The National Health and Nutrition Examination Survey (NHANES), 2021-2022: Adapting Data Collection in a COVID-19 Environment.

The National Health and Nutrition Examination Survey (NHANES) is a unique source of national data on the health and nutritional status of the US population, collecting data through interviews, standard exams, and biospecimen collection. Because of the COVID-19 pandemic, NHANES data collection was suspended, with more than a year gap in data collection. NHANES resumed operations in 2021 with the NHANES 2021-2022 survey, which will monitor the health and nutritional status of the nation while adding to the knowledge of COVID-19 in the US population. This article describes the reshaping of the NHANES program and, specifically, the planning of NHANES 2021-2022 for data collection during the COVID-19 pandemic. Details are provided on how NHANES transformed its participant recruitment and data collection plans at home and at the mobile examination center to safely collect data in a COVID-19 environment. The potential implications for data users are also discussed. (Am J Public Health. 2021;111(12):2149-2156. https://doi.org/10.2105/AJPH.2021.306517).

Self-Care Instruments to Measure Nutrition Practices in Children and Parents: Psychometric Analysis.

The purposes of this study were to evaluate the psychometric properties of English and Spanish instruments that measure the nutrition behavior and practices of children and their parents. Orem's self-care deficit nursing theory was used in this methodological study. A convenience sample of 333 children and 262 mothers participated from two schools in Washington, D.C. and two schools in Santiago, Chile. Principal component analysis indicated three component per instrument corresponding to Orem's Theory of operations demonstrating construct validity of the instrument. The study findings showed evidence for validity and reliability of the English and Spanish versions and indicated that the instruments appropriately represented Orem's operations. The results have implications for the development of health behavior measurement instruments that are valid, reliable, designed for children, culturally appropriate, and efficient. Measuring the nutrition behavior of children and parents is critical for determining the effectiveness of nutrition intervention programs. Furthermore, instruments are needed so that researchers can compare corresponding child and parent behaviors or compare behaviors across cultures.

Food insecurity measurement and prevalence estimates during the COVID-19 pandemic in a repeated cross-sectional survey in Mexico.

OBJECTIVE: To validate the telephone modality of the Latin American and Caribbean Food Security Scale (ELCSA) included in three waves of a phone survey to estimate the monthly household food insecurity prevalence during the COVID-19 pandemic in Mexico. DESIGN: We examined the reliability and internal validity of the ELCSA scale in three repeated waves of cross-sectional surveys with Rasch models. We estimated the monthly prevalence of food insecurity in the general population and in households with and without children and compared them with a national 2018 survey. We tested concurrent validity by testing associations of food insecurity with socio-economic status and anxiety. SETTING: ENCOVID-19 is a monthly telephone cross-sectional survey collecting information on the well-being of Mexican households during the pandemic lockdown. Surveys used probabilistic samples, and we used data from April (n 833), May (n 850) and June 2020 (n 1674). PARTICIPANTS: Mexicans 18 years or older who had a mobile telephone. RESULTS: ELCSA had an adequate model fit and food insecurity was associated, within each wave, with more poverty and anxiety. The COVID-19 lockdown was associated with an important reduction in food security, decreasing stepwise from 38·9 % in 2018 to 24·9 % in June 2020 in households with children. CONCLUSIONS: Telephone surveys were a feasible strategy to monitor reductions in food security during the COVID-19 lockdown.

Cultural Adaptation and Evaluation of the Perceived Nutrition Environment Measures Survey to the Mediterranean Spanish Context (NEMS-P-MED).

Individuals' perceptions of their food environments are a mediator between exposure to the environment and people's interaction with it. The Nutrition Environment Measures Surveys (NEMS) are valid and reliable measures to assess food environments. In Spain, there is no adapted instrument to measure the perceived obesogenic environment. This article aims to adapt and evaluate the Perceived Nutrition Environment Measures Survey for a Spanish context (NEMS-P-MED). The Spanish version has 32 questions to measure the perception about availability, accessibility and marketing of 3 types of environment: home, shops and restaurants. We assess feasibility, construct validity and internal consistency reliability through a sample of 95 individuals. The internal consistency was acceptable for most items (Cronbach's alpha coefficients range from 0.6 to 0.9), similar to that of the original scale. The NEMS-P-MED has been shown to be valid and, on certain items reliable, and was useful to assess the population's perceptions of the food environment in the home, restaurants and food stores in a Spanish context. Adapting standardized measurement tools to specific contexts to assess the perceived and observed characteristics of food environments may facilitate the development of effective policy interventions to reduce excess weight.

Estado nutricional de pacientes geriátricos con ventilación mecánica en cuidados intensivos / Nutritional status of geriatric patients with mechanical ventilation under intensive care

Introducción: La desnutrición en pacientes ingresados en una sala de terapia intensiva es elevada, pero en el anciano crítico es aún mayor, con repercusión sobre el aparato respiratorio, prolongación de la ventilación y otras complicaciones. Objetivo: Caracterizar el estado nutricional en pacientes geriátricos con ventilación mecánica en una unidad de cuidados intensivos. Métodos: Se realizó un estudio descriptivo, prospectivo y de corte transversal durante el periodo de enero de 2017 a marzo de 2019 en la unidad de cuidados intensivos del Hospital General Docente "Orlando Pantoja Tamayo". Se estudiaron 83 pacientes con edades mayor o igual a 60 años, los cuales requirieron del uso de ventilación mecánica más de 24 h. El estado nutricional fue evaluado con el empleo del índice de control nutricional. Resultados: Predominó el sexo masculino, el grupo de edades de 60 a 74 años, y las enfermedades tipo quirúrgicas. Solo 9,1 % de los que recibieron ventilación mecánica invasiva no estaban desnutrido. Los que fallecieron tenían desnutrición moderada o severa. Conclusiones: En los pacientes geriátricos ventilados, ingresados en la unidad de cuidados intensivos, se encontró un alto grado de malnutrición. La desnutrición moderada o severa predominó en la mayoría de los que recibieron ventilación mecánica invasiva y en el grupo de fallecidos(AU)

Introduction: Malnutrition in patients hospitalized in an intensive care room is high, but it is even higher in the critically-ill elderly patient, with repercussions on the respiratory system, prolonged ventilation, and other complications. Objective: To characterize the nutritional status of geriatric patients under mechanical ventilation in an intensive care unit. Methods: A descriptive, prospective and cross-sectional study was carried out during the period from January 2017 to March 2019, in the intensive care unit of Orlando Pantoja Tamayo General Teaching Hospital. 83 patients aged 60 or older were studied; they required mechanical ventilation for more than 24 hours. The nutritional status was evaluated with the use of the nutritional control score. Results: There was a predominance of the male sex, the age group 60-74 years, and of surgical diseases. Only 9.1% of those who received invasive mechanical ventilation were not undernourished. Those who died had moderate or severe undernutrition. Conclusions: In ventilated geriatric patients hospitalized in the intensive care unit, a high degree of malnutrition was found. Moderate or severe malnutrition predominated in the majority of those who received invasive mechanical ventilation and in the group of the deceased(AU)

Validity, reliability and use of a Kuwait child nutrition knowledge assessment questionnaire.

BACKGROUND: Little is known about the nutritional knowledge of children in Kuwait and school-based nutrition interventions are scarce. No validated tool to assess the nutrition knowledge of schoolchildren in Kuwait is available. AIMS: This study determined the validity and reliability of a nutrition knowledge questionnaire in Kuwaiti primary-school children, and measured children's nutrition knowledge before and after a nutrition awareness intervention. METHODS: The questionnaire included five questions to measure nutritional knowledge. The face and content validity were assessed by nutrition and paediatric experts. To assess questionnaire reliability and nutrition knowledge, 642 schoolchildren (8-12 years) were assigned to an intervention, control or reliability group. Each group completed the questionnaire twice, one or two weeks apart. Students in the intervention group attended a nutrition knowledge presentation before completing the questionnaire the second time. Independent and paired samples t-tests were used to assess score differences between and within the intervention and control groups for changes in nutrition knowledge. Pearson correlation coefficients were used to measure score consistency in the reliability group. RESULTS: Overall, the questionnaire had good content validity and moderate to strong reliability (r = 0.44, P < 0.001). Students in the intervention group had significantly higher mean nutritional knowledge scores after the intervention (from 3.65 (SD 1.03) to 4.20 (SD 1.02); P = 0.17). Control group scores were mostly unchanged. CONCLUSIONS: The Kuwait child nutrition knowledge questionnaire is a valid and reliable tool to assess nutritional knowledge in schoolchildren in Kuwait. Nutrition knowledge of Kuwaiti schoolchildren should be improved using age-appropriate interventions in school.

Validation of a Food Propensity Questionnaire for the Hellenic National Nutrition and Health Survey (HNNHS) and Results on This Population's Adherence to Key Food-Group Nutritional Guidelines.

BACKGROUND: Food propensity questionnaires (FPQs) are means of dietary assessment in nutritional epidemiology, which provide valuable information for long term intakes and food group consumption. These tools, however, may be subjected to misreporting and need to be validated against standard quantitative methods. AIM: The aim of this study was to examine the validity of the qualitative FPQ developed to assess the dietary habits of the general population in Greece during the Hellenic National Nutrition and Health Survey (HNNHS) and to assess the population's intake of specific food groups in relation to guidelines. METHODS: Validation analysis was based on 3796 [1543 men (42.82%) and 2253 women (57.18%)] participants of the HNNHS in relation to two interviewer-administered 24 h recalls (24 hR). Participants were asked to report the frequency of their dietary intake, using the FPQ provided. Correlations and significance between methods were assessed via Spearman correlation and a Two-sample Wilcoxon rank-sum (Mann-Whitney) test, respectively. Agreement between the FPQ and the 24 hR was performed using the Bland-Altman test and differences between the FPQ's shown intakes and the recommended intakes by the Dietary Guidelines for Greek Adults were calculated. RESULTS: Medium to weak correlations, but statistically significant (p < 0.05), were observed for most food groups between 24 hR and the FPQ; medium for fruits, dairy products, drinks, and spirits (ranging from ρ = 0.371 to ρ = 0.461; highest for drinks and spirits) and weak for vegetables, meat, fish, eggs, starch foods, sweets, nuts, fats and oils, and fast food (ρ = 0.111 to ρ = 0.290; lowest for starch foods). A non-significant correlation was found for legumes (ρ = 0.070). The mean intake agreement (Bland-Altman analysis) between the FPQ and the 24 hR was 96.08% and ranged from 94.43 to 99.34% for the 14 food groups under examination. When food group intakes were compared to guidelines, results showed that the population's dietary intake was below the guidelines for fruits, vegetables, whole grains, fish, and legumes. On the other hand, it was above the guidelines for most of the "unhealthy" food groups, in particular, fast food, sweets, drinks and spirits, red meat, and sweets. CONCLUSIONS: The specific FPQ provides valid information on major food groups and can be used to examine long term dietary patterns in nutritional studies. Ιn addition, dietary intakes of Greek adults are problematic and initiatives at the public health level are necessary.

Development and Validation of a Multidimensional Instrument: Assessing Barriers to Dietary Practices.

BACKGROUND AND PURPOSE: Poor dietary practices are linked to many chronic diseases. The purpose of this validation study was to develop a psychometrically sound instrument that can be administered by health practitioners to measure dietary barriers. METHODS: The Dietary Health Status (DHS) instrument, designed to measure dietary barriers is comprised of items in the National Health and Nutrition Examination Survey-What We Eat in America datasets. Content validity was established for DHS using an expert review process. Principal component analysis (PCA) was then used to assess validity and reliability as determined by Cronbach's alpha values. RESULTS: The PCA supported a 10-component solution, explaining 61% of the total variance. Cronbach's alpha was .67 for the entire instrument, ranging from .55 to .87 for the 10 subscales. CONCLUSION: Results suggest the instrument had sufficient construct and internal validity. This exploratory study is an important first step in validating the DHS instrument.

A cultural adaptation and validation of a child eating behaviour measure in a low- and middle-income country.

OBJECTIVE: The Child Eating Behaviour Questionnaire (CEBQ), a widely used instrument that has been validated mostly in high-income countries, has limitations in its factorial validity when used among different cultures. This study examines whether the CEBQ instrument is culturally appropriate and valid to be used in a low- and middle-income country (LMIC) in a setting where child undernutrition remains prevalent. DESIGN: The study employed a qualitative process to validate the content of items relative to the culture and setting, which was followed by a survey to test the psychometric properties of the instrument. Tests of factorial validity, convergent validity and reliability were performed. SETTING: Three different socio-economic settings of Yogyakarta, Indonesia. PARTICIPANTS: The participants of this study were mothers of children aged 25-60 months. In-depth interviews were conducted with twenty-four mothers and the questionnaire validation process involved 238 mothers in the survey. RESULTS: A Confirmatory Factor Analysis model with eight subscales provided the best fit (root-mean-square error of approximation = 0·048 (90 % CI 0·040, 0·057); Comparative Fit Index = 0·95 and Tucker Lewis Index = 0·95) after three new items and eight items from the original CEBQ were removed. Convergent validity with child's weight was found for two subscales, slowness in eating and satiety responsiveness. Reliability measured using Cronbach's alpha provided values between 0·62 and 0·78. CONCLUSION: The original eight-factor structure of the CEBQ showed adequate content validity and provided factorial, discriminant and convergent validity with mothers of preschool children living in a LMIC where child nutrition remains a significant public health issue.

Revision and Psychometric Validation of a Survey Tool to Measure Critical Nutrition Literacy in Young Adults.

OBJECTIVE: To refine and psychometrically validate the Revised Critical Nutrition Literacy Tool in a young adult sample. METHODS: Young adults recruited from 3 universities completed the 11-item Critical Nutrition Literacy Tool claims scale. Exploratory factor analysis, confirmatory factor analysis (CFA), and item response theory were used to validate the Critical Nutrition Literacy Tool. Omega and Cronbach α assessed reliability. RESULTS: A total of 1,718 participants completed the survey. Results from exploratory factor analysis and CFA analyses suggested that a 2-factor, 7-item instrument showed a reasonable fit to the data based on the comparative fit index and standardized root mean residual values, χ2(13) =161.64, P < .001, comparative fit index = 0.90, root mean square error of approximation = 0.11, standardized root mean residual = 0.07. All items loaded well onto the factors from the CFA and item response theory perspectives. The full measure and both factors showed questionable (>0.60) or acceptable (>0.70) internal consistency. CONCLUSIONS AND IMPLICATIONS: A revised 2-factor instrument capturing (factor 1) critical appraisal of media and (factor 2) evidence-based sources of nutrition information demonstrated sound psychometric characteristics. Further item testing is necessary for different populations, and item development is warranted to capture Internet/social media sources and the relationship among critical nutrition literacy, dietary behaviors, and health outcomes.

Simple Skeletal Muscle Mass Estimation Formulas: What We Can Learn From Them.

One century ago Harris and Benedict published a short report critically examining the relations between body size, body shape, age, and basal metabolic rate. At the time, basal metabolic rate was a vital measurement in diagnosing diseases such as hypothyroidism. Their conclusions and basal metabolic rate prediction formulas still resonate today. Using the Harris-Benedict approach as a template, we systematically examined the relations between body size, body shape, age, and skeletal muscle mass (SM), the main anatomic feature of sarcopenia. The sample consisted of 12,330 non-Hispanic (NH) white and NH black participants in the US National Health and Nutrition Survey who had complete weight, height, waist circumference, age, and dual-energy X-ray (DXA) absorptiometry data. A conversion formula was used to derive SM from DXA-measured appendicular lean soft tissue mass. Weight, height, waist circumference, and age alone and in combination were significantly correlated with SM (all, p < 0.001). Advancing analyses through the aforementioned sequence of predictor variables allowed us to establish how at the anatomic level these body size, body shape, and age measures relate to SM much in the same way the Harris-Benedict equations provide insights into the structural origins of basal heat production. Our composite series of SM prediction equations should prove useful in modeling efforts and in generating hypotheses aimed at understanding how SM relates to body size and shape across the adult lifespan.

Development and validation testing of a weight management nutrition knowledge questionnaire for adults.

BACKGROUND/OBJECTIVES: Because no validated tool exists to assess nutrition knowledge regarding weight management we developed and tested the Weight Management Nutrition Knowledge Questionnaire (WMNKQ). SUBJECTS/METHODS: The questionnaire assesses nutrition knowledge in these categories: energy density of food, portion size/serving size, alcohol and sugar sweetened beverages, how food variety affects food intake, and reliable nutrition information sources. In total 60 questions were reviewed by 6 experts for face validity and quantitative analysis was used to assess item difficulty, item discrimination, internal consistency, inter-item-correlation, test-retest reliability, construct validity, criterion validity, and convergent validity. RESULTS: The final WMNKQ contained 43 items. Experts removed 3 of the original 60 questions and modified 41. Eighteen items did not meet criteria for item difficulty, item discrimination, and/or inter-item correlation; 4 were retained. The WMNKQ met criteria for internal consistency (Cronbach's alpha = 0.88), reliability (test-retest correlation ρ = 0.90, P < 0.0001), construct validity (known groups comparison) - dietitians scored 16% better (p < 0.0001) than information technology workers, and criterion validity (pre- to post-intervention improvement in knowledge scores = 11.2% (95% CI 9.8-12.5, p < 0.0001)). Participants younger than age 55 scored significantly better than those over age 55 (convergent validity). CONCLUSIONS: The WMNKQ measures how well nutrition principles of weight management are understood.

Validation of a Vitamin D Specific Questionnaire to Determine Vitamin D Status in Athletes.

The study objective was to validate a food frequency and lifestyle questionnaire (FFLQ) to assess vitamin D intake and lifestyle factors affecting status. METHODS: Data collected previously during the fall (n = 86), winter (n = 49), and spring (n = 67) in collegiate-athletes (Study 1) and in active adults (n = 123) (Study 2) were utilized. Study 1: Vitamin D intake and ultraviolet B exposure were estimated using the FFLQ and compared to serum 25(OH)D concentrations via simple correlation and linear regression modeling. Study 2: Vitamin D intake from food was estimated using FFLQ and compared to vitamin D intake reported in 7-Day food diaries via paired t-test and Bland-Altman analysis. RESULTS: Study 1: Serum 25(OH)D was not associated with vitamin D intake from food, food plus supplements, or sun exposure, but was associated with tanning bed use (r = 0.39) in spring, supplement use in fall (r = 0.28), and BMI (body mass index) (r = -0.32 to -0.47) across all seasons. Serum 25(OH)D concentrations were explained by BMI, tanning bed use, and sun exposure in fall, (R = 0.42), BMI in winter (R = 0.32), and BMI and tanning bed use in spring (R = 0.52). Study 2: Estimated Vitamin D intake from food was 186.4 ± 125.7 via FFLQ and 148.5 ± 228.2 IU/day via food diary. There was no association between intake estimated by the two methodologies (r = 0.12, p < 0.05). CONCLUSIONS: FFLQ-estimated vitamin D intake was not associated with serum 25(OH)D concentration or food-record-estimated vitamin D intake. Results highlight the difficulty of designing/utilizing intake methodologies for vitamin D, as its status is influenced by body size and both endogenous and exogenous (dietary) sources.

Accuracy of Physical Function Questions to Predict Moderate-Vigorous Physical Activity as Measured by Hip Accelerometry.

BACKGROUND: Functional capacity assessment is a core component of current perioperative cardiovascular evaluation and management guidelines for noncardiac surgery. The authors investigated the ability of standardized physical function questions to predict whether participants engaged in moderate physical activity as measured by hip accelerometers. METHODS: Participant responses to physical functioning questions and whether they engaged in moderate physical activity were extracted from the National Health and Nutrition Examination Survey (2003 to 2004 and 2005 to 2006). Physical activity intensity was measured using hip accelerometers. Adult participants with at least one Revised Cardiac Risk Index condition were included in the analysis. Standardized physical function questions were evaluated using a classification and regression tree analysis. Training and test datasets were randomly generated to create and test the analysis. RESULTS: Five hundred and twenty-two participants were asked the physical functioning questions and 378 of 522 (72.4%) had a bout of moderate-vigorous activity. Classification and regression tree analysis identified a "no difficulty" response to walking up 10 stairs and the ability to walk two to three blocks as the most sensitive questions to predict the presence of a 2-min bout of moderate activity. Participants with positive responses to both questions had a positive likelihood ratio of 3.7 and a posttest probability greater than 90% of a 2-min bout of moderate-vigorous activity. The sensitivity and specificity of positive responses to physical functioning questions in the pruned tree were 0.97 (95% CI, 0.94 to 0.98) and 0.16 (95% CI, 0.10 to 0.23) for training data, and 0.88 (95% CI, 0.75 to 0.96) and 0.10 (95% CI, 0.00 to 0.45) for the test data. Participants with at least one 2-min bout of moderate activity had a greater percentage of overall daily active time (35.4 ± 0.5 vs. 26.7 ± 1.2; P = 0.001) than those without. CONCLUSIONS: Standardized physical function questions are highly sensitive but poorly specific to identify patients who achieve moderate physical activity. Additional strategies to evaluate functional capacity should be considered.

Comparisons of Self-Reported and Measured Height and Weight, BMI, and Obesity Prevalence from National Surveys: 1999-2016.

OBJECTIVE: The aim of this study was to compare national estimates of self-reported and measured height and weight, BMI, and obesity prevalence among adults from US surveys. METHODS: Self-reported height and weight data came from the National Health and Nutrition Examination Survey (NHANES), the National Health Interview Survey, and the Behavioral Risk Factor Surveillance System for the years 1999 to 2016. Measured height and weight data were available from NHANES. BMI was calculated from height and weight; obesity was defined as BMI ≥ 30. RESULTS: In all three surveys, mean self-reported height was higher than mean measured height in NHANES for both men and women. Mean BMI from self-reported data was lower than mean BMI from measured data across all surveys. For women, mean self-reported weight, BMI, and obesity prevalence in the National Health Interview Survey and Behavioral Risk Factor Surveillance System were lower than self-report in NHANES. The distribution of BMI was narrower for self-reported than for measured data, leading to lower estimates of obesity prevalence. CONCLUSIONS: Self-reported height, weight, BMI, and obesity prevalence were not identical across the three surveys, particularly for women. Patterns of misreporting of height and weight and their effects on BMI and obesity prevalence are complex.

How to use replicate weights in health survey analysis using the National Nutrition and Physical Activity Survey as an example.

OBJECTIVE: To conduct nutrition-related analyses on large-scale health surveys, two aspects of the survey must be incorporated into the analysis: the sampling weights and the sample design; a practice which is not always observed. The present paper compares three analyses: (1) unweighted; (2) weighted but not accounting for the complex sample design; and (3) weighted and accounting for the complex design using replicate weights. DESIGN: Descriptive statistics are computed and a logistic regression investigation of being overweight/obese is conducted using Stata. SETTING: Cross-sectional health survey with complex sample design where replicate weights are supplied rather than the variables containing sample design information. PARTICIPANTS: Responding adults from the National Nutrition and Physical Activity Survey (NNPAS) part of the Australian Health Survey (2011-2013). RESULTS: Unweighted analysis produces biased estimates and incorrect estimates of se. Adjusting for the sampling weights gives unbiased estimates but incorrect se estimates. Incorporating both the sampling weights and the sample design results in unbiased estimates and the correct se estimates. This can affect interpretation; for example, the incorrect estimate of the OR for being a current smoker in the unweighted analysis was 1·20 (95 % CI 1·06, 1·37), t= 2·89, P = 0·004, suggesting a statistically significant relationship with being overweight/obese. When the sampling weights and complex sample design are correctly incorporated, the results are no longer statistically significant: OR = 1·06 (95 % CI 0·89, 1·27), t = 0·71, P = 0·480. CONCLUSIONS: Correct incorporation of the sampling weights and sample design is crucial for valid inference from survey data.

Brazilian Study of Nutrition and Health (EBANS) - Brazilian data of ELANS: methodological opportunities and challenges.

BACKGROUND: Epidemiological studies with dietary variables are complex methodologically, being the researcher responsible for anticipating, controlling, reducing and preventing methodological errors. Obesity accounts for almost one-third of the world's population and has consequences for childhood and adolescence. Multifactorial disorder must be faced in several aspects, being food and physical activity, modifiable risk factors. The EBANS aims to perform a diagnosis of the nutritional status of the Brazilian population from 15 to 65 years old, from all regions, and the parameters associated with obesity, with several possibilities of correlating data. METHODOLOGICAL PROCESS: Part of the ELANS study (n = 9218), the EBANS (n = 2000) has a weighted sample and data collection that allows: to evaluate the socioeconomic level of the population; perform a diagnosis of nutritional status (through anthropometric variables); to evaluate food intake (R24h and FFQ for beverages); and evaluate physical activity practice (IPAQ-long and accelerometer). METHODOLOGICAL OPPORTUNITIES: With national coverage, EBANS has the potential to compose regional analyzes, portray the current nutritional epidemiological condition, food consumption and physical activity pattern of the Brazilian population, at different life stages, and may have their data analyzed together or stratified, offering useful subsidies for the formulation of public policies. METHODOLOGICAL CHALLENGES: Each methodological step was designed to reduce errors and biases related to methodological challenges. CAAE REGISTRATION: 31670314.8.0000.5567. FINAL CONSIDERATIONS: Of great potential for future data analysis, EBANS tries to contribute to the generation of knowledge to foment policies and actions capable of changing the current obesity scenario.

Robustness of Food Processing Classification Systems.

Discrepancies exist among food processing classification systems and in the relationship between processed food intake and dietary quality of children. This study compared inter-rater reliability, food processing category, and the relationship between processing category and nutrient concentration among three systems (Nova, International Food Information Council (IFIC), and University of North Carolina at Chapel Hill (UNC)). Processing categories for the top 100 most commonly consumed foods children consume (NHANES 2013-2014) were independently coded and compared using Spearman's rank correlation coefficient. Relative ability of nutrient concentration to predict processing category was investigated using linear discriminant analysis and multinomial logistic regression and compared between systems using Cohen's kappa coefficient. UNC had the highest inter-rater reliability (ρ = 0.97), followed by IFIC (ρ = 0.78) and Nova (ρ = 0.76). UNC and Nova had the highest agreement (80%). Lower potassium was predictive of IFIC's classification of foods as moderately compared to minimally processed (p = 0.01); lower vitamin D was predictive of UNC's classification of foods as highly compared to minimally processed (p = 0.04). Sodium and added sugars were predictive of all systems' classification of highly compared to minimally processed foods (p < 0.05). Current classification systems may not sufficiently identify foods with high nutrient quality commonly consumed by children in the U.S.

Is Active Transport and Leisure-Time Physical Activity Associated With Inflammatory Markers in US Adults? A Cross-Sectional Analyses From NHANES.

BACKGROUND: To investigate the association between levels of active transport and leisure-time physical activity (LTPA) with C-reactive protein, white blood cell count, body mass index, waist circumference, and lipids in a large representative sample of adults residing in the United States. METHODS: Cross-sectional data from the National Health and Nutrition Examination Survey. Adjusted multinomial logistic regressions were carried out to quantify associations between levels of self-reported active transport (or LTPA) and quintiles of anthropometric measures and serum markers. RESULTS: A total of 3248 adults were included. For serum inflammatory biomarkers, the authors observed a lower likelihood of being in the top quintile groups of circulating C-reactive protein (adjusted odds ratio [aOR]: 0.60; 95% confidence interval [CI], 0.40-0.90) and white blood cell count (aOR: 0.65; 95% CI, 0.44-0.95) with engaging in low to medium levels of active transport but not with high levels of active transport. Higher levels of LTPA were associated with lower likelihood of having high levels of serum inflammatory biomarkers (aOR: 0.60; 95% CI, 0.42-0.86 in the top C-reactive protein group and aOR: 0.58; 95% CI, 0.39-0.87 in top white blood cell group). CONCLUSIONS: Promoting active transport and/or LTPA may be a beneficial strategy to improving some, but not all, cardiometabolic health outcomes.

Test-retest reliability of the Mini Nutritional Assessment and its relationship with quality of life in patients with stroke.

BACKGROUND & OBJECTIVE: Malnutrition is one of commonly issues in patients with stroke. The Mini Nutritional Assessment (MNA) is a widely used measure for assessing nutritional status in patients with stroke. A nutritional measure with acceptable test-retest reliability allows clinicians to consistently assess patients' nutritional status. Knowledge of the relationship between nutritional status and quality of life (QOL) could guide clinicians to improve QOL in patients with stroke more effectively. This study aimed to examine test-retest reliability of the MNA and its relationship with QOL in patients with stroke. METHODS: Fifty-nine patients participated in the test-retest reliability study and the correlation between the MNA and WHO Quality of Life-BREF (WHOQOL-BREF) study. A repeated-assessments design (1 week apart) was used to examine the test-retest reliability of the MNA. RESULTS: The intraclass correlation coefficient for the MNA was 0.91. The minimal detectable change and percentage of minimal detectable change for the MNA were 2.1 and 8.2%, respectively. The MNA was positively associated with the QOL (r = 0.32; p = 0.013). The result of linear regression analysis shows that after controlling for age, sex and activities of daily living functions, only the MNA was significantly associated with the WHOQOL-BREF (r2 = 0.104; p = 0.008). CONCLUSIONS: The MNA has satisfactory test-retest reliability that is useful for repeatedly assessing the nutritional status of patients with stroke. The MDC of the MNA has acceptable random measurement error which is useful for determining whether the change score of a patient is outside the range of random measurement error. Future studies that recruit stroke patients in the acute stage is needed to further examine the relationship between the nutritional status and QOL.