidade (de 22,6% para 28,9%). Pessoas que praticavam ao menos 150 minutos semanais de atividade física no lazer (OR = 0,44; IC95%: 0,26; 0,76), entre 10 e 150 minutos semanais de atividade física de deslocamento (OR = 0,49; IC95: 0,30; 0,80) e sem companheiro(a) (OR = 0,47; IC95%: 0,28; 0,78) tiveram menos chances de ter obesidade. Pessoas entre 40 e 59 anos (OR = 5,00; IC95%: 2,02; 12,38) e de cor de pele preta (OR = 4,70; IC95%: 1,85; 11,95) apresentaram maiores chances de ter obesidade. O estudo identificou um aumento na prevalência de obesidade durante o período, com aumento nas chances para pessoas de meia idade e cor da pele preta, e diminuição nas chances para pessoas que vivem sem companheiro(a) e para praticantes de atividades físicas no lazer e como forma de deslocamento. Esses resultados podem contribuir para dar suporte a programas e políticas para o controle da obesidade.

Abstract: This study aimed to investigate the association between sociodemographic and behavioral factors and obesity from 2014 to 2021 in adults in São Paulo city, Brazil. A prospective study was carried out with 1,241 adults aged 18 years or above who lived in São Paulo and participated in the São Paulo Health Survey cohort (ISA) - Physical Activity and Environment. The outcome was obesity (yes/no), classified by body mass index and specific cut-off points for each age group. The exposure variables included sex, age, education, skin color, marital status, regional health coordination, physical activity in the four domains, and sedentary behaviors. Multilevel logistic regression models were used for longitudinal analysis. This study found a significant increase (27.7%) in the prevalence of obesity (from 22.6% to 28.9%). People who practiced at least 150 minutes of leisure-time physical activity per week (OR = 0.44; 95%CI: 0.26; 0.76), between 10 and 150 minutes per week of commuting physical activity (OR = 0.49; 95%CI: 0.30; 0.80), and had no partner (OR = 0.47; 95%CI: 0.28; 0.78) were less likely to be obese. People aged from 40 to 59 years (OR = 5.00; 95%CI: 2.02; 12.38) and who were black (OR = 4.70; 95%CI: 1.85; 11.95) were more likely to be obese. This study found an increase in the prevalence of obesity during the studied period, with increased odds for middle-aged and black people and decreased odds for those without a partner and those who practice physical activities in their leisure and as a form of commuting. These results can contribute to support programs and policies to control obesity.

Resumen: El objetivo fue investigar la asociación entre factores sociodemográficos y conductuales y la presencia de la obesidad entre 2014 y 2021 en adultos de la ciudad de São Paulo, Brasil. Se realizó un estudio prospectivo con 1.241 adultos paulistanos, con 18 años o más, participantes de la cohorte Encuesta de Salud de São Paulo (ISA) - Actividad Física y Ambiente. El resultado fue obesidad (sí/no), clasificada a través del índice de masa corporal y con puntos de corte específicos para cada grupo de edad. Las variables de exposición fueron: sexo, edad, escolaridad, color de la piel, estado civil, coordinación regional de salud, actividad física en los cuatro dominios y comportamientos sedentarios. Para los análisis longitudinales se utilizaron modelos de regresión logística multinivel. Hubo un aumento significativo del 27,7% en la prevalencia de la obesidad (del 22,6% al 28,9%). Las personas que practicaron al menos 150 minutos semanales de actividad física por ocio (OR = 0,44; IC95%: 0,26; 0,76), entre 10 y 150 minutos semanales de actividad física de desplazamiento (OR = 0,49; IC95%: 0,30; 0,80) y sin compañero(a) (OR = 0,47; IC95%: 0,28; 0,78) tuvieron menos probabilidades de tener obesidad. Las personas entre 40 y 59 años (OR = 5,00; IC95%: 2,02; 12,38) y de color de piel negra (OR = 4,70; IC95%: 1,85; 11,95) presentaron mayores probabilidades de tener obesidad. El estudio identificó un aumento en la prevalencia de la obesidad durante ese período, con un aumento en las posibilidades para las personas de mediana edad y color de la piel negra, y una disminución en las posibilidades para las personas que viven sin pareja y para las que realizan actividades físicas por ocio y como forma de desplazamiento. Estos resultados pueden contribuir a apoyar los programas y políticas para el control de la obesidad.

Prevalence and maternal determinants of early and late introduction of complementary foods: results from the Growing Up in New Zealand cohort study.

A nationally generalisable cohort (n 5770) was used to determine the prevalence of non-timely (early/late) introduction of complementary food and core food groups and associations with maternal sociodemographic and health behaviours in New Zealand (NZ). Variables describing maternal characteristics and infant food introduction were sourced, respectively, from interviews completed antenatally and during late infancy. The NZ Infant Feeding Guidelines were used to define early (≤ 4 months) and late (≥ 7 months) introduction. Associations were examined using multivariable multinomial regression, presented as adjusted relative risk ratios and 95 % confidence intervals (RRR; 95% CI). Complementary food introduction was early for 40·2 % and late for 3·2 %. The prevalence of early food group introduction were fruit/vegetables (23·8 %), breads/cereals (36·3 %), iron-rich foods (34·1 %) and of late were meat/meat alternatives (45·9 %), dairy products (46·2 %) and fruits/vegetables (9·9 %). Compared with infants with timely food introduction, risk of early food introduction was increased for infants: breastfed < 6months (2·52; 2·19-2·90), whose mothers were < 30 years old (1·69; 1·46-1·94), had a diploma/trade certificate v. tertiary education (1·39; 1·1-1·70), of Maori v. European ethnicity (1·40; 1·12-1·75) or smoked during pregnancy (1·88; 1·44-2·46). Risk of late food introduction decreased for infants breastfed < 6 months (0·47; 0.27-0·80) and increased for infants whose mothers had secondary v. tertiary education (2·04; 1·16-3·60) were of Asian v. European ethnicity (2·22; 1·35, 3·63) or did not attend childbirth preparation classes (2·23; 1·24-4·01). Non-timely food introduction, specifically early food introduction, is prevalent in NZ. Interventions to improve food introduction timeliness should be ethnic-specific and support longer breast-feeding.

Custo e tempo como obstáculos para uma alimentação saudável entre universitários / Cost and time as obstacles to healthy eating among university students

Introdução: O Guia Alimentar para a População Brasileira aborda a compreensão e superação de potenciais obstáculos para a adoção de uma alimentação saudável, entre eles, custo dos alimentos e tempo. Objetivo: Investigar a ocorrência de tempo e custo enquanto obstáculos para uma alimentação adequada e saudável e sua associação com fatores demográficos e socioeconômicos em universitários. Método: Estudo transversal realizado de abril a maio de 2019. Os desfechos avaliados foram custo e tempo. As variáveis de exposição foram sexo, idade, composição de moradia, trabalho remunerado, classe econômica e turno de estudo. Resultados: Participaram da pesquisa 207 estudantes. Sobre o custo dos alimentos, 76,3% já deixaram de comprar frutas, verduras e/ou legumes devido ao preço. Em relação ao tempo, 69,9% já deixaram de preparar alguma refeição por falta de tempo. Custo se associou com sexo masculino, idade igual ou superior a 30 anos, morar com amigos, estudar no período noturno e/ou estar na classe econômica mais baixa; já tempo se associou com sexo masculino, idade inferior a 30 anos, morar sozinho, estudar no período diurno/integral e/ou não trabalhar. Conclusão: Grande proporção dos universitários enfrenta dificuldades, relativas a tempo e custo dos alimentos, para ter uma alimentação adequada e saudável.

Introduction: The Dietary Guidelines for the Brazilian Population addresses the understanding and overcoming of potential obstacles to adopting a healthy diet, including food costs and time. Objective: To investigate the occurrence of time and cost as obstacles to adequate and healthy eating and its association with demographic and socioeconomic factors in university students. Method: Cross-sectional study carried out from April to May 2019. The evaluated outcomes were cost and time. Exposure variables were sex, age, household composition, paid work, economic class and study shift. Results: 207 students participated in the research. Regarding the cost of food, 76.3% have already stopped buying fruits and/or vegetables due to the price. Regarding time, 69.9% have already stopped preparing a meal due to lack of time. Cost was associated with male gender, age equal to or greater than 30 years, living with friends, studying at night and/or being in the lowest economic class; time has been associated with being male, younger than 30 years old, living alone, studying daytime/full time and/or not working. Conclusion: A large proportion of university students face difficulties, related to time and food costs, to have a proper and healthy diet.

Omissão do café da manhã entre adolescentes brasileiros: resultados da PeNSE 2012 e 2015 / Skipping breakfast among Brazilian adolescents: results from PeNSE 2012 and 2015

Resumo Introdução: São restritos os estudos que apresentam estimativas com representatividade nacional sobre omissão do café da manhã entre adolescentes brasileiros. Objetivo: Estimar a prevalência da omissão do café da manhã entre estudantes adolescentes brasileiros, segundo características sociodemográficas, nos anos de 2012 e 2015. Método: Análise realizada com os dados da Pesquisa Nacional de Saúde do Escolar, com escolares do 9º, ano nos anos de 2012 e 2015. Foi estimada a prevalência de omissão do café da manhã (consumo por menos de cinco dias por semana), segundo sexo, faixa etária, dependência administrativa da escola e região do país, considerando o desenho complexo da amostra. Resultados: A prevalência de omissão do café da manhã verificada foi de 38,1% em 2012 e 35,6% em 2015, sendo mais elevada entre meninas e estudantes de escolas privadas. A omissão dessa refeição foi mais elevada entre os escolares das regiões Sul, Sudeste e Centro-Oeste. As capitais brasileiras pertencentes às regiões Sul e Centro-Oeste apresentaram as maiores prevalências de omissão do café da manhã. Conclusões: Não houve alteração significativa da prevalência de omissão de café da manhã entre os dois inquéritos realizados, sendo maior a sua omissão entre as meninas, estudantes de escolas públicas e de regiões mais desenvolvidas.

Abstract Background: There is limited research presenting nationally representative estimates regarding breakfast omission among Brazilian adolescents. Objective: The objective of this study was to estimate the prevalence of breakfast omission among Brazilian adolescent students, considering sociodemographic characteristics, in the years 2012 and 2015. Method: An analysis was conducted using data from the National School Health Survey, including 9th grade students in the years 2012 and 2015. The prevalence of breakfast omission (defined as consumption on fewer than 5 days per week) was estimated based on gender, age group, school administrative dependence, and region of the country, considering the complex sample design. Results: The prevalence of breakfast omission observed was 38.1% in 2012 and 35.6% in 2015, with higher rates among girls and students from private schools. Omission of this meal was more common among students in the South, Southeast, and Central West regions. Brazilian capitals located in the South and Central West regions exhibited the highest prevalence of breakfast omission. Conclusions: There was no significant change in the prevalence of breakfast omission between the two surveys, and its omission was higher among girls, students from public schools, and in more developed regions.

Indicadores antropométricos em povos e comunidades tradicionais do Brasil: análise de registros individuais do Sistema de Vigilância Alimentar e Nutricional, 2019 / Anthropometric indicators in traditional peoples and communities in Brazil: analysis of individual records from the Food and Nutrition Surveillance System, 2019 / Indicadores antropométricos en pueblos y comunidades tradicionales en Brasil: análisis de registros individuales del Sistema de Vigilancia Alimentaria y Nutricional, 2019

Objective: To describe the prevalence of underweight and obesity indicators among individuals registered as traditional peoples and communities in the Food and Nutrition Surveillance System, across Brazil, in 2019. Methods: This was a descriptive study using individual secondary data from participants receiving care in the Primary Health Care within the Brazilian National Health System. Results: In the study population (N = 13,944), there was a higher prevalence of short stature among male children and adolescents (14.2%), when compared to their female counterparts (11.8%); in the adult female population, there was a higher prevalence of obesity (23.0%), when compared to the male population (11.3%); the prevalence of low height-for-age in riverine communities (18.5%) and obesity in the adult faxinalense population (75.1%) stood out. Conclusion: Anthropometric disparities between different communities require tailored responses, emphasizing targeted primary health care and programs to ensure food and nutrition security.

Objetivo: Describir la prevalencia de indicadores de bajo peso y obesidad entre individuos registrados como pueblos y comunidades tradicionales en el Sistema de Vigilancia Alimentaria y Nutricional, en todo Brasil, en 2019. Métodos: Estudio descriptivo, con datos secundarios individuales de participantes atendidos en atención primaria de Salud del Sistema Único de Salud. Resultados: En la población estudiada (N = 13.944), hubo mayor prevalencia de talla baja en niños y adolescentes en el sexo masculino (14,2%), cuando se compara con el femenino (11,8%); en la población adulta femenina hubo mayor prevalencia de obesidad (23,0%), en comparación con la masculina (11,3%); se destacó la prevalencia de baja talla para la edad en comunidades ribereñas (18,5%), y obesidad en la población adulta faxinalense (75,1%). Conclusiones: Las heterogeneidades antropométricas entre comunidades requieren respuestas adaptadas, con énfasis en la atención primaria de salud y en garantizar la seguridad alimentaria y nutricional.

Objetivo: Descrever a prevalência de indicadores de baixo peso e de obesidade entre os indivíduos registrados como povos e comunidades tradicionais no Sistema de Vigilância Alimentar e Nutricional, de todo o Brasil, em 2019. Métodos: Estudo descritivo, com dados individualizados secundários de participantes atendidos na Atenção Básica do Sistema Único de Saúde. Resultados: Na população estudada (N = 13.944), houve maior prevalência de altura baixa entre crianças e adolescentes do sexo masculino (14,2%), quando comparados aos do sexo feminino (11,8%); na população adulta do sexo feminino, observou-se maior prevalência de obesidade (23,0%), quando comparada à do sexo masculino (11,3%); destacou-se a prevalência de altura baixa para a idade nas comunidades ribeirinhas (18,5%), e de obesidade na população adulta faxinalense (75,1%). Conclusões: As heterogeneidades antropométricas entre as comunidades exigem respostas adaptadas, com ênfase na atenção primária à saúde e na garantia da segurança alimentar e nutricional.

Evaluación de las ingestas dietéticas y prácticas alimentarias en niños de 6 a 23 meses en una localidad del noreste argentino / Assessment of dietary intakes and feeding practices in children aged 6­23 months in a town in the Northeast region of Argentina

Introducción. Una alimentación complementaria adecuada en cantidad y calidad resulta esencial durante los primeros dos años de vida. El objetivo del estudio fue evaluar la ingesta de nutrientes y prácticas alimentarias en niños de 6 a 23 meses de una localidad del noreste argentino. Población y métodos. Estudio descriptivo transversal (segundo semestre del 2019). Se evaluaron las ingestas de 24 horas mediante recordatorios a los cuidadores de niños de 6 a 23 meses. Los datos se compararon con las ingestas dietéticas de referencia. Las prácticas alimentarias se evaluaron según los indicadores establecidos por la Organización Mundial de la Salud. Resultados. Se evaluaron 138 niños de 6 a 23 meses de edad. La energía y las vitaminas A, D y E presentaron porcentajes medios de adecuación inferiores al 100 % en todas las edades, mientras que las proteínas alcanzaron una adecuación promedio del 142,8 % y el 168,1 % para los niños de 7-12 meses y de 13-23 meses, respectivamente. Los nutrientes que presentaron una proporción considerable de casos con ingestas por debajo del requerimiento promedio estimado en todos los grupos fueron la energía y la vitamina A. En cuanto a los indicadores de prácticas alimentarias, 50,8 % de los lactantes recibió una dieta mínima aceptable. Conclusiones. Existe una alta prevalencia de inadecuación energética y de nutrientes críticos durante la alimentación complementaria en los niños de 6 a 23 meses incluidos en el estudio. Intervenciones nutricionales que promuevan prácticas alimentarias que mejoren la ingesta de micronutrientes serían de suma importancia para su salud actual y futura.

Introduction. An adequate quantity and quality of complementary feeding is essential during the first 2 years of life. The objective of this study was to assess dietary intakes and feeding practices in children aged 6­23 months in a town in the Northeast region of Argentina. Population and methods. Descriptive, cross-sectional study (second semester of 2019). Intakes from 24-hour dietary recall interviews conducted among caregivers of children aged 6­23 months were assessed. Data were compared to dietary reference intakes. Feeding practices were assessed as per the World Health Organization's indicators. Results. A total of 138 children aged 6­23 months were assessed. The mean adequacy ratio of energy and vitamins A, D, and E was below 100% for all ages, whereas the protein adequacy for children aged 7-12 and 13-23 months was 142.8% and 168.1%, respectively. A remarkable number of cases had energy and vitamin A intakes below the estimated average requirement. In relation to feeding practice indicators, 50.8% of infants received a minimum acceptable diet. Conclusions. There is a high prevalence of an inadequate level of energy and critical nutrient intake during complementary feeding of the children aged 6­23 months included in the study. Nutritional interventions that promote feeding practices to improve micronutrient intake would be highly important for children's current and future health.

Assessment of dietary intakes and feeding practices in children aged 6-23 months in a town in the Northeast region of Argentina. / Evaluación de las ingestas dietéticas y prácticas alimentarias en niños de 6 a 23 meses en una localidad del noreste argentino.

INTRODUCTION: An adequate quantity and quality of complementary feeding is essential during the first 2 years of life. The objective of this study was to assess dietary intakes and feeding practices in children aged 6-23 months in a town in the Northeast region of Argentina. POPULATION AND METHODS: Descriptive, crosssectional study (second semester of 2019). Intakes from 24-hour dietary recall interviews conducted among caregivers of children aged 6-23 months were assessed. Data were compared to dietary reference intakes. Feeding practices were assessed as per the World Health Organization's indicators. RESULTS: A total of 138 children aged 6-23 months were assessed. The mean adequacy ratio of energy and vitamins A, D, and E was below 100% for all ages, whereas the protein adequacy for children aged 7-12 and 13-23 months was 142.8% and 168.1%, respectively. A remarkable number of cases had energy and vitamin A intakes below the estimated average requirement. In relation to feeding practice indicators, 50.8% of infants received a minimum acceptable diet. CONCLUSIONS: There is a high prevalence of an inadequate level of energy and critical nutrient intake during complementary feeding of the children aged 6-23 months included in the study. Nutritional interventions that promote feeding practices to improve micronutrient intake would be highly important for children's current and future health.

Introducción. Una alimentación complementaria adecuada en cantidad y calidad resulta esencial durante los primeros dos años de vida. El objetivo del estudio fue evaluar la ingesta de nutrientes y prácticas alimentarias en niños de 6 a 23 meses de una localidad del noreste argentino. Población y métodos. Estudio descriptivo transversal (segundo semestre del 2019). Se evaluaron las ingestas de 24 horas mediante recordatorios a los cuidadores de niños de 6 a 23 meses. Los datos se compararon con las ingestas dietéticas de referencia. Las prácticas alimentarias se evaluaron según los indicadores establecidos por la Organización Mundial de la Salud. Resultados. Se evaluaron 138 niños de 6 a 23 meses de edad. La energía y las vitaminas A, D y E presentaron porcentajes medios de adecuación inferiores al 100 % en todas las edades, mientras que las proteínas alcanzaron una adecuación promedio del 142,8 % y el 168,1 % para los niños de 7-12 meses y de 13-23 meses, respectivamente. Los nutrientes que presentaron una proporción considerable de casos con ingestas por debajo del requerimiento promedio estimado en todos los grupos fueron la energía y la vitamina A. En cuanto a los indicadores de prácticas alimentarias, 50,8 % de los lactantes recibió una dieta mínima aceptable. Conclusiones. Existe una alta prevalencia de inadecuación energética y de nutrientes críticos durante la alimentación complementaria en los niños de 6 a 23 meses incluidos en el estudio. Intervenciones nutricionales que promuevan prácticas alimentarias que mejoren la ingesta de micronutrientes serían de suma importancia para su salud actual y futura.

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

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

Ultra-processed food consumption and dietary, lifestyle and social determinants: a path analysis in Brazilian graduates (CUME project).

OBJECTIVE: To explore the relationship between ultra-processed foods (UPF) consumption and dietary, lifestyle and social determinants using pathway analysis in the baseline of the Cohort of Universities of Minas Gerais (CUME project). DESIGN: Cross-sectional study, in which path analysis was used to estimate direct and indirect effects of dietary practices, sleep, time on the computer and professional status on UPF consumption. SETTING: Data were collected in 2016, through an online questionnaire composed of sociodemographic, anthropometric, lifestyle and dietary practices questions, and a FFQ. PARTICIPANTS: Baseline participants from the CUME Project (n 2826), adults who graduated from Universidade Federal de Viçosa or Universidade Federal de Minas Gerais, Brazil. RESULTS: Being employed (P = 0·024), the time spent on the computer (P = 0·031) and the frequency of fried food intake (P < 0·001) were positively and directly associated with UPF consumption, whereas the sleep duration (P = 0·007) and the number of meals per d (P < 0·001) were negatively and directly associated with UPF consumption. Indirect effects were observed between being employed, mediated by the sleep duration (P = 0·032) and fried food intake (P = 0·005), whereas being a student is mediated by the time on the computer (P = 0·048). CONCLUSION: The time spent on the computer, sleep duration and fried food consumption showed direct effects on UPF consumption. They also acted as mediators on the relationship between professional status and UPF consumption. Besides, the number of meals eaten each day also was directly associated with UPF consumption.

Hunger and its associated factors in the western Brazilian Amazon: a population-based study.

BACKGROUND: Hunger affects millions of people worldwide. In the current pandemic scenario of coronavirus Brazil has experienced an epidemic peak of hunger, amplifying existing prepandemic vulnerabilities, mainly in the North Region of the country. The aim of the present study was to investigate the prevalence of food insecurity and its associated factors in homes with children under 5 years of age in an urban area of a municipality of the western Brazilian Amazon. METHODS: A household survey was conducted with a probabilistic sample of 557 children and their families. Food insecurity (FI) was determined using the Brazilian Food Insecurity Scale. Associations between variables were analyzed based on the prevalence ratio (PR) and respective 95% confidence intervals (CI) calculated through multiple Poisson regression analysis. Variables with a P value < 0.05 after adjustments were considered significantly associated with the outcome. RESULTS: A prevalence of 76.5% (CI 1.36-2.67) food insecurity was found among the families in the study; 42.9% had moderate (CI 1.31-2.83) and severe (CI 1.10-1.83) food insecurity. Moderate and severe FI was associated with low family income (P = 0.00), participation in governmental income transfer programs (P = 0.01), and heads of household with less than 7 years of schooling (P = 0.02). Moreover, substantial frequencies of height deficit and being overweight were found among the children. CONCLUSIONS: The high prevalence of hunger and food insecurity and its associated factors reflects the context of geographic isolation and social exclusion in which these families live, suggesting that a substantial portion of the population under 5 years of age had experienced episodes of hunger in the 90 days prior to the survey. The prevalence of height deficit and being overweight among the children reveals a scenario of epidemiological/nutritional polarization, requiring the formulation of specific public policies for this population.

Interaction effect between breakfast skipping and sedentary behavior in the dietary inflammatory potential of Brazilian school-age children.

OBJECTIVES: Missed nutrients from skipped meals affect diet quality. However, the extent to which breakfast skipping affects the inflammatory potential of a diet, as indicated by Children's Dietary Inflammatory Index (C-DII) score, remains unknown. We aimed to evaluate the association between breakfast skipping and C-DII score, and investigate the presence of interaction with sociodemographic factors and sedentary behavior. METHODS: This representative cross-sectional study enrolled 378 children ages 8 and 9 y from Viçosa, Minas Gerais, Brazil in 2015. We collected sociodemographic data (sex, age, race, and household per-capita income) and screen time using a semistructured questionnaire. Dietary intake and breakfast skipping were evaluated by three 24-h dietary recalls from which energy-adjusted C-DII scores were calculated. We performed linear regression models to test the associations and possible interactions. RESULTS: The prevalence of breakfast skipping and sedentary behavior were 20.1% and 47.6%, respectively. The mean ± standard deviation of the C-DII scores was 0.60 ± 0.94, and ranged from -2.16 (most anti-inflammatory diet) to 2.75 (most proinflammatory diet). Breakfast skipping was associated with a higher intake of lipids, monounsaturated fat, and polyunsaturated fat, as well as lower carbohydrate, calcium, and magnesium intake (P < 0.05). After adjustment, breakfast skippers had higher C-DII scores (ß = 0.33; 95% confidence interval, 0.12-0.54). This association was more pronounced in children with sedentary behavior (ß = 0.53; 95% confidence interval, 0.24-0.82). CONCLUSIONS: Breakfast skipping was associated with a more proinflammatory diet in school-age children, and there was significant interaction with sedentary behavior. Early childhood interventions encouraging the habit of eating a breakfast and engaging in physical activity may help reduce the dietary inflammatory potential and prevent related cardiometabolic disorders.

The AHA Recommendations for a Healthy Diet and Ultra-Processed Foods: Building a New Diet Quality Index.

The American Heart Association (AHA) has developed the concept of "ideal cardiovascular health" (ICH), a seven-component score, which includes health dietary metrics. Higher ultra-processed foods intake is related with several cardiometabolic and cardiovascular diseases. We propose to develop and validate the Cardiovascular Health Diet Index (CHDI), a diet quality index that combines the AHA's recommendations of a healthy diet for cardiovascular health and ultra-processed foods. We used dietary data obtained through a 114-item FFQ from 14,779 participants of the Brazilian Longitudinal Study of Adults Health (ELSA-Brasil). The CHDI had 11 components and a total score ranging from 0 to 110 points. Validation and reliability analyses were performed, including principal component analyses, association with selected nutrients, means differences between groups (for example, smokers vs. non-smokers), Cronbach's alpha, and linear regression analyses between CHDI and overall dietary quality. The mean CHDI was 57.1 points (95% CI 47.9:66.0). The CHDI had four dimensions; in addition, it was associated with nutrients related to cardiovascular health, and the points were significantly (p < 0.001) lower in smokers (52.1) than in non-smokers (57.8). Cronbach's alpha value was 0.50. After age and sex adjustment, the CHDI score remained associated with a higher overall dietary quality (ß 0.87, 95%CI 0.84:0.89, p < 0.001). The CHDI proved to be valid and reliable for use, in addition to being associated with higher overall dietary quality. The use of CHDI is expected to assess the population's compliance with dietary recommendations for promoting cardiovascular health and preventing cardiovascular disease.

Deficiency and Insufficiency of Vitamin D in Women of Childbearing Age: A Systematic Review and Meta-analysis / Deficiência e insuficiência de vitamina D em mulheres na idade reprodutiva: Uma revisão sistemática e meta-análise

Abstract Objective To estimate the prevalence of inadequate vitamin D level and its associated factors for women of childbearing age in Brazil. Methods A systematic reviewwas conducted (last updatedMay 2020).Meta-analyses were performed using the inverse-variance for fixed models with summary proportion calculation by Freeman-Tukey double arcsine. Reporting and methodological quality were assessed using the Joanna Briggs Institute tool for prevalence studies. Results Our review identified 31 studies, comprising 4,006 participants. All the studies had at least one weakness, mainly due to the use of convenience sampling and small sample size. The overall prevalence of vitamin D deficiency, insufficiency, and both deficiency and insufficiency were 35% (confidence interval, 95%CI: 34-37%), 42% (95%CI: 41-44%), and 72% (95%CI: 71-74%), respectively. Conclusion Although the magnitude of the prevalence of inadequate levels of vitamin D is uncertain, the evidence suggests that presence of vitamin D deficiency or insufficiency in women of reproductive age can cause moderate to severe problems.

Resumo Objetivo Estimar a prevalência de níveis inadequados de vitamina D e seus fatores associados para mulheres em idade fértil no Brasil. Métodos Uma revisão sistemática foi realizada (última atualização em maio de 2020). As meta-análises foram realizadas usando o inverso da variância para o modelo fixo com cálculo de proporção sumarizada por transformação arco-seno duplo de Freeman-Tukey. A qualidade metodológica e de reporte foi avaliada usando a ferramenta do Joanna Briggs Institute para estudos de prevalência. Resultados Nossa revisão identificou 31 estudos, compreendendo 4.006 participantes. Todos os estudos apresentaram pelo menos uma limitação, principalmente devido ao uso de amostra de conveniência e tamanho amostral pequeno. As prevalências gerais de deficiência, insuficiência e deficiência de vitamina D foram 35% (intervalo de confiança, IC 95%: 34-37%), 42% (IC 95%: 41-44%) e 72% (IC 95%: 71-74%), respectivamente. Conclusão Embora a magnitude da prevalência de níveis inadequados de vitamina D seja incerta, a evidência sugere que presença de deficiência ou insuficiência de vitamina D em mulheres em idade reprodutiva pode causar problemas moderados a graves.

Nutrient Intakes among Brazilian Children Need Improvement and Show Differences by Region and Socioeconomic Level.

Brazil is the most populous country in South America. Using 24 h dietary data, we compared the nutrient intakes of 4-13-year-olds to reference values and tested for regional and socioeconomic (SES) differences. A considerable proportion reported intakes below the Estimated Average Requirements (EAR) for vitamins E (78.1%, 96.5%), D (100% for both), and calcium (80.5%, 97.7%) for 4-8 and 9-13-year-olds, respectively. Few exceeded Adequate Intakes (AI) for potassium or fiber. Older children reported greater inadequacies and, while there was regional variability, patterns of inadequacy and excess tended to be similar. For vitamin C, the percent of children below EAR in the Northeast and Southeast was lower than in the South. Most children, regardless of SES, had energy intakes within the Acceptable Macronutrient Distribution Ranges (AMDRs) for carbohydrates and protein. Over a quarter reported total energy from fat less than the AMDR, and inversely associated with SES (low 50.9%, moderate 26.0%, and high 15.0%), but also exceeding the percentage of energy recommendation for saturated fat, increasing with SES (low 18.1%, moderate 38.9%, and high 48.8%). The contrast observed between the diets of young Brazilians and recommendations underscores the need for individual and regional environmental interventions to promote healthier dietary patterns.

Different statistical methods identify similar population-specific dietary patterns: an analysis of Longitudinal Study of Adult Health (ELSA-Brasil).

In recent decades, different data-driven approaches have emerged to identify dietary patterns (DP) and little is discussed about how these methods are able to capture diet complexity within the same population. This study aimed to apply three statistical methods to identify the DP of the Longitudinal Study of Adult Health (ELSA-Brasil) population and evaluate the similarities and differences between them. Dietary data were assessed at baseline in the ELSA-Brasil study using a FFQ. DP were identified by applying three statistical methods: (1) factor analysis (FA), (2) treelet transform (TT) and (3) reduced rank regression (RRR). The characteristics of individuals classified in the last tertile of each DP were compared. Cross-classification and Pearson's correlation coefficients were assessed to evaluate the agreement between individuals' adherence to DP of the three methods. A similar convenience DP was identified for all three methods. FA and TT also identified a similar prudent DP and a DP highly loaded for the food groups rice and beans. Individuals classified in the third tertile of similar DP of each method presented similar socio-demographic and nutrient intake characteristics. Regarding the cross-classification, prudent DP from FA and TT presented a higher level of agreement (75 %), while convenience DP from TT and RRR presented the lowest agreement (44·8 %). The different statistical methods were able to capture the populations' DP in a similar way while highlighting the particularities of each method.

Health economic impacts associated with the consumption of sugar-sweetened beverages in Brazil.

Introduction: The consumption of sugar-sweetened beverages (SSBs) is among the main risk factors for non-communicable diseases (NCDs). This study aimed to estimate the financial costs of hospitalizations and procedures of high and medium complexity for NCDs attributable to the consumption of SSBs in the Brazilian Unified Health System (SUS) in 2019. Methods: This ecological study used data from the Global Burden of Disease (GBD) 2019 and the Department of Informatics of the Unified Health System (DATASUS). The attributable costs were estimated from the population-attributable fraction (PAF) and the costs in the treatment of chronic diseases [type 2 diabetes mellitus and ischemic heart disease (IHD)], stratified by sex, age group, level of complexity of treatment, and federative units. Results: In 2019, in Brazil, US$ 14,116,240.55 were the costs of hospitalizations and procedures of high and medium complexity in the treatment of NCDs attributable to the consumption of SSBs. These values were higher in males (US$ 8,469,265.14) and the southeast and southern regions, mainly in the state of São Paulo. However, when evaluating these results at a rate per 10,000 inhabitants, it was observed that the states of Paraná, Tocantins, and Roraima had higher costs per 10,000 inhabitants. Regarding the age groups, higher costs were observed in the older age groups. Conclusion: This study revealed the high financial impact of the NCDs treatment attributed to the consumption of SSBs in Brazil and the variability among Brazilian macro-regions. The results demonstrate the urgency and need for the expansion of policies to reduce the consumption of SSBs in Brazil with strategies that consider regional particularities.

Validade do instrumento para triagem de domicílios em risco de insegurança alimentar em diversos estratos da população brasileira / Validity of an instrument for screening households at risk of food insecurity in different strata of the Brazilian population / Validez del instrumento de triaje de hogares en riesgo de inseguridad alimentaria en diferentes estratos de la población brasileña

A ausência de instrumentos de triagem de risco para insegurança alimentar compromete a capacidade de avaliar, monitorar e ofertar assistência imediata a pessoas em situação de fome, especialmente durante emergências, como a crise da COVID-19. Assim, o objetivo deste estudo foi testar a validade do instrumento de Triagem para Risco de Insegurança Alimentar (TRIA), em diversos estratos da população brasileira. A TRIA é composta pelas questões 2 e 4 da Escala Brasileira de Insegurança Alimentar (EBIA), validada, originalmente, a partir de dados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS 2006). Neste estudo, utilizando dados da Pesquisa Nacional por Amostra de Domicílios (PNAD 2013), testou-se sua reprodutibilidade por meio da repetição dos procedimentos combinatórios originais, examinando se os parâmetros de sensibilidade, especificidade, acurácia e valores preditivos positivo (VPP) e negativo (VPN) resultariam no mesmo arranjo de questões. Ainda, analisou-se a validade convergente comparando a força de associação entre insegurança alimentar e variáveis alimentares por meio de dois modelos de regressão binomial (TRIA x EBIA). Os resultados indicaram que a combinação das questões 2 e 4 apresentou melhor desempenho entre os estratos populacionais estudados, além de ótima validade convergente. O VPP e VPN ajustado pela prevalência de insegurança alimentar nos estados variou de 42,8% (Santa Catarina) a 87,6% (Amazonas) e 95,8% (Amazonas) a 99,5% (Santa Catarina), respectivamente. Em conclusão, além de ser reprodutível, a TRIA apresentou excelentes parâmetros de validade, sobretudo em grupos vulnerabilizados. Assim, seu uso pode ser recomendado na prática assistencial e como instrumento de vigilância alimentar e nutricional no Brasil.

The absence of risk screening tools for food insecurity compromises the ability to assess, monitor, and provide immediate assistance to those in hunger, especially during emergencies such as the COVID-19 crisis. Hence, this study sought to test the validity of an instrument for Screening Households at Risk of Food Insecurity (TRIA) in different strata of the Brazilian population TRIA uses questions 2 and 4 of the Brazilian Food Insecurity Scale (EBIA), originally validated using data from the Brazilian National Survey of Demography and Health of Children and Women (PNDS 2006). In this study, using data from the Brazilian National Household Sample Survey (PNAD 2013), its reproducibility was tested by repeating the original combinatorial procedures, examining whether the parameters of sensitivity, specificity, accuracy, and positive predictive values (PPV) and negative values (NPV) would result in the same arrangement of questions. Moreover, convergent validity was analyzed by comparing the strength of association between food insecurity and dietary variables using two binomial regression models (TRIA x EBIA). Results indicated that the combination of questions 2 and 4 performed best among the population strata studied, and presented optimal convergent validity. PPV and NPV adjusted for food insecurity prevalence in states ranged from 42.8% (Santa Catarina) to 87.6% (Amazonas) and 95.8% (Amazonas) to 99.5% (Santa Catarina), respectively. In conclusion, besides being reproducible, TRIA presented excellent validity parameters, especially among vulnerable groups. It can thus be used in care practice and as an instrument of food and nutritional surveillance in Brazil.

La ausencia de instrumentos de triaje de riesgo para la inseguridad alimentaria compromete la capacidad de evaluar, monitorear y brindar asistencia inmediata a las personas en situación de hambre, especialmente durante emergencias como la crisis de la COVID-19. Por lo tanto, el objetivo de este estudio fue probar la validez del instrumento de Triaje para Riesgo de Inseguridad Alimentaria (TRIA) en diferentes estratos de la población brasileña. El TRIA consta de las preguntas 2 y 4 de la Escala Brasileña de Inseguridad Alimentaria (EBIA), originalmente validada con base en datos de la Encuesta Nacional de Demografía y Salud de la Mujer y el Niño (PNDS 2006). En este estudio, utilizando datos de la Encuesta Nacional por Muestra de Domicilios (PNAD 2013), se probó su reproducibilidad repitiendo los procedimientos combinatorios originales, examinando si los parámetros de sensibilidad, especificidad, exactitud y valores predictivos positivos (VPP) y negativo (VPN) resultarían en el mismo arreglo de preguntas. Además, se analizó la validez convergente comparando la fuerza de asociación entre la inseguridad alimentaria y las variables alimentarias por medio de dos modelos de regresión binomial (TRIA x EBIA). Los resultados indicaron que la combinación de las preguntas 2 y 4 presentó el mejor desempeño entre los estratos poblacionales estudiados, además de excelente validez convergente. El VPP y el VPN ajustado por la prevalencia de inseguridad alimentaria en los estados osciló entre el 42,8% (Santa Catarina) y el 87,6% (Amazonas) y entre el 95,8% (Amazonas) y el 99,5% (Santa Catarina), respectivamente. En conclusión, además de ser reproducible, el TRIA presentó excelentes parámetros de validez, especialmente en grupos en situación de vulnerabilidad. Por lo tanto, se puede recomendar su uso en la práctica asistencial y como instrumento para la vigilancia alimentaria y nutricional en Brasil.