Diet quality and associated factors in Brazilian undergraduates during the COVID-19 pandemic.

Background: Diet quality is associated with psychobiological, psychological, biological, and physiological factors of individuals, and in the context of prolonged stress, such as the COVID-19 pandemic, it can lead to a worsening of the quality of food for undergraduates. This study aimed to analyze diet quality and associated factors in Brazilian undergraduates. Methods: Data were collected from 4,799 undergraduate students from all Brazilian regions, from August 2020 to February 2021. The online questionnaire contained socioeconomic variables, the ESQUADA scale to assess diet quality, self-referred changes in weight, the Brazilian food insecurity scale (EBIA), sleep assessment and the perceived stress scale. Unconditional multiple logistic regression analysis was performed to study variables associated with poor and very poor diet quality. Results: Most of participants presented a good diet quality (51.7%), while 9.8% had a poor or very poor diet quality and only 1.1% had an excellent diet quality. 58.2% of undergraduates reported to have an increase in weight during the pandemic and 74.3% of the students presented elevated stress during the pandemic. Logistic regressions showed students who gained weight during the pandemic presented the highest AOR = 1.56 (95% CI = 1.12-2.20) for poor or very poor diet quality. The elevated perceived stress was also associated with a higher AOR = 2.85 (95% CI = 1.71-4.74) for poor or very poor diet quality. Conclusion: Most of the studied undergraduates presented a good diet quality. Nevertheless, poor/very poor diet quality was associated with higher perceived stress and weight gain. Our study indicated that policies should beaimed at the socioeconomically most vulnerable undergraduates, those in a situation of food and nutritional insecurity, high perceived stress, and who gained weight during the pandemic.

Instrument for measuring home cooking skills in primary health care.

OBJECTIVE: To develop and validate an instrument for measuring the home cooking skills of health professionals involved with guidelines for promoting adequate and healthy food in primary health care. METHODS: This is a methodological study with a psychometric approach, carried out in the city of São Paulo between January and November 2020, to develop and validate a self-applied online instrument. The data of the 472 participants were presented by descriptive statistics. Content validation was performed by expert judgment using the two round Delphi technique and empirical statistics for consensus evidence. Exploratory factor analysis was used for construct validation and reliability analysis, and the model adjustment rates and composite reliability were analyzed. RESULTS: The instrument presented satisfactory content validity for CVRc indices and 𝜅 in the two rounds of the Delphi technique. After the factor analysis, the final model of the Primary Health Care Home Cooking Skills Scale presented 29 items with adequate factorial loads (> 0.3). Bartlett's and Kaiser-Meyer-Olkin's (KMO) tests of sphericity performed in exploratory factorial analysis suggested interpretability in the correlation matrix, the parallel analysis indicated four domains and explained variance of 64.1%. The composite reliability of the factors was adequate (> 0.70) and the H-index suggested replicable factors in future studies. All adjustment rates proved to be adequate. CONCLUSIONS: The Primary Health Care Home Cooking Skills Scale presented evidence of validity and reliability. It is short and easy to apply and will make it possible to reliably ascertain the need for qualification of the workforce, favoring the planning of actions and public policies of promotion of adequate and healthy food in primary health care.

Food Insecurity and Associated Factors in Brazilian Undergraduates during the COVID-19 Pandemic.

Undergraduates may face challenges to assure food security, related to economic and mental distress, especially during the COVID-19 pandemic. This study aimed to assess food insecurity and its associated factors in undergraduates during the COVID-19 pandemic. An online cross-sectional study was conducted from August 2020 to February 2021 with 4775 undergraduates from all Brazilian regions. The questionnaire contained socio-economic variables, the validated Brazilian food insecurity scale, and the ESQUADA scale to assess diet quality. The median age of the students was 22.0 years, and 48.0% reported income decreasing with the pandemic. Food insecurity was present in 38.6% of the students, 4.5% with severe food insecurity and 7.7% moderate. Logistic regressions showed students with brown and black skin color/race presented the highest OR for food insecurity; both income and weight increase or reduction during the pandemic was also associated with a higher OR for food insecurity, and better diet quality was associated with decreased OR for food insecurity. Our study showed a considerable presence of food insecurity in undergraduates. Policy for this population must be directed to the most vulnerable: those with brown and black skin color/race, who changed income during the pandemic, and those presented with difficulties maintaining weight and with poor diet quality.

[Development and validation of performance indicators of the National School Food Program management]. / Desenvolvimento e validação de indicadores de desempenho da gestão do Programa Nacional de Alimentação Escolar.

The evaluation of the National School Food Program (PNAE) is a strategic action to ensure the quality of management. This study aims to develop and validate an instrument of performance indicators to assess the management of the PNAE in the national context. A psychometric study was carried out for the development and validation of performance indicators. Twelve indicators were subsequently established and evaluated by an expert panel concerning seven attributes. The Delphi technique was used for the consensus of the expert panel, and the content validity of the indicators was analyzed with the Content Validity Ratio. Nutritionists working on the implementation of the PNAE assessed the relevance of the indicators by answering an online questionnaire to construct validity and reliability. Thirteen (43.3%, 13/30) experts participated in the Delphi round 1 and nine (69.2%, 9/13) completed the Delphi round 2. A new indicator was developed after the experts' suggestions. Furthermore, 281 nutritionists participated in this study assessing the relevance of the indicators. Overall, content and construct validity were achieved for 13 indicators. All were considered relevant and had the potential to promote the assessment of PNAE operational management.

A avaliação do Programa Nacional de Alimentação Escolar (PNAE) é ação estratégica para garantir a qualidade da gestão. O objetivo deste estudo é desenvolver e validar um instrumento de indicadores de desempenho para avaliação da gestão do PNAE no contexto nacional. Trata-se de um estudo psicométrico de construção e validação de indicadores de desempenho. Foram estabelecidos 12 indicadores, posteriormente, avaliados em painel de especialistas em relação a sete atributos. Para obter consenso foi utilizada a técnica Delphi e a validade de conteúdo foi analisada com a Razão de Validade de Conteúdo. Para a validade de constructo e confiabilidade, nutricionistas que trabalham na execução do PNAE avaliaram a relevância dos indicadores respondendo um questionário online. A taxa de resposta dos especialistas na primeira rodada da técnica Delphi foi de 43,3% (13/30) e de 69,2% (9/13) na segunda rodada. Um novo indicador foi desenvolvido após a avaliação do painel de especialistas. Um total de 281 nutricionistas participaram do estudo da relevância dos indicadores. No geral, a validade de conteúdo e constructo foi alcançada para 13 indicadores. Todos os 13 indicadores se apresentaram relevantes, com potencial para promover a avaliação da gestão operacional do PNAE.

Desenvolvimento e validação de indicadores de desempenho da gestão do Programa Nacional de Alimentação Escolar / Development and validation of performance indicators of the National School Food Program management

Resumo A avaliação do Programa Nacional de Alimentação Escolar (PNAE) é ação estratégica para garantir a qualidade da gestão. O objetivo deste estudo é desenvolver e validar um instrumento de indicadores de desempenho para avaliação da gestão do PNAE no contexto nacional. Trata-se de um estudo psicométrico de construção e validação de indicadores de desempenho. Foram estabelecidos 12 indicadores, posteriormente, avaliados em painel de especialistas em relação a sete atributos. Para obter consenso foi utilizada a técnica Delphi e a validade de conteúdo foi analisada com a Razão de Validade de Conteúdo. Para a validade de constructo e confiabilidade, nutricionistas que trabalham na execução do PNAE avaliaram a relevância dos indicadores respondendo um questionário online. A taxa de resposta dos especialistas na primeira rodada da técnica Delphi foi de 43,3% (13/30) e de 69,2% (9/13) na segunda rodada. Um novo indicador foi desenvolvido após a avaliação do painel de especialistas. Um total de 281 nutricionistas participaram do estudo da relevância dos indicadores. No geral, a validade de conteúdo e constructo foi alcançada para 13 indicadores. Todos os 13 indicadores se apresentaram relevantes, com potencial para promover a avaliação da gestão operacional do PNAE.

Abstract The evaluation of the National School Food Program (PNAE) is a strategic action to ensure the quality of management. This study aims to develop and validate an instrument of performance indicators to assess the management of the PNAE in the national context. A psychometric study was carried out for the development and validation of performance indicators. Twelve indicators were subsequently established and evaluated by an expert panel concerning seven attributes. The Delphi technique was used for the consensus of the expert panel, and the content validity of the indicators was analyzed with the Content Validity Ratio. Nutritionists working on the implementation of the PNAE assessed the relevance of the indicators by answering an online questionnaire to construct validity and reliability. Thirteen (43.3%, 13/30) experts participated in the Delphi round 1 and nine (69.2%, 9/13) completed the Delphi round 2. A new indicator was developed after the experts' suggestions. Furthermore, 281 nutritionists participated in this study assessing the relevance of the indicators. Overall, content and construct validity were achieved for 13 indicators. All were considered relevant and had the potential to promote the assessment of PNAE operational management.

Instrument for measuring home cooking skills in primary health care / Instrumento para mensurar habilidades culinárias domésticas na atenção primária à saúde

ABSTRACT OBJECTIVE To develop and validate an instrument for measuring the home cooking skills of health professionals involved with guidelines for promoting adequate and healthy food in primary health care. METHODS This is a methodological study with a psychometric approach, carried out in the city of São Paulo between January and November 2020, to develop and validate a self-applied online instrument. The data of the 472 participants were presented by descriptive statistics. Content validation was performed by expert judgment using the two round Delphi technique and empirical statistics for consensus evidence. Exploratory factor analysis was used for construct validation and reliability analysis, and the model adjustment rates and composite reliability were analyzed. RESULTS The instrument presented satisfactory content validity for CVRc indices and �� in the two rounds of the Delphi technique. After the factor analysis, the final model of the Primary Health Care Home Cooking Skills Scale presented 29 items with adequate factorial loads (> 0.3). Bartlett's and Kaiser-Meyer-Olkin's (KMO) tests of sphericity performed in exploratory factorial analysis suggested interpretability in the correlation matrix, the parallel analysis indicated four domains and explained variance of 64.1%. The composite reliability of the factors was adequate (> 0.70) and the H-index suggested replicable factors in future studies. All adjustment rates proved to be adequate. CONCLUSIONS The Primary Health Care Home Cooking Skills Scale presented evidence of validity and reliability. It is short and easy to apply and will make it possible to reliably ascertain the need for qualification of the workforce, favoring the planning of actions and public policies of promotion of adequate and healthy food in primary health care.

RESUMO OBJETIVO Desenvolver e validar instrumento para mensuração de habilidades culinárias domésticas de profissionais de saúde envolvidos com orientações de promoção da alimentação adequada e saudável da atenção primária à saúde. MÉTODOS Estudo metodológico com abordagem psicométrica, realizado no município de São Paulo entre janeiro e novembro de 2020, para desenvolvimento e validação de instrumento on-line autoaplicável. Os dados dos 472 participantes foram apresentados por estatística descritiva. A validação de conteúdo foi realizada por julgamento de especialistas utilizando técnica Delphi de dois rounds e estatísticas empíricas para evidência de consenso. Empregou-se análise fatorial exploratória para validação de constructo e análise de confiabilidade, analisados índices de ajuste do modelo e fidedignidade composta. RESULTADOS O instrumento apresentou validade de conteúdo satisfatória para índices de CVRc e �� nos dois rounds da técnica Delphi. Após análise fatorial, o modelo final da Escala de Habilidades Culinárias Domésticas da Atenção Primária à Saúde apresentou 29 itens com cargas fatoriais adequadas (> 0,3). Os testes de esfericidade de Bartlett e Kaiser-Meyer-Olkin (KMO) realizados em análise fatorial exploratória sugeriram interpretabilidade na matriz de correlação, a análise paralela indicou quatro domínios e variância explicada de 64,1%. A fidedignidade composta dos fatores foi adequada (> 0,70) e o índice H sugeriu fatores replicáveis em estudos futuros. Todos os índices de ajustes mostraram-se adequados. CONCLUSÕES A Escala de Habilidades Culinárias Domésticas da Atenção Primária à Saúde apresentou evidências de validade e confiabilidade. É curta e de fácil aplicação e possibilitará a averiguação de forma fidedigna da necessidade de qualificação da força de trabalho, favorecendo o planejamento de ações e políticas públicas de promoção da alimentação adequada e saudável na atenção primária à saúde.

Sampling plan and methodological aspects: a household healthcare survey in Piauí.

OBJECTIVE: To describe the methodological aspects of the Piauí home healthcare survey (ISAD-PI) and assess the relation between sampling plan, precision, and design effects, assuming that population health surveys are relevant instruments for health monitoring. METHODS: ISAD-PI was a population-based cross-sectional study that analyzed the living conditions and health status of the population residing in urban areas in the municipalities of Teresina and Picos, in Piauí. Sampling was carried out by conglomerates in two stages: Primary Sampling Units and households. To calculate the sample size, we considered the stratification of the population in both cities, according to the age of the individuals. We evaluated the "non-response" rate (NRR) and estimated the proportions according to sex and age, as well as the prevalence of social determinants of health in order to assess the compliance of the sampling plan. Analyses related to the precision according to the coefficient of proportion variation of the standard error (Cv-pˆ) and the design effect (deff). Cv-pˆ less than 20% and deff less than 1.5 were considered adequate. The total NRR of households was 38.2% in Teresina and 38.3% in Picos. We carried out twenty-four proportion estimates in relation to age and sex and 48 prevalence of social and health determinants estimates, totaling 72 estimates. Among them, 71 had Cv-pˆ less than 20% and 61 had deff less than or equal to 1.5. CONCLUSION: Data generated from the ISAD-PI may contribute to the assessment of health and morbidity conditions in the population. Furthermore, methodological aspects employed in this research may serve as a basis for studies carried out in other cities in Brazil.

Systematic review of instruments for assessing culinary skills in adults: What is the quality of their psychometric properties?

BACKGROUND: Culinary skills are important objects of study in the field of Public Health. Studies that propose to develop instruments for assessing such construct show lack of methodological uniformity to report validity and reliability of their instruments. OBJECTIVE: To identify studies that have developed instruments to measure culinary skills in adult population, and critically assess their psychometric properties. DESIGN: We conducted a systematic review according to the PRISMA statement. We searched literature PubMed/Medline, Scopus, LILACS, and Web of Science databases until January 2021, and consulted Google Scholar for relevant grey literature. Two reviewers independently selected the studies, conducted data extraction, and assessed the psychometric quality of the instruments. A third reviewer resolved any doubts or disagreements in all steps of the systematic review. RESULTS: The search identified 1148 potentially relevant studies, out of which 9 met the inclusion criteria. In addition, we included 3 studies by searching the related articles and the reference lists of these studies, totaling 12 included studies in this review. Ten studies reported the development of tools measuring culinary skills in adults and 2 studies performed cross-cultural adaptations of original instruments. We considered adequate quality of internal consistency reliability in four studies. One study received adequate rating for test-retest reliability. No studies presented adequate rating for content validity and four studies showed satisfactory results for at least one type of construct validity. One study reported criterion validity and the quality of this psychometric property was inadequate. CONCLUSIONS: We identified many studies that surveyed culinary skills. Although the isolated measures appraised in this review show good promise in terms of quality of psychometric properties, no studies presented adequate measures for each aspect of reliability and validity. A more consistent and consensual definition of culinary skills is recommended. The flaws observed in these studies show that there is a need for ongoing research in the area of the psychometric properties of instruments assessing culinary skills.

Two validity evidences of the ESQUADA and Brazilians' dietary quality levels.

OBJECTIVE: Assess two validity evidences of the diet quality scale (ESQUADA) for the selection of items with better discrimination of the Brazilians' diet quality and propose a description in score levels. METHODS: Brazilian adolescents and adults residing in the country (n = 2,059) answered an online questionnaire with 52 items, shared on social networks and email lists between March and April 2018. Statistical tests were applied to analyze the validity and reliability of the instrument's evidence. Factor analysis was applied to study the dimensionality of the questionnaire items. Item response theory was applied to identify the discrimination and location of items on the continuum, construct the scale and assess the differential item functioning in terms of sex and age. RESULTS: Among the 52 items of the questionnaire, 25 had greater measurement accuracy, with adequate adjustment and reliability. The item on the habit of eating ultra-processed foods at home showed the best discrimination of diet quality. No item showed differential functioning regarding sex and age. In the construction of the ESQUADA, five diet quality levels were identified: very poor, poor, good, very good and excellent. It was observed that while breakfast cereals and/or cereal bars are more frequently consumed by individuals with "very poor" diet quality; nuts and/or walnuts are most often consumed by those individuals with "excellent" diet quality. CONCLUSION: The ESQUADA consists of 25 precise items with no differential functioning to assess the quality of Brazilians' diet. The construction of the ESQUADA made it possible to recognize food consumption and dietary practices characteristic of each level of diet quality.

Evaluation of quality indicators for management of the National School Feeding Program in Brazil: a systematic review.

This article aims to identify studies that developed quality indicator for the management of the National School Feeding Program (PNAE, in Brazilian context) and to critically appraise the properties of their instruments. Systematic review using Scopus, Lilacs, Pubmed and Web of Science for data collection. The search was limited to studies between 2009 and 2019. The search strategy included search terms related to school feeding, program evaluation, and indicator. The indicators were evaluated using the Appraisal of Indicators through Research and Evaluation instrument. The search identified 1,355 studies, of which 14 were potentially relevant records and 10 met the inclusion criteria. Most studies used a literature review with consensus techniques in the development of the instrument and a frame work format to evaluate the PNAE. None of them presented evidence of validity of the instrument. The highest level was achieved on the domain 'Purpose, relevance and organizational context', followed by 'Stakeholder involvement', 'Additional evidence, formulation and usage', and 'Scientific evidence'. This review found gaps in the methodology of studies that had developed quality indicators for the management of PNAE. Future development of these instruments should include validity evidence.

Nutritional status and metabolic risk in adults: association with diet quality as assessed with ESQUADA. / Estado nutricional e risco metabólico em adultos: associação com a qualidade da dieta medida pela ESQUADA.

OBJECTIVE: To analyze the association between diet quality assessed with the Diet Quality Scale (ESQUADA) and the nutritional status and metabolic risk in adults. METHODS: The data included 1,147 adults aged 20 to 59, from the population-based study with complex sampling. Weight, height, tricipital (TSF) and subscapular (SSF) skinfolds, and waist (WC) and mid-arm (MAC) circumferences were measured. Body mass index (BMI) and mid-arm muscle circumference (MAMC) were calculated. Nutritional status and metabolic risk were classified considering BMI and WC values, respectively. Diet quality was assessed with ESQUADA. Data were collected at household using the Epicollect5 application. Diet quality (in scores) was analyzed as continuous data and later categorized. The confidence interval was used for comparison between groups, Fisher's exact test for an association study. Adjusted multiple linear regression models were also estimated. P < 0.05 was adopted for statistical significance. RESULTS: Overweight prevailed in 60.33% of individuals, especially among women (60.73%). High or very high metabolic risk was more frequent among women with "very good or excellent" diet quality. Higher diet quality score was associated with a reduction in TSF (ß = -0.07; 95%CI -0.13 - -0.01) and an increase in MAMC (ß = 0.09; 95%CI 0.00 - 0,18) in men and the reduction in weight (ß = -0.04; 95%CI -0.07 - -0.01), SSF (ß = -0.07; 95%CI -0.13 - -0,00) and WC in women (ß = -0.06; 95%CI -0.09 - -0.02). CONCLUSION: A better diet quality is positively associated with lean mass in men, and negatively with fat mass in men and women.

OBJETIVO: Analisar a associação entre qualidade da dieta medida pela Escala de Qualidade da Dieta (ESQUADA) e estado nutricional e risco metabólico em adultos. MÉTODOS: Analisaram-se dados de 1.147 adultos (de 20 a 59 anos), participantes de inquérito populacional com amostragem complexa por conglomerado. Aferiram-se peso, altura, pregas cutâneas tricipital (PCT), subescapular (PSE) e circunferências da cintura (CC) e do braço (CB). Calcularam-se índice de massa corporal (IMC) e circunferência muscular do braço (CMB). O estado nutricional e o risco metabólico foram classificados considerando valores de IMC e CC, respectivamente. A qualidade da dieta foi avaliada com aplicação da ESQUADA. Os dados foram coletados em domicílio com o aplicativo Epicollect5. A qualidade da dieta foi medida em escores e analisada de forma contínua e em categorias. O intervalo de confiança foi utilizado para comparação entre grupos, e o teste exato de Fisher, para estudo de associação, além de modelo de regressão linear ajustado. Adotou-se p < 0,05 para significância estatística. RESULTADOS: O excesso de peso prevaleceu em 60,33% dos indivíduos, especialmente entre mulheres (60,73%). O risco metabólico elevado ou muito elevado foi mais frequente entre mulheres com qualidade da dieta muito boa ou excelente. O maior escore de qualidade da dieta associou-se à redução da PCT (ß = -0,07; intervalo de confiança de 95% - IC95% -0,13 - -0,01) e ao aumento da CMB (ß = 0,09; IC95% 0 - 0,18) em homens e à redução do peso (ß = -0,04; IC95% -0,07 - -0,01), da PSE (ß = -0,07; IC95% -0,13 - -0,00) e da CC em mulheres (ß = -0,06; IC95% -0,09 - -0,02). CONCLUSÃO: A melhor qualidade da dieta associa-se positivamente a medidas antropométricas que indicam massa magra em homens e negativamente à massa gorda em homens e mulheres.

Relative validity of FFQ to assess food items, energy, macronutrient and micronutrient intake in children and adolescents: a systematic review with meta-analysis.

FFQ are one of the most widely used tools of research into nutritional epidemiology, and many studies have been conducted in several countries using this dietary assessment method. The present study aimed to evaluate the relative validity of FFQ, in comparison with other methods, in assessing dietary intake of children and adolescents, through a systematic review. Four electronic databases (Embase, PubMed, Scopus and Web of Science) found sixty-seven articles, which met the inclusion criteria (healthy children and adolescents from 3 to 18 years of age; journal articles written in English, Spanish and Portuguese between 1988 and March 2019; results showing the comparison between the FFQ with other methods of assessment of dietary intake). The articles were analysed by two independent reviewers. A meta-analysis was conducted using correlation coefficients as estimate effects between the FFQ and the reference standard method. Subgroup analysis and meta-regression were performed to identify the probable source of heterogeneity. In fifty-five of the sixty-seven studies, a single dietary assessment method was used to evaluate the FFQ; nine combined the two methods and three used three reference methods. The most widely used reference method was the 24-h recall, followed by the food record. The overall relative validity of the FFQ to estimate energy, macronutrient, certain micronutrient and certain food item intakes in children and adolescents may be considered weak. The study protocol was registered in PROSPERO under number CRD42016038706.

Sampling plan and methodological aspects: a household healthcare survey in Piauí / Plano de amostragem e aspectos metodológicos: inquérito de saúde domiciliar no Piauí

ABSTRACT OBJECTIVE To describe the methodological aspects of the Piauí home healthcare survey (ISAD-PI) and assess the relation between sampling plan, precision, and design effects, assuming that population health surveys are relevant instruments for health monitoring. METHODS ISAD-PI was a population-based cross-sectional study that analyzed the living conditions and health status of the population residing in urban areas in the municipalities of Teresina and Picos, in Piauí. Sampling was carried out by conglomerates in two stages: Primary Sampling Units and households. To calculate the sample size, we considered the stratification of the population in both cities, according to the age of the individuals. We evaluated the "non-response" rate (NRR) and estimated the proportions according to sex and age, as well as the prevalence of social determinants of health in order to assess the compliance of the sampling plan. Analyses related to the precision according to the coefficient of proportion variation of the standard error (Cv-pˆ) and the design effect (deff). Cv-pˆ less than 20% and deff less than 1.5 were considered adequate. The total NRR of households was 38.2% in Teresina and 38.3% in Picos. We carried out twenty-four proportion estimates in relation to age and sex and 48 prevalence of social and health determinants estimates, totaling 72 estimates. Among them, 71 had Cv-pˆ less than 20% and 61 had deff less than or equal to 1.5. CONCLUSION Data generated from the ISAD-PI may contribute to the assessment of health and morbidity conditions in the population. Furthermore, methodological aspects employed in this research may serve as a basis for studies carried out in other cities in Brazil.

RESUMO OBJETIVO Descrever os aspectos metodológicos do Inquérito de Saúde Domiciliar no Piauí (ISAD-PI), bem como avaliar a conformidade do plano amostral em relação à precisão e aos efeitos do desenho, dado que os inquéritos populacionais de saúde constituem instrumentos importantes para o monitoramento da situação de saúde da população. MÉTODOS O ISAD-PI foi um estudo de base populacional, transversal, que analisou as condições de vida e situação de saúde da população residente nas áreas urbanas dos municípios de Teresina e Picos, no Piauí. A amostragem foi realizada por conglomerados, em dois estágios: Unidades Primárias de Amostragem e domicílios. Para o cálculo do tamanho da amostra, considerou-se a estratificação da população de ambas as cidades, de acordo com a idade dos indivíduos, para ambos os sexos. Para avaliação da conformidade do plano amostral, foi avaliada a taxa de "não-resposta" (TNR) e, além disso, as estimativas de proporções segundo sexo e idade, bem como as prevalências de determinantes sociais de saúde, que foram analisadas em relação à precisão por meio do coeficiente de variação da proporção do erro padrão (Cv-pˆ) e do efeito do delineamento (deff). Foram considerados adequados Cv-pˆ menores que 20%, e deff menores que 1,5. A TNR-Total dos domicílios foi de 38,2% em Teresina e de 38,3% em Picos. Foram realizadas 24 estimativas de proporção em relação à idade e ao sexo e 48 estimativas de prevalência de determinantes sociais e de saúde, totalizando 72 estimativas, das quais 71 apresentaram Cv-pˆ menor que 20% e 61 apresentaram deff menor ou igual a 1,5. CONCLUSÃO Dados gerados a partir do ISAD-PI poderão contribuir para a avaliação das condições de saúde e morbidade na população. Ademais, aspectos metodológicos empregados nesta pesquisa poderão servir de base para estudos realizados em outras cidades do Brasil.

Sampling plan and methodological aspects: a household healthcare survey in Piauí / Plano de amostragem e aspectos metodológicos: inquérito de saúde domiciliar no Piauí

ABSTRACT OBJECTIVE To describe the methodological aspects of the Piauí home healthcare survey (ISAD-PI) and assess the relation between sampling plan, precision, and design effects, assuming that population health surveys are relevant instruments for health monitoring. METHODS ISAD-PI was a population-based cross-sectional study that analyzed the living conditions and health status of the population residing in urban areas in the municipalities of Teresina and Picos, in Piauí. Sampling was carried out by conglomerates in two stages: Primary Sampling Units and households. To calculate the sample size, we considered the stratification of the population in both cities, according to the age of the individuals. We evaluated the "non-response" rate (NRR) and estimated the proportions according to sex and age, as well as the prevalence of social determinants of health in order to assess the compliance of the sampling plan. Analyses related to the precision according to the coefficient of proportion variation of the standard error (Cv-pˆ) and the design effect (deff). Cv-pˆ less than 20% and deff less than 1.5 were considered adequate. The total NRR of households was 38.2% in Teresina and 38.3% in Picos. We carried out twenty-four proportion estimates in relation to age and sex and 48 prevalence of social and health determinants estimates, totaling 72 estimates. Among them, 71 had Cv-pˆ less than 20% and 61 had deff less than or equal to 1.5. CONCLUSION Data generated from the ISAD-PI may contribute to the assessment of health and morbidity conditions in the population. Furthermore, methodological aspects employed in this research may serve as a basis for studies carried out in other cities in Brazil.

RESUMO OBJETIVO Descrever os aspectos metodológicos do Inquérito de Saúde Domiciliar no Piauí (ISAD-PI), bem como avaliar a conformidade do plano amostral em relação à precisão e aos efeitos do desenho, dado que os inquéritos populacionais de saúde constituem instrumentos importantes para o monitoramento da situação de saúde da população. MÉTODOS O ISAD-PI foi um estudo de base populacional, transversal, que analisou as condições de vida e situação de saúde da população residente nas áreas urbanas dos municípios de Teresina e Picos, no Piauí. A amostragem foi realizada por conglomerados, em dois estágios: Unidades Primárias de Amostragem e domicílios. Para o cálculo do tamanho da amostra, considerou-se a estratificação da população de ambas as cidades, de acordo com a idade dos indivíduos, para ambos os sexos. Para avaliação da conformidade do plano amostral, foi avaliada a taxa de "não-resposta" (TNR) e, além disso, as estimativas de proporções segundo sexo e idade, bem como as prevalências de determinantes sociais de saúde, que foram analisadas em relação à precisão por meio do coeficiente de variação da proporção do erro padrão (Cv-pˆ) e do efeito do delineamento (deff). Foram considerados adequados Cv-pˆ menores que 20%, e deff menores que 1,5. A TNR-Total dos domicílios foi de 38,2% em Teresina e de 38,3% em Picos. Foram realizadas 24 estimativas de proporção em relação à idade e ao sexo e 48 estimativas de prevalência de determinantes sociais e de saúde, totalizando 72 estimativas, das quais 71 apresentaram Cv-pˆ menor que 20% e 61 apresentaram deff menor ou igual a 1,5. CONCLUSÃO Dados gerados a partir do ISAD-PI poderão contribuir para a avaliação das condições de saúde e morbidade na população. Ademais, aspectos metodológicos empregados nesta pesquisa poderão servir de base para estudos realizados em outras cidades do Brasil.

Estado nutricional e risco metabólico em adultos: associação com a qualidade da dieta medida pela ESQUADA / Nutritional status and metabolic risk in adults: association with diet quality as assessed with ESQUADA

RESUMO: Objetivo: Analisar a associação entre qualidade da dieta medida pela Escala de Qualidade da Dieta (ESQUADA) e estado nutricional e risco metabólico em adultos. Métodos: Analisaram-se dados de 1.147 adultos (de 20 a 59 anos), participantes de inquérito populacional com amostragem complexa por conglomerado. Aferiram-se peso, altura, pregas cutâneas tricipital (PCT), subescapular (PSE) e circunferências da cintura (CC) e do braço (CB). Calcularam-se índice de massa corporal (IMC) e circunferência muscular do braço (CMB). O estado nutricional e o risco metabólico foram classificados considerando valores de IMC e CC, respectivamente. A qualidade da dieta foi avaliada com aplicação da ESQUADA. Os dados foram coletados em domicílio com o aplicativo Epicollect5. A qualidade da dieta foi medida em escores e analisada de forma contínua e em categorias. O intervalo de confiança foi utilizado para comparação entre grupos, e o teste exato de Fisher, para estudo de associação, além de modelo de regressão linear ajustado. Adotou-se p < 0,05 para significância estatística. Resultados: O excesso de peso prevaleceu em 60,33% dos indivíduos, especialmente entre mulheres (60,73%). O risco metabólico elevado ou muito elevado foi mais frequente entre mulheres com qualidade da dieta muito boa ou excelente. O maior escore de qualidade da dieta associou-se à redução da PCT (β = -0,07; intervalo de confiança de 95% - IC95% -0,13 - -0,01) e ao aumento da CMB (β = 0,09; IC95% 0 - 0,18) em homens e à redução do peso (β = -0,04; IC95% -0,07 - -0,01), da PSE (β = -0,07; IC95% -0,13 - -0,00) e da CC em mulheres (β = -0,06; IC95% -0,09 - -0,02). Conclusão: A melhor qualidade da dieta associa-se positivamente a medidas antropométricas que indicam massa magra em homens e negativamente à massa gorda em homens e mulheres.

ABSTRACT: Objective: To analyze the association between diet quality assessed with the Diet Quality Scale (ESQUADA) and the nutritional status and metabolic risk in adults. Methods: The data included 1,147 adults aged 20 to 59, from the population-based study with complex sampling. Weight, height, tricipital (TSF) and subscapular (SSF) skinfolds, and waist (WC) and mid-arm (MAC) circumferences were measured. Body mass index (BMI) and mid-arm muscle circumference (MAMC) were calculated. Nutritional status and metabolic risk were classified considering BMI and WC values, respectively. Diet quality was assessed with ESQUADA. Data were collected at household using the Epicollect5 application. Diet quality (in scores) was analyzed as continuous data and later categorized. The confidence interval was used for comparison between groups, Fisher's exact test for an association study. Adjusted multiple linear regression models were also estimated. P < 0.05 was adopted for statistical significance. Results: Overweight prevailed in 60.33% of individuals, especially among women (60.73%). High or very high metabolic risk was more frequent among women with "very good or excellent" diet quality. Higher diet quality score was associated with a reduction in TSF (β = -0.07; 95%CI -0.13 - -0.01) and an increase in MAMC (β = 0.09; 95%CI 0.00 - 0,18) in men and the reduction in weight (β = -0.04; 95%CI -0.07 - -0.01), SSF (β = -0.07; 95%CI -0.13 - -0,00) and WC in women (β = -0.06; 95%CI -0.09 - -0.02). Conclusion: A better diet quality is positively associated with lean mass in men, and negatively with fat mass in men and women.

A new measure of health motivation influencing food choices and its association with food intakes and nutritional biomarkers in European adolescents.

OBJECTIVE: To develop a scale to assess health motivation influencing food choices and to explore its performance in the associations with food intakes and nutritional biomarkers. DESIGN: Psychometric study using cross-sectional self-report questionnaires and nutritional biomarkers. SETTING: Multi-centre investigation conducted in ten European cities. PARTICIPANTS: 2954 adolescents who were included in the HELENA study and completed the Food Choices and Preferences (FCP) questionnaire. RESULTS: Nineteen out of 124 items of the FCP questionnaire were in the same dimension. Sixteen presented adequate parameters for the Scale of evaluatiOn of Food choIcEs (SOFIE). The scores were positively associated with the intakes of cereals, dairy products, meats and eggs, and fish, as well as with blood concentrations of vitamin C, ß-carotene, n-3 fatty acids, cobalamin, holo-transcobalamin and folate; scores were negatively associated with the intake of alcohol. CONCLUSIONS: SOFIE can improve the assessment of motivation influencing food choices based on items with the best performance and is proposed as a new measure to health-related studies.

Dietary Patterns in European and Brazilian Adolescents: Comparisons and Associations with Socioeconomic Factors.

Associations between dietary patterns (DP) and socioeconomic factors have been little explored in adolescents. The aim of this study was to identify DP in European and Brazilian adolescents and to investigate their associations with a range of socioeconomic indicators. Adolescents from the HELENA-study and the Household Budget Survey were analyzed. Factor analysis was used to obtain DP. Linear regression was used to examine the association between DP and SES. In Europeans, the Western DP was associated with low education of the mother, high socioeconomic status (boys), older age (boys), and living in cities of the Northern Europe; in Brazilians, the Western DP was associated with high secondary education of the mother, high socioeconomic status and living in Southern areas of the country. The Traditional European DP, in both genders, was associated with high secondary education of the mother and inversely associated with a high socioeconomic status; the Traditional Brazilian DP, was associated with university level education of the mother and older age (boys). The association between DP and socioeconomic factors is relevant for the understanding of food-related practices and highlight the importance of performing a complete assessment of the socioeconomic influence in adolescent's DP from developed and developing countries.

Dietary patterns associated with overweight among Brazilian adolescents.

The present study aims to identify the dietary patterns of adolescents and associate these patterns with overweight. We analyzed food-consumption data from 6784 adolescents in the age group 10-18 years old collected in the Household Budget Survey 2008-2009. Dietary patterns were assessed through exploratory factor analysis. Logistic regression models were used in order to associate dietary patterns with overweight. Four dietary patterns were recorded: Traditional Brazilian Pattern, Snacks Pattern, Fast Food Pattern, and the Milk, Fruit and Cereal Breakfast Pattern. Results were adjusted according to the sociodemographic variables and showed that the higher the adherence to Snacks (OR: 1.50 fifth quintile vs first (95% CI: 1.13, 1.99) p linear trend <0.001) and Fast Food patterns (OR: 1.55 fifth quintile vs first (95% CI = 1.12, 2.12) p linear trend <0.001), the higher the chances of becoming overweight. These data indicate that the local public health and nutrition policies focused on adolescents should be more attentive to the eating habits of this population in Brazil, since the current research related regular poor nutritional quality dietary patterns to increased overweight among adolescents. In addition, understanding adolescents' eating habits according to their dietary patterns may guide the development of healthy dietary recommendations based on the combination between food and food groups, rather than only on nutrients or nutritional adequacy.

Consumption of nutrients with antioxidant action and its relationship with lipid profile and oxidative stress in student users of a university restaurant.

INTRODUCTION: The relationship between diet and health has aroused scientific interest, especially the consumption of antioxidant nutrients naturally present in foods, because of its action against the deleterious effects of free radicals in the body. OBJECTIVE: This study aimed to estimate the intake of antioxidant nutrients and its relationship with lipid profile and oxidative stress in student users of a university restaurant in comparison with non-users. METHODS: This cross-sectional study involved 145 university students divided into two groups: users of the university restaurant (group 1, n = 73) and non-users (group 2, n = 72). We measured body mass index and waist circumference, and estimated the intake of antioxidant micronutrients. Serum concentrations of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride levels, and plasma concentrations of malondialdehyde were determined. RESULTS AND CONCLUSIONS: Intake of copper, zinc, selenium, and vitamin C were within the recommendations in both groups, and vitamins A and E were below the reference values. There was a correlation between the intake of vitamin C and triglycerides. Group 1 members had better dietary patterns in relation to antioxidant micronutrients, reflecting less atherogenic lipid profile and lower exposure to oxidative stress compared to group 2.

Consumption of nutrients with antioxidant action and its relationship with lipid profile and oxidative stress in student users of a university restaurant / El consumo de nutrientes con acción antioxidante y su relación con el perfil lipídico y el estrés oxidativo en los estudiantes usuarios del restaurante de una universidad

Introduction: The relationship between diet and health has aroused scientific interest, especially the consumption of antioxidant nutrients naturally present in foods, because of its action against the deleterious effects of free radicals in the body. Objective: This study aimed to estimate the intake of antioxidant nutrients and its relationship with lipid profile and oxidative stress in student users of a university restaurant in comparison with non-users. Methods: This cross-sectional study involved 145 university students divided into two groups: users of the university restaurant (group 1, n = 73) and non-users (group 2, n = 72). We measured body mass index and waist circumference, and estimated the intake of antioxidant micronutrients. Serum concentrations of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride levels, and plasma concentrations of malondialdehyde were determined. Results and conclusion: Intake of copper, zinc, selenium, and vitamin C were within the recommendations in both groups, and vitamins A and E were below the reference values. There was a correlation between the intake of vitamin C and triglycerides. Group 1 members had better dietary patterns in relation to antioxidant micronutrients, reflecting less atherogenic lipid profile and lower exposure to oxidative stress compared to group 2 (AU)

Introducción: la relación entre la dieta y la salud ha despertado interés científico, especialmente en lo referente al consumo de nutrientes antioxidantes presentes de forma natural en los alimentos, debido a su acción contra los efectos nocivos de los radicales libres en el cuerpo. Objetivo: el objetivo de este estudio fue estimar la ingesta de nutrientes antioxidantes y su relación con el perfil lipídico y el estrés oxidativo en estudiantes usuarios de un restaurante universitario, en comparación con los no usuarios. Métodos: este es un estudio transversal que incluye 145 estudiantes universitarios, divididos en dos grupos: los usuarios del restaurante universitario (grupo 1, n = 73) y no usuarios (grupo 2, n = 72). Fueron medidos el índice de masa corporal y la circunferencia de la cintura, y se estimó la ingesta de micronutrientes antioxidantes. Se determinaron las concentraciones séricas de colesterol total, colesterol unido a lipoproteínas de alta densidad, colesterol unido a lipoproteínas de baja densidad, los niveles de triglicéridos y las concentraciones plasmáticas de malondialdehído. Resultados y conclusiones: la ingesta de cobre, zinc, selenio y la vitamina C se encontraba dentro de las recomendaciones de los dos grupos, y la de vitaminas A y E estaba por debajo de los valores de referencia. Hubo una correlación entre el consumo de vitamina C y los triglicéridos. Miembros del grupo 1 mostraron mejores patrones dietéticos en relación con micronutrientes antioxidantes, lo que refleja menos perfil lipídico aterogénico y una menor exposición al estrés oxidativo en comparación con el grupo 2 (AU)