Food consumption in Brazil: influence of beef on environmental impact and nutritional quality of the diet.

OBJECTIVE: To estimate beef consumption and its influence on carbon and water footprints, as well as to improve the nutritional quality of the Brazilian diet. METHODS: The amount of beef and other foods consumed was evaluated by two 24-hour food records in a representative sample of the Brazilian population ≥ 10 years of age (n = 32,853) from 2008 to 2009. The environmental impact of the diet considered the coefficients of the carbon footprint (gCO2 and/kg) and the water footprint (liters/kg) of the foods, as well as their nutritional quality considering the nutrient composition of each food associated with the prevention of nutritional deficiencies or the increase/decrease in chronic disease risk. Linear and logistic regression models, crude and adjusted for sex, age, education, income, region, and area, were used to respectively study the association of fifths of the caloric contribution of beef with the environmental impacts of the diet and inadequate nutrient intake. RESULTS: Carbon and water footprints and protein, iron, zinc, vitamin B12, saturated fat, and sodium contents were higher in the fraction of the diet composed of beef, whereas fiber and added sugar contents were higher in the fraction composed by the other foods. Dietary beef contribution was directly associated with the carbon and water footprints of the diet and the risk of saturated fat and sodium excess, besides fiber insufficiency, inversely associated with the risk of protein, iron, zinc, and vitamin B12 insufficiency. CONCLUSION: Reducing beef consumption in Brazil would also reduce the carbon and water footprints of the diet, as well as the risk of chronic diseases related to food. Therefore, in order not to increase the risk of nutritional deficiencies, monitoring the increased intake of other foods rich in protein, iron, zinc, and vitamin B12 is suggested.

Ultra-processed food intake and diet carbon and water footprints: a national study in Brazil.

OBJECTIVE: To study the association between ultra-processed food consumption and carbon and water footprints of the Brazilian diet. METHODS: Cross-sectional analysis on data collected in 2008-2009 on a probabilistic sample of the Brazilian population aged ≥ 10 years (n = 32,886). Individual food intake was assessed using two 24-hour food records, on non-consecutive days. The environmental impact of individual diets was calculated by multiplying the amount of each food by coefficients that quantify the atmospheric emissions of greenhouse gases in grams of carbon dioxide equivalent (carbon footprint) and freshwater use in liters (water footprint), both per gram or milliliter of food. The two coefficients consider the food life cycle 'from farm to fork.' Crude and adjusted linear regression models and tests for linear trends assessed the association between the ultra-processed food contribution to total energy intake (quintiles) and the diet carbon and water footprints. Potential confounders included age, sex, education, income, and region. Total energy intake was assessed as a potential mediation variable. RESULTS: In the crude models, the dietary contribution of ultra-processed foods was linearly associated with the carbon and water footprints of the Brazilian diet. After adjustment for potential confounders, the association remained significant only regarding the diet water footprint, which increased by 10.1% between the lowest and highest quintile of the contribution of ultra-processed foods. Additional adjustment for total energy intake eliminated this association indicating that the dietary contribution of ultra-processed foods increases the diet water footprint by increasing energy intake. CONCLUSIONS: The negative impact of ultra-processed foods on the diet water footprint, shown for the first time in this study, adds to the negative impacts of these foods, already demonstrated regarding dietary nutrient profiles and the risk for several chronic non-communicable diseases. This reinforces the recommendation to avoid ultra-processed foods made in the official Brazilian Dietary Guidelines and increasingly in dietary guidelines of other countries.

Food consumption in Brazil: influence of beef on environmental impact and nutritional quality of the diet / Consumo alimentar no Brasil: influência da carne bovina no impacto ambiental e na qualidade nutricional da dieta

ABSTRACT OBJECTIVE To estimate beef consumption and its influence on carbon and water footprints, as well as to improve the nutritional quality of the Brazilian diet. METHODS The amount of beef and other foods consumed was evaluated by two 24-hour food records in a representative sample of the Brazilian population ≥ 10 years of age (n = 32,853) from 2008 to 2009. The environmental impact of the diet considered the coefficients of the carbon footprint (gCO2 and/kg) and the water footprint (liters/kg) of the foods, as well as their nutritional quality considering the nutrient composition of each food associated with the prevention of nutritional deficiencies or the increase/decrease in chronic disease risk. Linear and logistic regression models, crude and adjusted for sex, age, education, income, region, and area, were used to respectively study the association of fifths of the caloric contribution of beef with the environmental impacts of the diet and inadequate nutrient intake. RESULTS Carbon and water footprints and protein, iron, zinc, vitamin B12, saturated fat, and sodium contents were higher in the fraction of the diet composed of beef, whereas fiber and added sugar contents were higher in the fraction composed by the other foods. Dietary beef contribution was directly associated with the carbon and water footprints of the diet and the risk of saturated fat and sodium excess, besides fiber insufficiency, inversely associated with the risk of protein, iron, zinc, and vitamin B12 insufficiency. CONCLUSION Reducing beef consumption in Brazil would also reduce the carbon and water footprints of the diet, as well as the risk of chronic diseases related to food. Therefore, in order not to increase the risk of nutritional deficiencies, monitoring the increased intake of other foods rich in protein, iron, zinc, and vitamin B12 is suggested.

RESUMO OBJETIVO Estimar o consumo de carne bovina e a sua influência nas pegadas de carbono e na pegada hídrica, bem como mesurar a qualidade nutricional da dieta no Brasil. MÉTODOS A quantidade consumida de carne bovina e dos demais alimentos foi avaliada por dois registros alimentares de 24 horas em amostra representativa da população brasileira ≥ 10 anos de idade (n = 32.853) entre 2008 e 2009. O impacto ambiental da dieta considerou os coeficientes da pegada de carbono (gCO2e/kg) e da pegada hídrica (litros/kg) dos alimentos, bem como sua qualidade nutricional considerando a composição de cada alimento em nutrientes associados à prevenção de deficiências nutricionais ou ao aumento/diminuição do risco de doenças crônicas. Modelos de regressão linear e logística, brutos e ajustados para sexo, idade, escolaridade, renda, região e área, foram utilizados para estudar, respectivamente, a associação de quintos da contribuição calórica de carne bovina com os impactos ambientais da dieta e com a ingestão inadequada de nutrientes. RESULTADOS As pegadas de carbono e hídrica e os teores de proteína, ferro, zinco, vitamina B12, gordura saturada e sódio foram maiores na fração da dieta composta por carnes bovinas, enquanto o teor de fibra e de açúcar de adição foram maiores na fração composta pelos demais alimentos. A contribuição dietética de carne bovina mostrou-se associada diretamente com as pegadas de carbono e hídrica da dieta e com o risco de ingestão excessiva de gordura saturada e de sódio, além de ingestão insuficiente de fibra, associando-se inversamente com o risco de ingestão insuficiente de proteína, ferro, zinco e vitamina B12. CONCLUSÃO A redução no consumo de carne bovina no Brasil diminuiria as pegadas de carbono e hídrica da dieta, assim como o risco de doenças crônicas relacionadas à alimentação. Portanto, para não aumentar o risco de deficiências nutricionais, é sugerido o acompanhamento do aumento da ingestão de outros alimentos fontes de proteína, ferro, zinco e vitamina B12.

Ultra-processed food intake and diet carbon and water footprints: a national study in Brazil

ABSTRACT OBJECTIVE To study the association between ultra-processed food consumption and carbon and water footprints of the Brazilian diet. METHODS Cross-sectional analysis on data collected in 2008-2009 on a probabilistic sample of the Brazilian population aged ≥ 10 years (n = 32,886). Individual food intake was assessed using two 24-hour food records, on non-consecutive days. The environmental impact of individual diets was calculated by multiplying the amount of each food by coefficients that quantify the atmospheric emissions of greenhouse gases in grams of carbon dioxide equivalent (carbon footprint) and freshwater use in liters (water footprint), both per gram or milliliter of food. The two coefficients consider the food life cycle 'from farm to fork.' Crude and adjusted linear regression models and tests for linear trends assessed the association between the ultra-processed food contribution to total energy intake (quintiles) and the diet carbon and water footprints. Potential confounders included age, sex, education, income, and region. Total energy intake was assessed as a potential mediation variable. RESULTS In the crude models, the dietary contribution of ultra-processed foods was linearly associated with the carbon and water footprints of the Brazilian diet. After adjustment for potential confounders, the association remained significant only regarding the diet water footprint, which increased by 10.1% between the lowest and highest quintile of the contribution of ultra-processed foods. Additional adjustment for total energy intake eliminated this association indicating that the dietary contribution of ultra-processed foods increases the diet water footprint by increasing energy intake. CONCLUSIONS The negative impact of ultra-processed foods on the diet water footprint, shown for the first time in this study, adds to the negative impacts of these foods, already demonstrated regarding dietary nutrient profiles and the risk for several chronic non-communicable diseases. This reinforces the recommendation to avoid ultra-processed foods made in the official Brazilian Dietary Guidelines and increasingly in dietary guidelines of other countries.

Carbon footprint of the Brazilian diet.

OBJECTIVE: To estimate the carbon footprint of the Brazilian diet and of sociodemographic strata of this population. METHODS: Carbon footprint of the diet was estimated based on data from two 24-hour diet records, obtained in 2008 and 2009, from a probabilistic sample of the Brazilian population aged 10 years and over (n = 34,003) and on environmental impact coefficients of food and culinary preparations consumed in Brazil (gCO2e/kg). Means with 95% confidence intervals of food consumption (kcal/person/day) and the carbon footprint of the diet (gCO2e/person/day and in gCO2e/2,000kcal) were calculated for the population as a whole and for strata according to sex, age, income, education, macro-regions and Federative Unit. Linear regression models were used to identify significant differences (p < 0.05) in the dietary carbon footprint of different sociodemographic strata. RESULTS: The average carbon footprint of the Brazilian diet was 4,489gCO2e/person/day. It was higher for males, for the age group from 20 to 49 years and for the North and Midwest regions, and tended to increase with income and education. The pattern of association of footprint with sociodemographic variables did not change substantially with adjustment for differences in the amount of food consumed, except for a reduction in the relative excess of the footprint among males and an increase in the relative excess of the footprint in the Midwest region. CONCLUSION: The carbon footprint of the Brazilian diet exceeds by about 30% the footprint of the human diet, which could simultaneously meet the nutritional requirements of a healthy diet and the global goal of containing the increase in the planet's average temperature. The pattern of association of this footprint with sociodemographic variables can help identify priority targets for public actions aimed at reducing the environmental impacts of food consumption in Brazil.

Carbon footprint of the Brazilian diet / Pegada de carbono da dieta no Brasil

ABSTRACT OBJECTIVE: To estimate the carbon footprint of the Brazilian diet and of sociodemographic strata of this population. METHODS: Carbon footprint of the diet was estimated based on data from two 24-hour diet records, obtained in 2008 and 2009, from a probabilistic sample of the Brazilian population aged 10 years and over (n = 34,003) and on environmental impact coefficients of food and culinary preparations consumed in Brazil (gCO2e/kg). Means with 95% confidence intervals of food consumption (kcal/person/day) and the carbon footprint of the diet (gCO2e/person/day and in gCO2e/2,000kcal) were calculated for the population as a whole and for strata according to sex, age, income, education, macro-regions and Federative Unit. Linear regression models were used to identify significant differences (p < 0.05) in the dietary carbon footprint of different sociodemographic strata. RESULTS: The average carbon footprint of the Brazilian diet was 4,489gCO2e/person/day. It was higher for males, for the age group from 20 to 49 years and for the North and Midwest regions, and tended to increase with income and education. The pattern of association of footprint with sociodemographic variables did not change substantially with adjustment for differences in the amount of food consumed, except for a reduction in the relative excess of the footprint among males and an increase in the relative excess of the footprint in the Midwest region. CONCLUSION: The carbon footprint of the Brazilian diet exceeds by about 30% the footprint of the human diet, which could simultaneously meet the nutritional requirements of a healthy diet and the global goal of containing the increase in the planet's average temperature. The pattern of association of this footprint with sociodemographic variables can help identify priority targets for public actions aimed at reducing the environmental impacts of food consumption in Brazil.

RESUMO OBJETIVO: Estimar a pegada de carbono da dieta brasileira e de estratos sociodemográficos dessa população. MÉTODOS: A pegada de carbono da dieta foi estimada com base nos dados de dois registros alimentares de 24 horas, obtidos em 2008 e 2009, de uma amostra probabilística da população brasileira com 10 ou mais anos de idade (n = 34.003) e em coeficientes de impacto ambiental de alimentos e preparações culinárias consumidos no Brasil (gCO2e/kg). Médias com intervalos de confiança de 95% do consumo alimentar (kcal/pessoa/dia) e da pegada de carbono da dieta (gCO2e/pessoa/dia e em gCO2e/2.000kcal) foram calculadas para o conjunto da população e para estratos segundo sexo, idade, renda, escolaridade, macrorregiões e Unidade Federativa. Modelos de regressão linear foram utilizados para identificar diferenças significativas (p < 0,05) na pegada de carbono da dieta de diferentes estratos sociodemográficos. RESULTADOS: A pegada média de carbono da dieta brasileira foi de 4.489gCO2e/pessoa/dia. Foi maior para o sexo masculino, para a faixa etária de 20 a 49 anos e para as regiões Norte e Centro-Oeste, e tendeu a aumentar com a renda e a escolaridade. O padrão de associação da pegada a variáveis sociodemográficas não se alterou substancialmente com o ajuste para diferenças na quantidade consumida de alimentos, exceto por uma redução no excesso relativo da pegada entre homens e pelo aumento no excesso relativo da pegada na região Centro-Oeste. CONCLUSÃO: A pegada de carbono da dieta brasileira excede em cerca de 30% a pegada da dieta humana que poderia atender, simultaneamente, os requisitos nutricionais de uma dieta saudável e a meta global de contenção do aumento da temperatura média do planeta. O padrão de associação dessa pegada às variáveis sociodemográficas pode auxiliar na identificação de alvos prioritários para ações públicas que visem a reduzir os impactos ambientais do consumo alimentar no Brasil.

Neuroendocrine Control, Inflammation, and Psychological Aspects After Interdisciplinary Therapy in Obese Women.

Obesity is a chronic and multifactorial disease promoted by positive energy balance. The objective was to evaluate the effects of interdisciplinary therapy in the neuroendocrine control of food intake, inflammatory markers, and psychological aspects in obese women. Forty-seven obese women (43.32±5.82 years, 34.86±3.08 kg/m2), aged 30-50 years, participated in an interdisciplinary lifestyle change therapy, consisting of nutritional counseling, physical exercises, and psychological therapy for 36 weeks. After the long-term therapy, there was a decrease in body weight (Δ -5.36 kg), BMI (Δ -2.01 kg/m2), abdominal (Δ -9.09 cm), hip (Δ -5.03 cm), and thigh (Δ -5.07 cm) perimeters. There was also a significant improvement in body composition, with an increase in fat-free mass (Δ 1.60%) and reduction of body fat (Δ -3.74 kg). The therapy proposed also provided an improvement in depression scores (Δ -6.63), anxiety (Δ -4.07), body image (Δ -25.25), and binge eating (Δ -5.25). There was a significant reduction in serum levels of leptin (Δ -15.62 ng/ml). The interdisciplinary therapy was able to provide both, physical and psychological benefits in energy balance, which enables the use of this model as a feasible clinical strategy for the treatment of obesity.

The hyperleptinemia state can downregulate cardiorespiratory fitness and energy expenditure in obese women.

INTRODUCTION: In general, in obese people a state of hyperleptinemia may impair both energy balance and the inflammatory process. However, it has not been fully investigated whether there is a relationship between hyperleptinemia and cardiorespiratory fitness (CRF) and resting energy expenditure (REE), in obese women. METHODS: 83 obese women were enrolled in this cross-sectional study. Anthropometric measures, body composition, REE, CRF and serum concentration of leptin were measured. Pearson's correlation coefficient was performed to examine the relationship between circulating leptin level and other clinical variables. Multiple regression analysis was applied to determine predictors of REE and CRF. Effects were considered significant at p≤0.05. RESULTS: The most important finding in the present study is that the hyperleptinemia state was inversely correlated with CRF (r=-0.382, p=0.001) and REE (r=-0.447, p<0.001). Moreover, a positive correlation with fat mass was confirmed (r=0.419, p<0.001). In addition, hyperleptinemia was an independent negative predictor of REE (r2=-2.649, p=0.010) and CRF (r2=-2.335, p=0.023). CONCLUSION: Together our results may suggest a vicious cycle between the state of hyperleptinemia and a decrease in energy expenditure and cardiorespiratory fitness in obese women, which can impair whole body energy homeostasis. This information is important to contribute to clinical practices.

The excessive caloric intake and micronutrient deficiencies related to obesity after a long-term interdisciplinary therapy.

OBJECTIVE: The aim of this study was to assess the effectiveness of a long-term interdisciplinary lifestyle modification therapy on food intake, body composition, and anthropometric measurements of obese women. METHODS: Seventy obese women (age 41 ± 5.9 y) attended the interdisciplinary therapy, with nutrition, physical exercise, physiotherapy, and psychological support during the course of 1 y. Usual food intake was estimated by 3-d dietary record. Dual-energy x-ray absorptiometry was performed to determine body fat and fat-free mass. Waist and hip circumferences also were measured. Student's t test and Wilcoxon test were used for comparisons among categories; P < 0.05 was considered significant. RESULTS: The assessment of dietary intake showed significant changes after interdisciplinary therapy. A reduction in intake of total calories (18.3%), carbohydrates (15.6%), and total fats (13.1%) was observed. Total micronutrient intake did not change positively after therapy, as the intake level of 16 micronutrients was still lower than recommended. The therapy was effective in reducing significantly body weight (5.9%), body mass index (6.1%), body fat (4.7%), and waist (5.2%) and hip (3.8%) circumferences. CONCLUSIONS: Long-term interdisciplinary therapy was effective in decreasing the intake of calories, carbohydrates, and fats. The therapy positively changed the body composition and reduced anthropometric measurements. However, the intake of some micronutrients after therapy was still significantly lower than recommended. These results demonstrated that the proposed interdisciplinary methodology can be effective in treating obesity; however, the present study reinforced the need to address the micronutrient deficiency in the target population.

Terapia Interdisciplinar e a Diminuição da Sobrecarga Cardiovascular em Obesos / Interdisciplinary Therapy and Decrease of Cardiovascular Overload in Obese Patients

Fundamentos: Associação entre obesidade, terapia interdisciplinar e exercício físico intenso foi descrita para obesos. Contudo o estudo das atividades físicas representando as tarefas do dia a dia e o risco cardiovascular nas atividades do cotidiano torna-se necessário para verificar a ocorrência dessa associação. Objetivo: Investigar se um período de 18 semanas de terapia interdisciplinar é capaz de promover benefícios nos parâmetros cardiovasculares no repouso e durante o exercício físico em adultos obesos. Métodos: Amostra de 32 indivíduos de ambos os sexos com índice de massa corporal de 30 a 39,9 kg/m2 e idade entre 30 e 50 anos. Intervenção com terapia interdisciplinar (educação física, psicologia, nutrição e fisioterapia), duração de 18 semanas e mensuração de dados antropométricos de massa corporal, estatura, circunferências de cintura e quadril, avaliação de esforço máximo em ergômetro antes e após o período de terapia. Resultados: A terapia interdisciplinar diminuiu pressão arterial sistólica (PAS): 125,83±9,86 (basal) vs 120,28±16,82(final), frequência cardíaca (FC): 74,75 ± 11,02 (basal) vs 72,77 ± 10,72 (final), e duplo-produto (DP) em repouso. Reduziu também durante o esforço submáximo PAS estágios 1: 143,44 ± 9,28 (basal) vs 131,56 ± 15,26; estágio 2: 152,23 ± 21,91 (basal) vs 141,56 ± 17,43 (final), PAD estágio 2: 89,89 ± 9,58 (basal) vs 83,13 ± 9,65 (final), FC estágio 1: 118,40 ± 12,90 (basal) vs 110,87 ± 7,66 (final); estágio 2: 137,09 ± 16,54 (basal) vs 130,37 ± 11,51 (final) e o DP referentes aos estágios iniciais. Conclusão: A terapia interdisciplinar reduziu a sobrecarga do sistema cardiovascular em repouso e no esforço submáximo em adultos obesos otimizando o repouso e atividades do cotidiano

Background: Association between obesity, interdisciplinary therapy and intense physical exercise was described for obese patients. However, the study of physical activities representing daily tasks and cardiovascular risk in everyday activities becomes necessary to verify the occurrence of this association. Objective: To investigate whether a period of 18 weeks of interdisciplinary therapy is capable of promoting benefits in cardiovascular parameters at rest and during exercise in obese adults. Methods: Sample of 32 individuals of both sexes with body mass index of 30 to 39.9 kg/m2 and age between 30 and 50 years. Intervention with interdisciplinary therapy (physical education, psychology, nutrition and physiotherapy), duration of 18 weeks and measurement of anthropometric data of body mass, height, waist and hip circumferences, maximum exercise ergometer evaluation before and after the therapy period. Results: Interdisciplinary therapy decreased systolic blood pressure (SBP): 125.83 ± 9.86 (baseline) vs 120.28 ± 16.82 (final), heart rate (HR): 74.75 ± 11.02 (baseline) ) Vs 72.77 ± 10.72 (final), and double-product (DP) at rest. Reduced also during the submaximal PAS stress stages 1:143.44 ± 9.28 (baseline) vs 131.56 ± 15.26; Stage 2: 152.23 ± 21.91 (baseline) vs. 141.56 ± 17.43 (final), PAD stage 2: 89.89 ± 9.58 (baseline) vs 83.13 ± 9.65 (final) , FC stage 1: 118.40 ± 12.90 (baseline) vs 110.87 ± 7.66 (final); Stage 2: 137.09 ± 16.54 (baseline) vs 130.37 ± 11.51 (final) and the PD referring to the initial stages. Conclusion: Interdisciplinary therapy reduced the overload of the cardiovascular system at rest and submaximal effort in obese adults, optimizing rest and daily activities

Resting energy expenditure in obese women: comparison between measured and estimated values.

Assessing energy requirements is a fundamental activity in clinical dietetic practice. The aim of this study was to investigate which resting energy expenditure (REE) predictive equations are the best alternatives to indirect calorimetry before and after an interdisciplinary therapy in Brazilian obese women. In all, twelve equations based on weight, height, sex, age, fat-free mass and fat mass were tested. REE was measured by indirect calorimetry. The interdisciplinary therapy consisted of nutritional, physical exercise, psychological and physiotherapy support during the course of 1 year. The average differences between measured and predicted REE, as well as the accuracy at the ±10 % level, were evaluated. Statistical analysis included paired t tests, intraclass correlation coefficients and Bland-Altman plots. Validation was based on forty obese women (BMI 30-39·9 kg/m2). Our major findings demonstrated a wide variation in the accuracy of REE predictive equations before and after weight loss in non-morbid, obese women. The equations reported by Harris-Benedict and FAO/WHO/United Nations University (UNU) were the only ones that did not show significant differences compared with indirect calorimetry and presented a bias <5 %. The Harris-Benedict equation provided 40 and 47·5 % accurate predictions before and after therapy, respectively. The FAO equation provided 35 and 47·5 % accurate predictions. However, the Bland-Altman analysis did not show good agreement between these equations and indirect calorimetry. Therefore, the Harris-Benedict and FAO/WHO/UNU equations should be used with caution for obese women. The need to critically re-assess REE data and generate regional and more homogeneous REE databases for the target population is reinforced.