Are Brazilian adolescents eating enough fruits and vegetables? An assessment using data from the Study of Cardiovascular Risk in Adolescents / Os adolescentes brasileiros estão comendo frutas e vegetais suficientes? Uma avaliação com dados do Estudo de Risco Cardiovascular de Adolescentes

ABSTRACT Objective To estimate the usual consumption of fruits and vegetables by Brazilian adolescents. Methods We used 24-hour dietary recall data from the Study of Cardiovascular Risk in Adolescents conducted in 2013-2014 with 71,740 adolescents between 12 and 17 years old. The usual consumption of fruits and vegetables was estimated in the Statistical Analysis Software using the model of the United States National Cancer Institute, and evaluated according to sex, age, place of residence, economic class, and nutritional status of the participants. Results The mean of usual fruit and vegetable consumption was estimated at 171g/day, mostly fruits (128g/day), mainly in the form of fruit juice (64.8%). The minimum fruit and vegetable consumption of 400g/day recommended by the World Health Organization was reached only by 2% of the adolescents. The adolescents' socioeconomic class or nutritional status had no impact on the usual fruit and vegetable consumption, but adolescents from northern Brazil had a significantly lower consumption than those from the midwestern region. Orange was both the most consumed fruit on a daily basis (mean of 42.6g/day, 90% as juice) and the most reported fruit (by 12.7% of the adolescents), followed by apples (10g/day; 5.6%) and bananas (8.4g/day; 8.3%). Tomato was the most consumed vegetable (9.2g/day), reported by 11.5% of the adolescents. Conclusion Public health policies are necessary to encourage fruit and vegetable consumption among Brazilian adolescents, including of pure juice, essential foods to prevent chronic diseases in adulthood.

RESUMO Objetivo Estimar o consumo de frutas e vegetais por adolescentes brasileiros. Métodos Foram utilizados os dados do Estudo de Risco Cardiovascular de Adolescentes conduzido em 2013-2014 com 71.740 adolescentes entre 12 e 17 anos, que responderam ao questionário recordatório de 24 horas. O consumo usual de frutas e vegetais foi estimado no programa Statistical Analysis Software usando o modelo do Instituto Nacional de Câncer dos Estados Unidos e avaliado de acordo com sexo, idade, residência, classe econômica e estado nutricional dos participantes. Resultados O consumo médio usual estimado de frutas e vegetais dos participantes foi de 171g/dia, sendo 128g/dia de frutas, principalmente na forma de suco in natura (64,8%). O consumo mínimo de 400g/dia recomendado pela Organização Mundial da Saúde foi alcançado por apenas 2% dos adolescentes. A classe socioeconômica e o status nutricional não impactaram o consumo usual, mas adolescentes do norte do Brasil tiveram um consumo significativamente menor de frutas e vegetais se comparados com aqueles da região centro-oeste. A laranja foi a fruta mais consumida no período do estudo (média de 42.6g/dia, 90% como suco) e a mais relatada (por 12,7% dos adolescentes), seguido de maçã (10g/dia; 5,6%) e banana (8,4g/dia; 8,3%). Tomate foi o vegetal mais consumido (9,2g/dia), reportado por 11,5% dos adolescentes. Conclusão Políticas públicas são necessárias para encorajar o consumo de frutas e vegetais entre os adolescentes brasileiros, inclusive na forma de suco puro, pois são alimentos essenciais para prevenir o desenvolvimento de doenças crônicas na vida adulta.

Mycotoxins in cereals and cereal-based products: Incidence and probabilistic dietary risk assessment for the Brazilian population.

A probabilistic dietary risk assessment on mycotoxins was conducted using the Monte Carlo Risk Assessment software, with consumption data from the 2008/2009 Brazilian Household Budget Survey for individuals who were at least 10 years old and occurrence data for 646 samples of rice, maize, wheat, and their products, collected in the Federal District and in the state of Rio Grande do Sul, Brazil. Processing factors were estimated and applied to concentration data. Chronic exposure was estimated for fumonisins (free and bound/hidden), deoxynivalenol (DON) (including the acetylated forms) and zearalenone (ZON) (including alfa-zearalenol) and acute exposure was estimated for DON. For the general population, the chronic exposure exceeded the safe exposure levels at the 95P for DON and at the 99P for fumonisins. Additionally, safe level exceedance occurred at the 97.5P for fumonisins and at the 95P for DON for teenagers, as well as at the 99P for fumonisins for women of child-bearing-age. No exceedances were found for chronic exposure to ZON and acute exposure to DON. Maize couscous contributed most of the total fumonisins (91%) and ZON intakes (~40%) and bread to total intake of DON (~30%). Further studies should be conducted with updated Brazilian consumption data, which should include information for individuals aged less than 10 years old.

Probabilistic dietary risk assessment of triazole and dithiocarbamate fungicides for the Brazilian population.

Residue data for triazoles (TR) and dithiocarbamates (DT) in 30,786 samples of 30 foods were obtained from mainly two national monitoring programs, and consumption data from a national survey conducted among persons aged 10 years or older. About 16% of the samples contained TR, mainly grape (53.5%), and 16.2% contained DT, mainly apple (59.3%). Flusilazole was the index compound used for the acute effects of TR for women of child-bearing-age (cranium-facial malformation and skeletal variation), cyproconazole for the chronic effects of TR (hepatoxicity), and ethylene-bis-dithitiocarbamates (EBDC) for DT (thyroid toxicity). Exposures were estimated using the Monte Carlo Risk Assessment software. Different models were tested, and a Model-Then-Add approach was found to best estimate the chronic exposures to DT and TR. At the 99.9th percentile (P99.9), the cumulative acute TR intakes accounted for up to 0.5% of the flusilazole ARfD, mainly from beans and rice consumption. The chronic TR and DT intakes accounted for 1 and 6.7% of the respective index compound ADIs, with beans and rice accounting for most of the TR intake (∼70%), and apple for about 51-56% of the DT intake. The estimated risks from the exposure to TR and DT indicate no health concern for the Brazilian population.

Dietary cumulative acute risk assessment of organophosphorus, carbamates and pyrethroids insecticides for the Brazilian population.

Cumulative acute dietary risk assessments of organophosphorus (OPs), carbamates (CBs) and pyrethroids (PYs) were conducted for the Brazilian population. Residue data for 30786 samples of 30 foods were obtained from two national monitoring programs and one University laboratory, and consumption data from a national survey conducted among persons 10 years or older. Acephate and methamidophos were used as index compounds (IC) for OPs, oxamyl for CBs and deltamethrin for PYs. Exposures were estimated using the Monte Carlo Risk Assessment (MCRA 8.2) software. Orange and orange juice (mainly containing methidathion), pasta and salted bread (mainly pirimiphos-methyl) contributed most to the OPs intake. Rice accounted for 80% of the CBs intake (teenagers), mainly due to aldicarb. Pasta, salted bread and beans contributed most to the PYs intake (9-14%), mainly due to bifenthrin. The intake did not exceed the ARfD at the 99.9th percentile for OPs, CBs and PYs, and the risks from the exposure were not considered of health concern. When food consumption data become available for children under age 10, studies in the cumulative exposure should be conducted, as this age group is the most critical among the population, mainly due to their higher food consumption per kg body weight.

Validade relativa de questionário de frequência alimentar com suporte de imagens / Relative validity of a food frequency questionnaire supported by images

Resumo O objetivo do presente estudo foi avaliar a validade relativa de questionário de frequência alimentar (QFA), desenvolvido para adolescentes. O estudo envolveu amostra de 106 adolescentes (57% meninas) de 11 a 18 anos de idade. O QFA foi aplicado em entrevistas pessoais com o suporte de fotografias dos 93 itens alimentares. As médias deatenuadas da ingestão de energia e nutrientes de três recordatórios de 24 horas (R24h) foram consideradas como referência e foram comparadas com aquelas estimadas pelo QFA com o uso do coeficiente de correlação de Spearman, kappa ponderado para a concordância da categorização em quartis, e limites de concordância de Bland-Altman. Os coeficientes de correlação variaram de 0,27 a 0,49 (média = 0,43), o kappa ponderado variou de 0,28 a 0,51 (média = 0,40), e a concordância média estimada variou de 109 a 159% (média = 130%). Aproximadamente 30% das estimativas foram classificados de forma exata em um mesmo quartil e cerca de 90% em quartis iguais ou adjacentes. Resultados obtidos com a aplicação do QFA com o suporte de fotografias foram mais favoráveis do que os observados para o questionário isoladamente. O QFA foi considerado apropriado para categorizar adolescentes segundo gradientes de consumo energia e nutrientes.

Abstract The scope of this study was to evaluate the relative validity of a food frequency questionnaire (FFQ) designed for adolescents. The study involved a sample of 106 adolescents (57% girls) aged between 11 and 18. The FFQ was administered in one-on-one interviews with the support of the 93 photographs of food items. Overall averages of energy and nutrient intake of three 24-hour recalls (24h-R) were used as benchmarks. They were then compared with those estimated from the FFQ using the Spearman correlation coefficient, weighted kappa for the agreement between classifications into quartiles and Bland-Altman limits of agreement. The correlation coefficients ranged from 0.27 to 0.49 (mean = 0.43), the weighted kappa ranged from 0.28 to 0.51 (mean = 0.40), and the estimated Bland-Altman mean limits of agreement ranged from 109 to 159% (mean = 130%). Approximately 30% of the estimates were classified into the same quartile while about 90% were categorized into the same or adjacent quartiles. Supporting the application of the FFQ with photographs provided more favorable results than those observed for the questionnaire alone. The FFQ was considered appropriate to categorize adolescents according to gradients of dietary intake.

Dietary quality varies according to data collection instrument: a comparison between a food frequency questionnaire and 24-hour recall.

The objective of this study was to assess the agreement between the Brazilian Healthy Eating Index - Revised (BHEI-R), estimated by a food frequency questionnaire (FFQ) and multiple 24-hour recalls (24h-R). The Wilcoxon paired test, partial correlations (PC), intraclass correlation coefficient (ICC), and Bland-Altman method were used. The total BHEI-R scores and its components ("total fruits", "whole fruits", "total vegetables", "integral cereals", "saturated fat", "sodium", and "energy intake derived from solid fat, added sugar, and alcoholic beverages") were statistically different, with the ICC and PC indicating poor concordance and correlation. The mean concordance estimated for the total BHEI-R and its components varied from 68% for "integral cereals" to 147% for "whole fruits". The suitable concordance limits were violated for most of the components of the BHEI-R. Poor concordance was observed between the BHEI-R estimated by the FFQ and by multiple 24h-R, which indicated a strong reliability of the BHEI-R on the instrument used to collect information on food consumption.

Dietary quality varies according to data collection instrument: a comparison between a food frequency questionnaire and 24-hour recall / A qualidade da dieta varia de acordo com o instrumento de obtenção de dados: comparação entre questionário de frequência alimentar e recordatório de 24 horas / La calidad de la dieta varía de acuerdo a lo instrumento de obtención de datos: comparación de cuestionario de frecuencia alimentaria y recordatorio de 24 horas

Abstract The objective of this study was to assess the agreement between the Brazilian Healthy Eating Index – Revised (BHEI-R), estimated by a food frequency questionnaire (FFQ) and multiple 24-hour recalls (24h-R). The Wilcoxon paired test, partial correlations (PC), intraclass correlation coefficient (ICC), and Bland-Altman method were used. The total BHEI-R scores and its components (“total fruits”, “whole fruits”, “total vegetables”, “integral cereals”, “saturated fat”, “sodium”, and “energy intake derived from solid fat, added sugar, and alcoholic beverages”) were statistically different, with the ICC and PC indicating poor concordance and correlation. The mean concordance estimated for the total BHEI-R and its components varied from 68% for “integral cereals” to 147% for “whole fruits”. The suitable concordance limits were violated for most of the components of the BHEI-R. Poor concordance was observed between the BHEI-R estimated by the FFQ and by multiple 24h-R, which indicated a strong reliability of the BHEI-R on the instrument used to collect information on food consumption.

Resumo O objetivo do estudo foi avaliar a concordância entre o Índice de Qualidade da Dieta Revisado (IQD-R), estimado por questionário de frequência alimentar (QFA) e recordatório de 24 horas (R24h). O teste de Wilcoxon, correlações parciais (CP), coeficiente de correlação intra-classe (CCI) e o método Bland-Altman foram usados. Os escores totais do IQD-R e seus componentes (“frutas totais”, “frutas inteiras”, “vegetais totais”, “cerais integrais”, “gordura saturada”, “sódio” e “ingestão de energia derivada de gordura sólida, adicionados de açúcar e bebidas alcoólicas” foram estatisticamente diferentes, com o CCI e as CP indicando baixa concordância e correlação. A concordância média estimada para o IQD-R total e seus componentes variou de 68% para “cereais integrais” e 147% para as “frutas inteiras”. Os limites adequados de concordância foram ultrapassados para a maior parte dos componentes do IQD-R. Observou-se baixa concordância entre o IQD-R estimado pelo QFA e por múltiplos R24h, o que indica uma forte confiabilidade do IQD-R no instrumento usado para coletar informações sobre o consumo alimentar.

Resumen El objetivo del estudio fue evaluar la correlación entre el Índice de Calidad de la Dieta Revisado (ICD-R), estimado por cuestionario de frecuencia de alimentos (CFA) y recordatorio de 24 horas (R24h). Se utilizó la prueba de Wilcoxon, correlaciones parciales (CP), coeficiente de correlación intraclase (CCI) y el método de Bland-Altman. Las puntuaciones totales del ICD-R y sus componentes (“total de frutas”, “frutas enteras”, “vegetales totales”, “granos integrales”, “grasa saturada”, “sodio” y “consumo de energía derivada de grasa sólida, agregado de azúcar y alcohol”) fueron estadísticamente diferentes, con el CCI y el CP indicando baja concordancia y correlación. La concordancia media estimada para el ICD-R total y sus componentes varió de 68% para los “granos integrales” y 147% para las “frutas enteras”. Los límites adecuados de concordancia fureon excedidos para la mayor parte de los componentes del ICD-R. Se observó baja concordancia entre el ICD-R estimado por el CFA y múltiples R24h, lo que indica una fuerte confiabilidad del ICD-R en el instrumento que se utiliza para recopilar información sobre el consumo de alimentos.

Evaluation of photographs supporting an FFQ developed for adolescents.

OBJECTIVE: To evaluate the validity of food photographs used to support the reporting of food intake with an FFQ designed for adolescents from Rio de Janeiro, Brazil. DESIGN: A set of ninety-five food photographs was elaborated. The photographs' evaluation process included the acknowledgement of foods and portions in the pictures. In the identification of foods (ninety-five photographs) and typical portions (twelve photographs), the adolescents were requested to answer a structured questionnaire related to the food photographs. The identification of the portion size of amorphous foods (forty-three photographs) was performed using three different portion sizes of actual preparations. The proportions (and 95% confidence intervals) of adolescents who correctly identified foods and portion size in each photograph were estimated. SETTING: A public school in Niterói, Rio de Janeiro State, Brazil. SUBJECTS: Sixty-two adolescents between 11·0 and 18·9 years old, randomly selected. RESULTS: At least 90% of adolescents correctly identified the food in ninety-two photographs and the food in the three remaining photographs was recognized by 80-89% of the adolescents. At least 98% of the adolescents correctly identified eleven typical or natural portions in the food photographs. For amorphous foods, at least 70% of teenagers correctly identified the portion size in the photograph of thirty-one foods; for the other photographs, the portion size was correctly recognized by 50-69% of the adolescents for eight foods and by less than 50% of adolescents for four foods. CONCLUSIONS: The analysed photographs are appropriate visual aids to the reporting of food consumption by adolescents.