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

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

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

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

Top food sources of percentage of energy, nutrients to limit and total gram amount consumed among US adolescents: National Health and Nutrition Examination Survey 2011-2014.

OBJECTIVE: To identify most commonly consumed foods by adolescents contributing to percentage of total energy, added sugars, SFA, Na and total gram intake per day. DESIGN: Data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. SETTING: NHANES is a cross-sectional study nationally representative of the US population.ParticipantsOne 24 h dietary recall was used to assess dietary intake of 3156 adolescents aged 10-19 years. What We Eat in America food category classification system was used for all foods consumed. Food sources of energy, added sugars, SFA, Na and total gram amount consumed were sample-weighted and ranked based on percentage contribution to intake of total amount. RESULTS: Three-highest ranked food subgroup sources of total energy consumed were: sugar-sweetened beverages (SSB; 7·8 %); sweet bakery products (6·9 %); mixed dishes - pizza (6·6 %). Highest ranked food sources of total gram amount consumed were: plain water (33·1 %); SSB (15·8 %); milk (7·2 %). Three highest ranked food sources of total Na were: mixed dishes - pizza (8·7 %); mixed dishes - Mexican (6·7 %); cured meats/poultry (6·6 %). Three highest ranked food sources of SFA were: mixed dishes - pizza (9·1 %); sweet bakery products (8·3 %); mixed dishes - Mexican (7·9 %). Three highest ranked food sources of added sugars were: SSB (42·1 %); sweet bakery products (12·1 %); coffee and tea (7·6 %). CONCLUSIONS: Identifying current food sources of percentage energy, nutrients to limit and total gram amount consumed among US adolescents is critical for designing strategies to help them meet nutrient recommendations within energy needs.

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

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

Relationship between whole grain and fiber consumption and body weight measures among 6- to 18-year-olds.

OBJECTIVES: To examine the relationship between whole grain and fiber consumption and body weight measures in children 6 to 12 (n=3868) and adolescents 13 to 18 (n=4931) years old. STUDY DESIGN: Combined 1999 to 2004 National Health and Nutrition Examination Survey data were analyzed. Mean body mass index (BMI), BMI percentile, BMI z-score, waist circumference, and prevalence of overweight/obesity were compared across categories of whole grain consumption (0 to <0.6, >or=0.6 to <1.5, >or=1.5 to <3, and >or=3 servings) with (1) a sex, ethnicity, and total energy intake-adjusted model and (2) a cereal fiber plus model 1 covariates profile. RESULTS: Mean whole grain intake was 0.59 and 0.63 servings/d among children 6 to 12 years and adolescents 13 to 18 years, respectively. In children, consumption of >or=3 servings of whole grain was not associated with body weight measures; however, consumption of 1.5 to <3 servings was positively associated with all weight measures. In adolescents, BMI z-score was significantly lower in the highest whole grain consumption group compared with the lowest 2 groups; BMI percentile and waist circumference (model 1 only) were also significantly lower in the highest whole grain consumption group. CONCLUSIONS: Overall consumption of whole grain was below current recommendations of at least 3 servings per day. Only in adolescents was this level of whole grain intake associated with lower BMI z-scores.