Ideal Cardiovascular Health in adolescents: Findings from Study of Cardiovascular Risks in Adolescents.

BACKGROUND AND AIM: We assessed the Ideal Cardiovascular Health (CVH) in Brazilian adolescents according to demographics and socioeconomic characteristics. METHODS AND RESULTS: This is a cross-sectional study with data from the Study of Cardiovascular Risks in Adolescents (ERICA), with a nationwide representative sample of 36,956 Brazilian adolescents, aged 12-17 years, enrolled in public and private schools. The CVH metrics considered were body mass index (BMI), physical activity, smoking, healthy diet score, blood pressure, fasting plasma glucose, and total cholesterol. The demographics and socioeconomic characteristics analyzed were sex, age, race/skin color, and type of school attended. The study design was considered, and the significant difference determined by the non-overlapping of 95% Confidence Interval. The mean ideal CVH score was 4.0, higher for females, adolescents aged 15-17 years, and students from private schools. The prevalence of ideal fasting plasma glucose was 96%, of non-smoking 95.6%, of ideal blood pressure 75.5%, of ideal BMI 73.2%, of ideal total cholesterol 55.4%, of ideal physical activity 45.2%, and only 0.5% had an ideal diet. The prevalence of ideal CVH metrics varied according to demographics and socioeconomic characteristics. CONCLUSION: Females, older adolescents, and students who attended private school had a better CVH. Demographics and socioeconomic characteristics were associated with CVH metrics. The low ideal proportions found for diet and physical activity are of concern and reinforce the need for food and nutritional educational actions designed to promote healthy behaviors in adolescence to prevent the development of cardiovascular diseases.

Restricted dietary pattern may contribute to lowering blood pressure in adolescents with obesity: Study of Cardiovascular Risk in Adolescents.

OBJECTIVE: Dieting is one of the main target factors for interventions that seek to control and prevent rising blood pressure. This study identified dietary patterns and analyzed their association with adolescents' blood pressure. METHODS: This is a cross-sectional study with a probabilistic and nationally representative sample of adolescents aged 12-17 years, who participated in the Study of Cardiovascular Risk in Adolescents (ERICA), carried out in 2013-2014 with Brazilian adolescents (N = 36 956). Food consumption was assessed by 24 h recall. Dietary patterns were identified using the Reduced Rank Regression method, and considering waist circumference, fasting insulin, and dietary polyunsaturated fat/saturated fat ratio as intermediate variables. Multiple linear regression models stratified by weight were developed; SBP and DBP were the dependent variables, and dietary pattern scores were the independent ones, with adjustment for potential confounding factors. RESULTS: The following patterns were identified: 'Brazilian common', 'Restricted' and 'Added sugar'. The 'Restricted' pattern, which included diet/light foods, chicken and chicken-based dishes, leafy greens, vegetables and spices, red meats and dishes based on red meats and tubers, was inversely associated with SBP (ß = -1.55; 95% CI = -2.26 to -0.83) and DBP (ß = -1.19; 95% CI = -1.70 to -0.68) in adolescents with obesity. CONCLUSION: In adolescents with obesity, a low-energy density diet was associated with reduced blood pressure. These findings are consistent with international recommendations for preventing elevated blood pressure.

Evolution of out-of-home food consumption in Brazil in 2008-2009 and 2017-2018.

OBJECTIVE: To describe the evolution of out-of-home food consumption in Brazil in 2008-2018. METHODS: We used the 2008-2009 and 2017-2018 data from the Inquéritos Nacionais de Alimentação (INA - National Food Surveys), conducted amid 34,003 and 46,164 individuals, to estimate the frequency of out-of-home food consumption and the contribution of this consumption to specific foods. Food consumption was analyzed using food records in the 2008-2009 INA and 24-hour recalls in 2017-2018. Estimates were generated for Brazil in general, for urban and rural areas, for age groups (adolescent, adult, elderly), and for income bracket. RESULTS: The frequency of out-of-home consumption decreased by 8.8% between the two surveys, with no change in the rural area, in the Northeast and South regions, and for the lowest income brackets. We observed a slight increase among the elderly and in the Midwest region. The contribution of out-of-home food consumption to daily energy intake also decreased (16.3% vs. 12.7%), excepting the rural area, where there was a reduction in the difference in relation to the urban area between the two surveys. For most items evaluated, the out-of-home food consumption decreased. The most consumed out-of-home food were alcoholic beverages, fried and baked snacks, soft drinks, pizza, sweets, and sandwiches in both surveys. CONCLUSION: In 10 years, the prevalence of food consumption and the percentage of contribution of out-of-home food decreased in Brazil, but ultra-processed foods still figure as the most consumed food group outside the home.

Effectiveness of a school-based randomized controlled trial aimed at increasing physical activity time in adolescents.

BACKGROUND: This study aimed to evaluate the effectiveness of obesity prevention educational activities, isolated or combined with the modification of the school environment on total physical activity time. METHODS: This is a school-based randomized controlled trial, conducted with 2511 students from fifth and sixth-grade in Brazil, that employed a parallel, three-group experimental arms: control group (CG), PAAPPAS group (PG) and PAAPPAS-environment group (PEG). During the 2016 school year, the PG received educational activities in the classroom, providing a general basis for a healthy lifestyle. The PEG received the same educational activities and also modifications in the school environment to stimulate physical activity practice during one month. Physical activity was evaluated through a validated physical activity questionnaire. Intention-to-treat analysis was performed to evaluate the rate of change of physical activity time between groups using PROC GENMOD procedure. All analyses were performed using SAS. RESULTS: Total physical activity time increased by 22% in PEG compared with CG (P = 0.003). No difference was observed between PEG and PG (Δ = 60.20 vs. 36.37, respectively; P = 0.27) and between PG and CG (Δ = 36.37 vs. 9.70, respectively; P = 0.23). The proportion of individuals who attended at least 150 min week-1 of physical activity increased in PEG compared with PG (P = 0.04); however, no difference was observed between PEG and CG (P = 0.19) and between PG and CG (P = 0.26). For 300 min week-1, no difference was observed between groups. CONCLUSION: A school-based multi-component intervention including modification of the school environment was effective for increasing physical activity time among adolescents.

School-based obesity interventions in the metropolitan area of Rio De Janeiro, Brazil: pooled analysis from five randomised studies.

School-based studies, despite the large number of studies conducted, have reported inconclusive results on obesity prevention. The sample size is a major constraint in such studies by requiring large samples. This pooled analysis overcomes this problem by analysing 5926 students (mean age 11·5 years) from five randomised school-based interventions. These studies focused on encouraging students to change their drinking and eating habits, and physical activities over the one school year, with monthly 1-h sessions in the classroom; culinary class aimed at developing cooking skills to increase healthy eating and attempts to family engagement. Pooled intention-to-treat analysis using linear mixed models accounted for school clusters. Control and intervention groups were balanced at baseline. The overall result was a non-significant change in BMI after one school year of positive changes in behaviours associated with obesity. Estimated mean BMI changed from 19·02 to 19·22 kg/m2 in the control group and from 19·08 to 19·32 kg/m2 in the intervention group (P value of change over time = 0·09). Subgroup analyses among those overweight or with obesity at baseline also did not show differences between intervention and control groups. The percentage of fat measured by bioimpedance indicated a small reduction in the control compared with intervention (P = 0·05). This large pooled analysis showed no effect on obesity measures, although promising results were observed about modifying behaviours associated with obesity.

Evolution of out-of-home food consumption in Brazil in 2008-2009 and 2017-2018 / Evolução do consumo de alimentos fora do domicílio no Brasil de 2008-2009 a 2017-2018

ABSTRACT OBJECTIVE To describe the evolution of out-of-home food consumption in Brazil in 2008-2018. METHODS We used the 2008-2009 and 2017-2018 data from the Inquéritos Nacionais de Alimentação (INA - National Food Surveys), conducted amid 34,003 and 46,164 individuals, to estimate the frequency of out-of-home food consumption and the contribution of this consumption to specific foods. Food consumption was analyzed using food records in the 2008-2009 INA and 24-hour recalls in 2017-2018. Estimates were generated for Brazil in general, for urban and rural areas, for age groups (adolescent, adult, elderly), and for income bracket. RESULTS The frequency of out-of-home consumption decreased by 8.8% between the two surveys, with no change in the rural area, in the Northeast and South regions, and for the lowest income brackets. We observed a slight increase among the elderly and in the Midwest region. The contribution of out-of-home food consumption to daily energy intake also decreased (16.3% vs. 12.7%), excepting the rural area, where there was a reduction in the difference in relation to the urban area between the two surveys. For most items evaluated, the out-of-home food consumption decreased. The most consumed out-of-home food were alcoholic beverages, fried and baked snacks, soft drinks, pizza, sweets, and sandwiches in both surveys. CONCLUSION In 10 years, the prevalence of food consumption and the percentage of contribution of out-of-home food decreased in Brazil, but ultra-processed foods still figure as the most consumed food group outside the home.

RESUMO OBJETIVO Descrever a evolução do consumo de alimentos fora do domicílio no Brasil no período 2008-2018. MÉTODOS Foram usados dados dos Inquéritos Nacionais de Alimentação (INA) de 2008-2009 e 2017-2018, realizados com 34.003 e 46.164 indivíduos, respectivamente, para estimar a frequência de consumo de alimentos fora de casa e a contribuição desse consumo para alimentos específicos. O consumo de alimentos foi investigado por meio de registros alimentares no INA 2008-2009 e de recordatórios 24 horas em 2017-2018. As estimativas foram geradas para o Brasil como um todo, para áreas urbana e rural, para faixas de idade (adolescente, adulto, idoso) e para faixas de renda. RESULTADOS A frequência de consumo fora de casa diminuiu 8,8% entre os dois inquéritos, sem alteração na área rural, nas regiões Nordeste e Sul e nas menores faixas de renda. Houve leve aumento entre idosos e na região Centro-Oeste. De modo geral, a contribuição do consumo alimentar fora de casa para a ingestão diária de energia também diminuiu (16,3% vs. 12,7%), com exceção da área rural, onde houve redução da diferença em relação à área urbana entre os dois inquéritos. O consumo de alimentos fora de casa foi reduzido para a maioria dos itens avaliados. Os alimentos mais consumidos fora de casa em ambos os inquéritos foram as bebidas alcoólicas, salgadinhos fritos e assados, refrigerantes, pizzas, doces e sanduíches. CONCLUSÃO Em 10 anos, a prevalência de consumo de alimentos e o percentual de contribuição dos alimentos consumidos fora de casa diminuíram no Brasil, mas os alimentos ultraprocessados ainda figuram como o grupo de alimento mais consumido fora de casa.

Prevalence of inadequate intake of folate after mandatory fortification: results from the first National Dietary Survey in Brazil.

PURPOSE: Our aim was to estimate the prevalence of folate inadequacy (POFI) according to life stage, socio-economic status, and geographical regions after the mandatory fortification of wheat and maize flour in Brazil. METHODS: This was a population-based study. Data from two non-consecutive food records from the National Dietary Survey/Household Budget Survey 2008-2009 were used to estimate the usual dietary folate intake in µg dietary folate equivalents (DFEs). The National Cancer Institute method was used to account for within-person variance and the Estimated Average Requirement (EAR) cut-point method was used to calculate the POFI. The survey included 32,749 individuals, 15,700 males and 17,049 females, over 10 years old. Pregnant women, lactating women, and individuals with unreliable energy intake data were excluded. RESULTS: Overall POFI was 31.5% and mean dietary folate intake was 411.1 µg DFE. The lowest POFI occurred in the youngest age group of 10-13 years in both sexes, while the highest POFI was observed in the group ≥ 71 years. In women of childbearing age, POFI was around 32%. The lowest income strata had the highest POFI. The most developed regions (South and Southeast) had the lowest POFI compared to less developed regions. CONCLUSIONS: Our data show that folate inadequacy is still prevalent in Brazil mainly in low-income groups and less developed regions. Actions need to be taken to ensure that women of childbearing age, who presented a high prevalence of inadequate folate intake, achieve the recommended daily intake of 400 µg DFEs.

Effectiveness of school-home intervention for adolescent obesity prevention: parallel school randomised study.

Many school-based interventions for obesity prevention have been proposed with positive changes in behaviour, but with unsatisfactory results on weight change. The objective was to verify the effectiveness of a combined school- and home-based obesity prevention programme on excessive weight gain in adolescents. Teachers delivered the school-based primary prevention programme to fifth- and sixth-graders (nine schools, forty-eight control classes, forty-nine intervention classes), which included encouraging healthy eating habits and physical activity. A subgroup of overweight or obese adolescents also received a home-based secondary prevention programme delivered by community health professionals. Schools were randomised to intervention or control group. Intent-to-treat analysis used mixed models for repeated continuous measures and considered the cluster effect. The main outcomes were changes in BMI and percentage body fat (%body fat) after one school-year of intervention and follow-up. Against our hypothesis, BMI increased more in the intervention group than in the control group (Δ = 0·3 kg/m2; P = 0·05) with a greater decrease in %body fat among boys (Δ = -0·6 %; P = 0·03) in the control group. The intervention group increased physical activity by 12·5 min per week compared with the control group. Female adolescents in the intervention group ate healthier items more frequently than in the control group. The subgroup that received both the school and home interventions had an increase in %body fat than in the control group (Δ = 0·89 %; P = 0·01). In the present study, a behavioural change led to a small increase in physical activity and healthy eating habits but also to an overall increase in food intake.

Adapting the standardised computer- and interview-based 24 h dietary recall method (GloboDiet) for dietary monitoring in Latin America.

OBJECTIVE: The present study describes the procedure and approaches needed to adapt and harmonise the GloboDiet methodology, a computer- and interview-based 24 h dietary recall, for use in two Latin American pilot countries, Brazil and Mexico. DESIGN: About seventy common and country-specific databases on foods, recipes, dietary supplements, quantification methods and coefficients were customised and translated following standardised guidelines, starting from existing Spanish and Portuguese versions. SETTING: Brazil and Mexico. SUBJECTS: Not applicable. RESULTS: New subgroups were added into the existing common food classification together with new descriptors required to better classify and describe specific Brazilian and Mexican foods. Quantification methods were critically evaluated and adapted considering types and quantities of food consumed in these two countries, using data available from previous surveys. Furthermore, the photos to be used for quantification purposes were identified for compilation in country-specific but standardised picture booklets. CONCLUSIONS: The completion of the customisation of the GloboDiet Latin America versions in these two pilot countries provides new insights into the adaptability of this dietary international tool to the Latin American context. The ultimate purpose is to enable dietary intake comparisons within and between Latin American countries, support building capacities and foster regional and international collaborations. The development of the GloboDiet methodology could represent a major benefit for Latin America in terms of standardised dietary methodologies for multiple surveillance, research and prevention purposes.

PAAPPAS community trial protocol: a randomized study of obesity prevention for adolescents combining school with household intervention.

BACKGROUND: The prevalence of childhood obesity is increasing at a high rate in Brazil, making prevention a health priority. Schools are the central focus of interventions aiming the prevention and treatment of childhood obesity, however, randomized trials and cohort studies have not yet provided clear evidence of strategies to reduce prevalence of obesity. The aim of this study is to present a protocol to evaluate the efficacy of combining school and household level interventions to reduce excessive weight gain among students. METHODS: The intervention target fifth and sixth graders from 18 public schools (9 interventions and 9 controls) in the municipality of Duque de Caxias, metropolitan area of Rio de Janeiro, Brazil. A sample size of 2500 students will be evaluated at school for their weight status and those from the intervention group who are overweight or obese will be followed monthly at home by community health agents. Demographic, socioeconomic, anthropometric, eating behavior and food consumption data will be collected at school using a standardized questionnaire programmed in personal digital assistant. At school, all students from the intervention group will be encouraged to change eating habits and food consumption and to increase physical activity and reducing sedentary behavior. DISCUSSION: This study will provide evidence whether integration of school with primary health care can prevent excessive weight gain among adolescents. Positive results will inform a sustainable strategy to be disseminated in the health care system in Brazil. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02711488 . Date of registration: March 11, 2016.

Revista de Saúde Pública: 50 years disseminating the knowledge in nutrition.

This work describes and comments on articles in the area of Public Health Nutrition published in Revista de Saúde Pública (RSP - Public Health Journal) from 1967 to 2016. We searched in the PubMed database restricted to the periodical "Revista de Saúde Pública" and using terms related to key topics in the area of Public Health Nutrition. We retrieved 742 articles and, after exclusion of duplicates and articles unrelated to the subject, we analyzed 441 articles, grouped according to subject: dental caries, anemia, hypovitaminosis A, macro/micronutrients, malnutrition, nutritional assessment, overweight/obesity, food consumption, low birthweight, and breastfeeding. We observed significant increase in the number of articles published and diversification of subjects addressed over the 50 years, representing the consistent development of the scientific field of Nutrition in Brazil. Since its inception, RSP has played an important role in the dissemination of knowledge about the main nutritional issues in Brazil. RESUMO Este trabalho descreve e comenta os artigos na área de Nutrição em Saúde Pública, publicados na Revista de Saúde Pública (RSP) de 1967 a 2016. Foi realizada busca na base de dados PubMed restrita ao periódico "Revista de Saúde Pública" e utilizando termos relacionados com temáticas chaves da área de Nutrição em Saúde Pública. Foram recuperados 742 artigos e, após as exclusões dos artigos repetidos e daqueles não relacionados com a temática, foram analisados 441 artigos, agrupados segundo o tema: cárie dental, anemia, hipovitaminose A, macro/micronutrientes, desnutrição, avaliação do estado nutricional, sobrepeso/obesidade, consumo de alimentos, baixo peso ao nascer, e aleitamento materno. Observou-se incremento significativo no número de artigos publicados e a diversificação dos temas tratados ao longo destes 50 anos, retratando o consistente desenvolvimento do campo científico da Nutrição no Brasil. Desde seu início, a RSP desempenhou importante papel na divulgação do conhecimento sobre os principais agravos nutricionais no Brasil.

Soft drink consumption, mainly diet ones, is associated with increased blood pressure in adolescents.

OBJECTIVE: The aim of this cross-sectional study was to investigate the association between consumption of sugar-sweetened and diet soft drinks with blood pressure (BP) in adolescents. METHODS: Fifth graders of 20 public schools were invited to participate in an intervention aimed at behavioral dietary changes and had their BP, weight, and height measured at baseline. Type and frequency of soft drink consumption were assessed using a food and beverages frequency questionnaire, and students were classified as nonconsumers, sugar-sweetened soft drink consumers, and diet soft drink consumers. RESULTS: Of the 574 students invited, 512 were examined and 488 had their BP measured. Of these, 25 (5.1%) reported to be nonconsumers, 419 (85.9%) were sugar-sweetened soft drink consumers, and 44 (9%) were diet soft drink consumers. Mean SBP and DBP were 101.3/57.8, 102.6/58.8, and 106.0/61.3 mmHg for these three groups of consumption, respectively. After adjustment for sex, age, BMI, physical activity, addition of salt to food, and education of the head of the family, SBP was 5.4 mmHg higher in the diet soft drink consumers group compared with the nonconsumers group and 3.3 mmHg higher compared with the sugar-sweetened consumers group (P value of trend = 0.01). Moreover, DBP was also higher among diet soft drink consumers compared with nonconsumers, with a difference of 3.3 mmHg, and compared with sugar-sweetened consumers, with a difference of 2.3 mmHg (P value of trend = 0.04). CONCLUSION: The results indicate that the consumption of soft drink is associated with increased BP, which is further increased by drinking diet type sodas.

Revista de Saúde Pública: 50 years disseminating the knowledge in nutrition / Revista de Saúde Pública: 50 anos disseminando o conhecimento em Nutrição

ABSTRACT This work describes and comments on articles in the area of Public Health Nutrition published in Revista de Saúde Pública (RSP - Public Health Journal) from 1967 to 2016. We searched in the PubMed database restricted to the periodical "Revista de Saúde Pública" and using terms related to key topics in the area of Public Health Nutrition. We retrieved 742 articles and, after exclusion of duplicates and articles unrelated to the subject, we analyzed 441 articles, grouped according to subject: dental caries, anemia, hypovitaminosis A, macro/micronutrients, malnutrition, nutritional assessment, overweight/obesity, food consumption, low birthweight, and breastfeeding. We observed significant increase in the number of articles published and diversification of subjects addressed over the 50 years, representing the consistent development of the scientific field of Nutrition in Brazil. Since its inception, RSP has played an important role in the dissemination of knowledge about the main nutritional issues in Brazil.

RESUMO Este trabalho descreve e comenta os artigos na área de Nutrição em Saúde Pública, publicados na Revista de Saúde Pública (RSP) de 1967 a 2016. Foi realizada busca na base de dados PubMed restrita ao periódico "Revista de Saúde Pública" e utilizando termos relacionados com temáticas chaves da área de Nutrição em Saúde Pública. Foram recuperados 742 artigos e, após as exclusões dos artigos repetidos e daqueles não relacionados com a temática, foram analisados 441 artigos, agrupados segundo o tema: cárie dental, anemia, hipovitaminose A, macro/micronutrientes, desnutrição, avaliação do estado nutricional, sobrepeso/obesidade, consumo de alimentos, baixo peso ao nascer, e aleitamento materno. Observou-se incremento significativo no número de artigos publicados e a diversificação dos temas tratados ao longo destes 50 anos, retratando o consistente desenvolvimento do campo científico da Nutrição no Brasil. Desde seu início, a RSP desempenhou importante papel na divulgação do conhecimento sobre os principais agravos nutricionais no Brasil.

Cross-continental comparison of national food consumption survey methods--a narrative review.

Food consumption surveys are performed in many countries. Comparison of results from those surveys across nations is difficult because of differences in methodological approaches. While consensus about the preferred methodology associated with national food consumption surveys is increasing, no inventory of methodological aspects across continents is available. The aims of the present review are (1) to develop a framework of key methodological elements related to national food consumption surveys, (2) to create an inventory of these properties of surveys performed in the continents North-America, South-America, Asia and Australasia, and (3) to discuss and compare these methodological properties cross-continentally. A literature search was performed using a fixed set of search terms in different databases. The inventory was completed with all accessible information from all retrieved publications and corresponding authors were requested to provide additional information where missing. Surveys from ten individual countries, originating from four continents are listed in the inventory. The results are presented according to six major aspects of food consumption surveys. The most common dietary intake assessment method used in food consumption surveys worldwide is the 24-HDR (24 h dietary recall), occasionally administered repeatedly, mostly using interview software. Only three countries have incorporated their national food consumption surveys into continuous national health and nutrition examination surveys.

Energy and macronutrient intakes in Brazil: results of the first nationwide individual dietary survey.

OBJECTIVE: To characterize energy and macronutrient intakes in Brazil and to describe the top food items contributing to energy and macronutrient intakes. DESIGN: Two non-consecutive 24 h dietary records were collected and energy and macronutrient data were adjusted for usual intake distribution. Descriptive statistics and ANOVA with the Bonferroni post hoc test were analysed using SAS version 9·1. Means and standard deviations were estimated for sex, age and income strata. SETTING: Nationwide cross-sectional survey, 2008-2009. SUBJECTS: Nationally representative sample of individuals ≥10 years old (n32 749), excluding pregnant and lactating women (n 1254). RESULTS: The average energy intake was 7958 kJ/d (1902 kcal/d) and mean energy density was 6·82 kJ/g (1·63 kcal/g). Added sugar represented 13 % of total energy intake and animal protein represented 10 %. The mean contribution of total fat to energy intake was 27 %, while the mean saturated fat contribution was 9 %. Compared with the lowest quartile of income, individuals in the highest income quartile had greater mean intakes of energy, added sugar, alcohol, animal protein, total fat, saturated fat, monounsaturated fat and trans fat. Rice, beans, beef, bread and coffee were among the top five foods contributing most to the intakes of energy, carbohydrates, protein, fat and fibre. CONCLUSIONS: In general, Brazilians' dietary intake is compatible with a high risk of obesity and non-communicable chronic diseases, being characterized by high intakes of added sugar and saturated fat. Income may be a major determinant of diet nutritional characteristics.

Beverage consumption in Brazil: results from the first National Dietary Survey.

OBJECTIVE: To provide an overview of beverage consumption patterns using the first nationally representative survey of dietary intake in Brazil. DESIGN: Beverage consumption data were obtained by 1 d food records in an individual dietary survey. SETTING: Nationwide cross-sectional survey, 2008-2009. SUBJECTS: Nationally representative sample of individuals aged ≥10 years (n 34 003). RESULTS: Beverages contributed 17.1 % of total energy consumption. Caloric coffee beverages provided the greatest level of energy overall (464 kJ (111 kcal)/d). Individuals aged 10-18 years (243 kJ (58 kcal)/d) and 19-39 years (230 kJ (55 kcal)/d) consumed a higher proportion of energy from sugar-sweetened soft drinks than individuals over this age (142 kJ (34 kcal)/d for those aged 40-59 years and 79 kJ (19 kcal)/d for those aged ≥60 years). CONCLUSIONS: Overall, the contribution of beverages, particularly sugary beverages, to total energy consumption in Brazil represents an important public health challenge and is comparable with those from other countries.

Sources of excessive saturated fat, trans fat and sugar consumption in Brazil: an analysis of the first Brazilian nationwide individual dietary survey.

OBJECTIVE: To examine the patterns of consumption of foods high in solid fats and added sugars (SoFAS) in Brazil. DESIGN: Cross-sectional study; individual dietary intake survey. Food intake was assessed by means of two non-consecutive food records. Foods providing >9·1% of energy from saturated fat, or >1·3% of energy from trans fat, or >13% of energy from added sugars per 100 g were classified as high in SoFAS. SETTING: Brazilian nationwide survey, 2008-2009. SUBJECTS: Individuals aged ≥10 years old. RESULTS: Mean daily energy intake was 8037 kJ (1921 kcal), 52% of energy came from SoFAS foods. Contribution of SoFAS foods to total energy intake was higher among women (52%) and adolescents (54%). Participants in rural areas (43%) and in the lowest quartile of per capita family income (43%) reported the smallest contribution of SoFAS foods to total energy intake. SoFAS foods were large contributors to total saturated fat (87%), trans fat (89%), added sugar (98%) and total sugar (96%) consumption. The SoFAS food groups that contributed most to total energy intake were meats and beverages. Top SoFAS foods contributing to saturated fat and trans fat intakes were meats and fats and oils. Most of the added and total sugar in the diet was supplied by SoFAS beverages and sweets and desserts. CONCLUSIONS: SoFAS foods play an important role in the Brazilian diet. The study identifies options for improving the Brazilian diet and reducing nutrition-related non-communicable chronic diseases, but also points out some limitations of the nutrient-based criteria.

Variation of BMI and anthropometric indicators of abdominal obesity in Brazilian adolescents from public schools, 2003-2008.

OBJECTIVE: The aim of the present study was to compare BMI and anthropometric indicators of abdominal obesity in Brazilian adolescents from public schools between 2003 and 2008. DESIGN: A comparison of anthropometric indicators in adolescents was done based on two cross-sectional surveys conducted in 2003 (n 530) and in 2008 (n 498). BMI (= weight/height2), waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were evaluated. The age-adjusted means were compared between the two studies by linear regression and the percentile values were compared by quantile regression. A P value <0·05 was adopted for statistical significance. SETTING: Metropolitan area of Rio de Janeiro, Brazil. SUBJECTS: Two probabilistic samples of students aged 15-19 years old, from public schools. RESULTS: There was a decrease in boys' mean WC (72·9 cm v. 70·9 cm, P = 0·01) and an increase in girls' mean BMI (21·1 kg/m2 v. 22·0 kg/m2, P = 0·03). Among boys, the WC, HC and WHtR percentiles were lower whereas the WHR percentiles were higher in 2008 than in 2003. Among girls, the percentiles of all measures were higher in 2008, except for WHR. CONCLUSIONS: Anthropometric measures among boys tended to decrease, while among girls there was a tendency to increase from 2003 to 2008, indicating an important gender effect and a higher morbidity risk associated with excess body fat in girls. The school setting offers opportunities for interventions to address this situation.

Most consumed foods in Brazil: National Dietary Survey 2008-2009.

OBJECTIVE: To describe the most commonly consumed foods in Brazil. METHODS: This analysis is based on food intake data obtained on the first of two non-consecutive days' food records from 34,003 subjects aged 10 or over, resident in 13,569 households selected to participate in the National Dietary Survey 2008-2009 from the probabilistic sample defined for the Household Budget Survey 2008-2009. Consumption patterns were analyzed according to gender, age, regions and per capita family income. RESULTS: The most frequently recorded foods were rice (84.0%), coffee (79.0%), beans (72.8%), bread (63.0%), and red meat (48.7%). The intake of fruit juice (39.8%) and soft drinks (23.0%) is notable, as is the low intake of fruit (16.0%) and vegetables (16.0%). This scenario was similar across all age and sex groups; however, adolescents were the only age group which did not report any vegetables and included candies, sweetened dairy beverages and cookies among the most frequently recorded foods. Some foods are of markedly regional intake, such as manioc flour in the North and Northeast and tea in the South Region. Analysis according to income quartile revealed important differences between the highest and lowest income stratum. Subjects in the highest income quartile reported consuming sandwiches, tomatoes, and lettuce and those in the lowest income quartile cited manioc flour and fish and seafood among the most recorded foods. CONCLUSIONS: There is a basic food intake pattern in Brazil based on rice, beans, coffee, bread, and beef with small but consistent regional variation. The consumption of items rich in fat and sugar is also frequent, particularly among adolescents.