Influence of the C677T Polymorphism of the MTHFR Gene on Oxidative Stress in Women With Overweight or Obesity: Response to a Dietary Folate Intervention.

The C677T polymorphism of the methylenetetrahydrofolate reductase gene (MTHFR) is related to folate metabolism and can alter the levels of biochemical markers.Objective: Investigate the influence of the MTHFR C677T polymorphism on the effects of a dietary folate intervention on oxidative stress in women with overweight or obesity.Methods: Forty-eight adult women with overweight or obesity were subjected to a 24-hour dietary recall, anthropometric measurements, biochemical analysis, and genotyping of the MTHFR C677T polymorphism. They were allocated by convenience sampling to 2 groups, which received 300 g of folate-rich vegetables containing 191 µg/d (Group 1) (n = 24) or 95 µg/d (Group 2) (n = 24) of folate for 8 weeks.Results: The dietary intervention increased the serum folic acid levels in the 2 analyzed groups. The intervention with 191 µg/d of folate led to relevant results in terms of homocysteine levels (p = 0.0005) and total antioxidant capacity (p = 0.0261); the effect was larger among carriers of the TT genotype.Conclusions: The study demonstrated the beneficial effect of folate intake in terms of a TAC elevation for the CC and TT genotypes of the MTHFR C677T polymorphism, an increase in folic acid levels for all genotypes, and a reduction in the Hcy levels for the TT genotype in response to an intervention consisting of an intake of 191 µg/d of folate supplied by vegetables.

Food choices to meet nutrient recommendations for the adult Brazilian population based on the linear programming approach.

OBJECTIVE: To identify optimal food choices that meet nutritional recommendations to reduce prevalence of inadequate nutrient intakes. DESIGN: Linear programming was used to obtain an optimized diet with sixty-eight foods with the least difference from the observed population mean dietary intake while meeting a set of nutritional goals that included reduction in the prevalence of inadequate nutrient intakes to ≤20 %. SETTING: Brazil. SUBJECTS: Participants (men and women, n 25 324) aged 20 years or more from the first National Dietary Survey (NDS) 2008-2009. RESULTS: Feasible solution to the model was not found when all constraints were imposed; infeasible nutrients were Ca, vitamins D and E, Mg, Zn, fibre, linolenic acid, monounsaturated fat and Na. Feasible solution was obtained after relaxing the nutritional constraints for these limiting nutrients by including a deviation variable in the model. Estimated prevalence of nutrient inadequacy was reduced by 60-70 % for most nutrients, and mean saturated and trans-fat decreased in the optimized diet meeting the model constraints. Optimized diet was characterized by increases especially in fruits (+92 g), beans (+64 g), vegetables (+43 g), milk (+12 g), fish and seafood (+15 g) and whole cereals (+14 g), and reductions of sugar-sweetened beverages (-90 g), rice (-63 g), snacks (-14 g), red meat (-13 g) and processed meat (-9·7 g). CONCLUSION: Linear programming is a unique tool to identify which changes in the current diet can increase nutrient intake and place the population at lower risk of nutrient inadequacy. Reaching nutritional adequacy for all nutrients would require major dietary changes in the Brazilian diet.

An evaluation of the effectiveness of the flour iron fortification programme in Brazil.

OBJECTIVE: The present communication reports a strategy to calculate the intake of Fe based on data available for folic acid and evaluate the programme of flour fortification in Brazil. DESIGN: Cross-sectional study conducted in Brazil during 2008 and 2009. A 2d dietary record of individuals was used. The usual intake of folic acid by sex and age group was estimated using the National Cancer Institute method. The quantity of folic acid and Fe established by mandatory food fortification in Brazil was used, and based on that quantity we calculated the amount of flour consumed and the intake of Fe from fortification and Fe from food. Then, the absorption of each nutrient was calculated. SETTING: Brazilian households (n 16,764). SUBJECTS: Individuals (men and women, n 34,003, aged 10 to 60+ years) from a Brazilian nationwide survey. RESULTS: Mean intake and absorption of Fe from fortification (electrolytic Fe) was low in men and women. CONCLUSIONS: The impact from the consumption of fortified products is small in relation to Fe intake in Brazil. The strategy proposed to estimate Fe intake from the fortification programme indicates that the amount of flour intake observed in Brazil does not justify the current ranges of mandatory flour fortification and the form of Fe that is mainly used (electrolytic Fe).

Brazilian pregnant and lactating women do not change their food intake to meet nutritional goals.

BACKGROUND: Nutritional requirements are increased during pregnancy and lactation. The aim of this study was to compare the food intake and prevalence of inadequate nutrient intake among pregnant, lactating and reproductive-age women. METHODS: Two-day dietary records of 322 pregnant and 751 lactating women were compared to those of 6837 non-pregnant and non-lactating women aged 19 to 40 years from a nationwide representative sample. The usual nutrient intake was estimated using the National Cancer Institute method, and compared to nutritional goals to estimate prevalence of inadequate intake. RESULTS: Pregnant, lactating and reproductive-age women did not differ in their average consumption of 18 food groups, except for rice, with greatest intake among lactating women. The prevalence of nutrient inadequacy in pregnant women was higher than in reproductive-age women for folate (78% versus 40%) and vitamin B6 (59% versus 33%). In lactating women, prevalence was higher than in reproductive-age women for vitamin A (95% versus 72%), vitamin C (56% versus 37%), vitamin B6 (75% vs. 33%), folate (72% versus 40%) and zinc (64% versus 20%). The percentage of sodium intake above the upper limit was greater than 70% in the three groups. CONCLUSIONS: Inadequate intake is frequent in women and increases during pregnancy and lactation, because women do not change their food intake. Guidelines should stimulate healthy food intake for women across the lifespan.

Independent associations of income and education with nutrient intakes in Brazilian adults: 2008-2009 National Dietary Survey.

OBJECTIVE: To verify associations of income and education with nutrient intakes in Brazilian adults. DESIGN: Data from the population-based National Dietary Survey conducted in 2008-2009. Family per capita income and education levels were categorized into quartiles. Prevalences of inadequate nutrient intakes and excessive intakes of saturated fat and Na were calculated by using the method prescribed by the National Cancer Institute. The Estimated Average Requirement was used as a reference for micronutrient intake. Linear regression models for both the independent and the mutually adjusted associations of education and income with nutrient intakes were tested. Interaction between education and income was tested. SETTING: Households (n 13 569) selected using a two-stage cluster sampling design. SUBJECTS: Food records for two non-consecutive days were obtained for 21 003 Brazilian adults (aged 20-59 years). RESULTS: For most of eleven nutrients, the prevalence of inadequate intake declined with increasing income and education levels; however, it remained high across all income and education quartiles. Excessive intake of saturated fat and low fibre intake increased with both variables. Most nutrients were independently associated with income and education in both sexes. Fe, vitamin B12 and Na intakes among women were associated only with education. There was an interaction between income and education for Na intake in men, P intake in women and Ca intake in both sexes. CONCLUSIONS: Education is one important step to improve nutrient intakes in Brazil. Emphasis should be laid on enhancing dietary knowledge and formulating economic strategies that would allow lower-income individuals to adopt a healthy diet.

Burden of ischemic heart disease attributable to trans fatty acids, 1990-2019.

BACKGROUND & AIM: The impact of cardiovascular disease attributable to trans fatty acids (TFAs) in the Brazilian population has not been systematically evaluated. This study aims to analyze the burden of ischemic heart disease (IHD) attributable to TFAs in Brazil between 1990 and 2019. METHODS: Data from the Global Burden of Disease Study 2019 were used to investigate the attributable burden in Brazil and its 27 federative units, for both sexes-pooled adults aged ≥25 years. Mortality and disability-adjusted life years (DALYs) from IHD attributable to TFAs were expressed as crude and age-standardized rates and differences from 1990 to 2019 by percentage and annualized rate of change. Linear regression was used to investigate trends. National voluntary and regulatory policies for industrial TFAs (iTFAs) implemented until 2019, summary exposure value (SEV) and sociodemographic index (SDI) were examined. RESULTS: Between 1990 and 2019, crude and age-standardized mortality rates from IHD attributable to TFAs decreased by -15.9% and -58.0%, respectively, in Brazil. A decrease in crude (-23.3%) and age-standardized (-56.4%) DALY rates of IHD attributable to TFAs was also noticed in the country. States of the South, Southeast, and the Federal District had the largest declines of IHD attributable to TFAs, while states of the Northeast and North had the smallest or even an increase. The policies already adopted had little effect on the IHD burden. A lower SEV and higher SDI value seemed to reduce the burden of IHD. CONCLUSIONS: Although a downward trend in IHD attributable to TFAs and a reduction in exposure to TFAs were observed, this burden is still relevant in Brazil, reinforcing the importance of diet policies, such as banning iTFAs.

Evolution of household availability of regional foods in Amazonas.

OBJECTIVE: To evaluate the evolution of household availability of regional foods in the state of Amazonas, their distribution according to sociodemographic characteristics, and potential differences when compared to the remaining areas of Brazil. METHODS: Data on food acquisition for home consumption from the 2002-2003, 2008-2009, and 2017-2018 Pesquisa de Orçamentos Familiares (POFs - Consumer Expenditure Surveys) were analyzed, covering, respectively, 48,470, 55,970, and 57,920 households in Brazil, of which 1,075, 1,344, and 1,833 are in Amazonas. Foods were categorized into three groups: cassava and its derivatives, freshwater fish, and regional fruits. The study analyzed the amount of regional food purchased, expressed in relative household caloric share, for the entire area of Amazonas. Additionally, the data was stratified and analyzed according to sociodemographic variables, with differences assessed through the overlapping of 95% confidence intervals. FINDINGS: The household caloric share of the total regional foods in Amazonas was 22.54% in 2002-2003, 18.18% in 2008-2009, and 6.49% in 2017-2018. Across Brazil, those percentages were much lower in the same period: 3.67%, 3.34%, and 1.82%, respectively. Changes in Amazonas were primarily attributed to the steep drop in the cassava and derivatives group, which decreased from 14.30% in 2002-2003 to 12.74% in 2008-2009 and further declined to 3.09% in 2017-2018. Additionally, there was a gradual decline in household availability of freshwater fish, decreasing from 7.30% in 2002-2003 to 4.85% in 2008-2009 and reaching 2.90% in 2017-2018. Households in rural areas and with lower per capita income presented a higher proportion of calories from total regional foods; this particular stratum also experienced the most significant reductions in their consumption. CONCLUSION: During the study period, there was a significant decrease in the consumption of regional foods in Amazonas, particularly in lower income households in rural areas. Among them, the family reference person was typically a younger male with a lower educational background.

Burden of non-communicable diseases attributable to dietary risks in Brazil, 1990-2019: an analysis of the Global Burden of Disease Study 2019.

INTRODUCTION: An unhealthy diet is a modifiable risk factor for non-communicable diseases (NCDs), one of the most important public health problems in Brazil. This study aimed to analyze the burden of NCDs attributable to dietary risks in Brazil between 1990-2019. METHODS: Secondary data from the Global Burden of Disease Study were used to estimate the burden attributable to fifteen dietary risks in Brazil. The main sources of data for Brazil were national surveys and international databases. A comparative risk assessment was used to obtain the population attributable fraction. We described the intake of each dietary risk and the distribution of number and rates of deaths and Disability-adjusted life years (DALYs) attributable to diet by sex, age, state, and year from 1990-2019. RESULTS: Cardiovascular diseases, diabetes mellitus, and neoplasms were the main NCDs attributable to an unhealthy diet. Age-standardized mortality and DALYs rates attributable to unhealthy diet decreased between 1990-2019 (-51.5% and -48.8, respectively). Diet high in red meat and sodium, and low in whole grains were the three main risk factors contributing to the burden of NCDs both in 1990 and 2019. The burden of NCDs was higher among males in the middle-aged population (around 50 years), as well as in the states of Maranhão, Rio de Janeiro, and Alagoas. CONCLUSIONS: The present study found a suboptimum diet among the Brazilian population. The major contributors to this burden were diet high in red meat and sodium and low in whole grains. This study supports priorities in public policies on food and nutrition to reduce the burden of NCDs.

Comparison of Quality of Carbohydrate Metrics Related to Fasting Insulin, Glycosylated Hemoglobin and HOMA-IR in Brazilian Adolescents.

Low glycemic index (GI) and glycemic load (GL) diets are effective for glycemic control (GC) associated with a carbohydrate-controlled meal plan. However, whether GI and GL peaks are related to GC is unknown. Objective: To compare the daily GI (DGI)/GL (DGL) and average GI (AvGI)/GL (AvGL) of meals (accounting for peaks) related to GC markers (GCM) in Brazilian adolescents. Methods: A representative national school-based (public/private) sample of students without diabetes, 12−17 years of age, was evaluated. Food intake was based on a 24 h recall. The models for complex cluster sampling were adjusted (sex, sexual maturation, age, and physical activity). Results: Of 35,737 students, 74% were from public schools, 60% girls, 17% overweight, and 8% obese. The minimum DGI and DGL were observed at lunch, with higher values at night. Fasting insulin was 1.5 times higher in overweight/obese (OW) girls, and 1.7 times higher in OW boys than in normal-weight (NW) girls. The same trend was observed for the homeostatic model assessment for insulin resistance (HOMA-IR) (OW = 2.82 vs. NW = 1.84 in girls; OW = 2.66 vs. NW = 1.54 in boys; p < 0.05). The daily and average metrics were greater for NW adolescents. Glycosylated hemoglobin was not associated with these metrics, except for AvGL. Insulin and HOMA-IR were associated with all metrics in NW adolescents, with greater coefficients associated with AvGL. Among overweight/obese adolescents, only GI metrics were associated (ß = 0.23; AvGI and insulin) and appeared to have the best association with GCM. Conclusions: Among NW adolescents, GL is a better measure of carbohydrate quality, but for those with overweight/obesity, carbohydrate consumption is more associated with GC, probably because they eat/report small amounts of carbohydrates.

Feasibility in meeting nutrient amounts of the National School Feeding Program and its relationship with the menu cost. / Viabilidade no atendimento às normas do Programa Nacional de Alimentação Escolar e sua relação com custo dos cardápios.

We evaluated the feasibility of the menu adequacy regarding the nutritional constraints established by the National School Feeding Program (PNAE) and its relation to the cost. Each menu accounted for a given food combination within each food group. A diet optimization model comprising each set of foods was designed to obtain food quantities in order to meet the exigences of the PNAE at the lowest cost (menus with 20% and 30% of dietary reference intake for energy, macronutrients, calcium, iron, magnesium, zinc, vitamins A and C, also restrictions for sodium, saturated and trans fats, and added sugar). There was no feasible solution that accommodated all nutrient targets. Limiting components were calcium, sodium, and carbohydrates; but the menus were adequate for the other nutrients. There was a positive correlation between the menu cost and the frequency of meat and fruits, and a negative correlation with the contents of sodium and carbohydrates, and with the frequencies of rice and beans. The probability of obtaining carbohydrate adequacy was close to zero when the meat frequency was higher than one serving per week. In conclusion, it is unlikely to obtain menus that meet all the requirements of the PNAE.

O estudo avaliou a viabilidade da adequação de cardápios em relação às exigências nutricionais estabelecidas pelo Programa Nacional de Alimentação Escolar (PNAE) e a relação entre o custo do cardápio. Cada cardápio semanal contou de uma combinação de alimentos dentro de cada grupo. Para cada combinação de alimentos foi elaborado um modelo de otimização de dados para obter as quantidades de cada alimento de forma a atender às exigências do PNAE ao menor custo possível (cardápios com 20% e 30% da ingestão dietética de referência para energia, macronutrientes, cálcio, ferro, magnésio, zinco, vitaminas A e C, além de restrições para sódio, gorduras saturada e trans, e açúcar de adição). Não foi obtida nenhuma solução que acomodasse todas as exigências do PNAE. Os componentes limitantes foram cálcio, sódio e carboidratos; para os demais os cardápios foram adequados. O custo foi diretamente correlacionado com a frequência de carne e frutas, e inversamente com os conteúdos de sódio e carboidratos, e com as frequências de arroz e feijão. A probabilidade de adequação de carboidratos foi próxima de zero quando a frequência de carne foi acima de 1 vez por semana. Concluindo, é pouco provável a obtenção de cardápios que atendam à todas as exigências do PNAE.

Cost of healthy and culturally acceptable diets in Brazil in 2009 and 2018.

OBJECTIVE: To estimate the lowest cost of a healthy and culturally acceptable diet and to assess the evolution of its cost in the periods 2008-2009 and 2017-2018. METHODS: We used data on the individual food consumption and food prices from the Pesquisas de Orçamentos Familiares (Household Budget Surveys), in the 2008-2009 and 2017-2018. The sample strata of each period were aggregated, forming 108 new strata with geographic and economic homogeneity. Linear programming models generated diets for each new stratum, considering the constraints in two models: model 1 (≥ 400g of fruits and vegetables); and model 2 (≥ 400g of fruits and vegetables, < 2300mg of sodium, sodium/potassium ratio < 1, ≥ 500mg of calcium). Each food could progressively deviate 5g from the observed consumption averages until the models found a solution in each of the strata. The objective function was to minimize the total cost of the diet. RESULTS: The average observed and optimized costs were R$4.96, R$4.62 (model 1) and R$5.08 (model 2) in 2008-2009, and R$9.18, R$8.69 and R$9.87 in 2017-2018. Models 1 and 2 resulted in an increase of up to 6% and 11% in 2008-2009, and of up to 25% and 34% in 2017-2018 in the lowest income strata. The main changes observed in the two models include the reduction in the amounts of sweetened beverages, sweets, sauces, ready-to-eat foods, and an increase in fruits and vegetables, flour, and tubers. CONCLUSION: The adequate amount of fruits and vegetables resulted in an increase in costs to some population strata. When the adequacy of calcium, sodium, and potassium was considered, we observed a more significant increase in cost, especially in 2017-2018.

Food consumption patterns, overweight and cardiovascular risk: a cross-sectional analysis of the Pró-Saúde Study, Brazil, 2013. / Padrão de consumo de alimentos, excesso de peso e risco cardiovascular: uma análise transversal do Estudo Pró-Saúde, 2013.

OBJECTIVE: To identify food consumption patterns and association between overweight and risk of cardiovascular disease. METHODS: This was a cross-sectional study with staff of the Universidade do Estado do Rio de Janeiro, Brazil, who took part in the Pró-Saúde Study. Food consumption was investigated using a food frequency questionnaire. Association between dietary patterns (exposure) and overweight and cardiovascular risk (outcomes) was estimated using linear regression. RESULTS: Among the 520 staff assessed, four dietary patterns were found: 'ultra-processed', 'healthy', 'meat' and 'traditional'. After adjustment, the 'meat' pattern was inversely associated with waist circumference (ß=-1.52 - 95%CI -2.66;-0.39), body mass index (ß=-0.56 - 95%CI -1.01;-0.11), and the Framingham Risk Score (ß=-0.36 - 95%CI -0.64;-0.09). CONCLUSION: In view of excess weight, risk of cardiovascular disease and inverse association between the 'meat' food consumption pattern and BMI, it is important to conduct further investigations, with non-working groups, with the aim of gaining greater understanding of the health-disease process related to food consumption.

Association Between Family Physical Violence Victimization and Food Consumption Among Brazilian Adolescents.

Few studies have evaluated the relationship between stressful events, such as child abuse and food consumption. Thus, the objective of this study is to assess whether family physical violence victimization is associated with food consumption in adolescents. We used data from the Brazilian National Adolescent School-based Health Survey, carried out in 2015, in a representative sample of 102,072 students attending ninth grade from public and private schools. We used Venn diagrams and logistic regression analysis to, respectively, graphically represent and evaluate the association between the consumption of ultra-processed food (soft drinks, sweets/candies, and salty biscuits, packaged snacks, or processed meat) and in natura food (beans, fruits and vegetables) with victimization from family physical violence. We found a lower consumption of in natura and higher consumption of ultra-processed foods among adolescent victims when compared with nonvictims of family physical violence. The probability of consuming 4 or more times a week increased by 44% for salty biscuits, packaged snacks, or processed meats; 38% for soft drinks; and 22% for sweets among adolescents who reported violence. On the contrary, the probability of consuming 4 or more times a week decreased by 25% for beans, 19% for vegetables, and 13% for fruits among adolescent victims of family physical violence. We conclude that family physical violence victimization is associated with high consumption of ultra-processed food and low consumption of in natura food among Brazilian adolescents. Therefore, issues related to violence in childhood and adolescence should be addressed in interventions aimed at altering food consumption and consequent prevention, control, and treatment of nutrition-related outcomes to increase their effectiveness.

Limitations in the comparison of the Brazilian National Dietary Surveys of 2008-2009 and 2017-2018.

OBJETIVE: To present particular characteristics of two Brazilian National Dietary Surveys (Inquéritos Nacionais de Alimentação - INA) and the methodology used to better compare their data. METHODS: This study details the differences between both INA conducted by the Brazilian Institute of Geography and Statistics (IBGE) in 2008-2009 and 2017-2018. We present the alterations in data collecting methods and food composition tables as well as the analysis strategies recommended to obtain such data. A validation study with 95 participants of the third wave of the Longitudinal Study of Adult Health assessed the measurement error associated with the procedures adopted in the 24-hours dietary recall of INA 2017-2018. The reference standards were urinary protein recovery, sodium, and potassium biomarkers. Different strategies were used in the analysis of INA to compare two essential dietary items that had their collection method changed: fats and sugars. RESULTS: The validation study indicated lower underreport in the most recent survey with higher means of energy intake. The correlation of means for the 24-hours recalls with their respective biomarkers was 0.58 for proteins, 0.31 for potassium, and 0.30 for sodium. Comparing the food composition tables used in both surveys with the data obtained by INA 2008-2009, the mean variation of energy, macronutrients, and minerals was lower than 15%, except for trans fats and selenium, which had means 40% and 52% lower in the Tabela Brasileira de Composição de Alimentos (TBCA - Brazilian Food Composition Table). INA 2017-2018 presents lower means for added sugar, using a generic question about the frequency of sugar consumption as a measure for sugar as an additional item. CONCLUSION: The methodological changes promoted in the most recent INA enhanced food groups and nutrients intake estimation, adding detailed and specific data in dietary habits reports.

Evolution of energy and nutrient intake in Brazil between 2008-2009 and 2017-2018.

OBJECTIVE: To assess the evolution of energy and nutrient intake and the prevalence of inadequate micronutrients intakes according to sociodemographic characteristics and Brazilian regions. METHODS: The food consumption of 32,749 individuals from the National Dietary Survey of the Household Budget Survey 2008-2009 was analyzed by two food registries, as well as 44,744 subjects from two 24-hour recalls in 2017-2018. Usual intake and percentage of individuals with consumption below the average recommendation for calcium, magnesium, phosphorus, copper and zinc, vitamins A, C, D, E, thiamine, riboflavin, pyridoxine and cobalamin were estimated. Sodium intake was compared to the reference value to reduce the risk of chronic diseases. Analyses were stratified by sex, age group, region and income. RESULTS: Mean daily energy intake was 1,753 kcal in 2008-2009 and 1,748 kcal in 2017-2018. The highest prevalence of inadequacy (> 50%) in the two periods were calcium; magnesium; vitamins A, D and E; pyridoxine and, only among adolescents, phosphorus. There was an increase in the prevalence of inadequate vitamin A, riboflavin, cobalamin, magnesium, and zinc among women, and riboflavin among men. The prevalence of inadequacy decreased for thiamine. Sodium intake was excessive in approximately 50% of the population in both periods. The highest variations (about 50%) in the prevalence of inadequacy between the lowest and highest income (< 0.5 minimum wage and > 2 minimum wages per capita) were observed for vitamin B12 and C in both periods. The North and Northeast regions had the highest prevalence of inadequacy. CONCLUSION: Both surveys found high prevalence of inadequate nutrient intake and excessive sodium intake. The inadequacy varies according to income strata, increasing in the poorest regions of the country.

Development of a Food Frequency Questionnaire for Brazilian athletes.

AIM: Until recently most dietary survey methods have been developed for non-athletic populations. In this study, we aimed to develop a Food Frequency Questionnaire (FFQ) to assess the regular dietary intake of Brazilian athletes. METHODS: We interviewed 141 athletes (23.36 ± 7.77 years old) for their dietary intake using 24-hour recalls. After grouping conceptually similar food items into 113 food items, percentage contribution analysis and stepwise regression models were used to highlight foods contributing to at least 90% of the between-person variability of key nutrients. RESULTS: The developed FFQ contained 59 foods which were important predictors of the variance in nutrient intake. Vitamin C and pyridoxine had the lowest number of selected foods. Conversely, 13 food items were required to explain the between-person variation for energy, carbohydrate and magnesium intake. CONCLUSIONS: Using a multiple regression analysis we developed a 59-food item questionnaire, which includes culturally specific food items and may represent an important dietary tool to analyse athletic populations. Reproducibility and validity of this FFQ will be verified in future research.

Usual diet quality among 8- to 12-year-old Brazilian children.

Nutritional surveys are important information sources for public policy in the food and nutrition field. They focus on assessing usual dietary patterns, because health outcomes result from the long-term intake. Here we aimed to evaluate diet quality adjusted for day-to-day variance among Brazilian children. Data were collected between March 2013 and August 2015. The sample included 8- to 12-year-old children (n = 1,357) from public schools from all administrative regions of a Brazilian city. One 24-h dietary recall (24HR) was collected for the whole sample and two 24HR for two non-consecutive days of the same week for a subsample. The Healthy Eating Index-2010 (HEI-2010) was adapted to Brazilian food habits and the Brazilian dietary guidelines were used to evaluate diet quality. Statistical analysis included a multipart, nonlinear mixed model with correlated random effects proposed by the U.S. National Cancer Institute to correct diet quality for day-to-day variance. The adapted HEI-2010 total score was 51.8. Children with poorer diet quality (< 10th percentile) scored less than 41.1, and children with higher diet quality (> 90th percentile) scored more than 62.4. The overall adequacy of adapted HEI-2010 components was low. Higher adequacy percentages were identified for total protein foods (94.9%), greens (62.3%), and seafood and plant proteins (52.2%). Seven components showed less than 10% of adequacy: refined grains, fatty acids, dairy, sodium, total vegetable, whole grains, and empty calories. This study identified the main inadequacies among children's diet quality, which can guide promotion actions for healthy eating.

Food consumption according to degree of processing and sociodemographic characteristics: Estudo Pró-Saúde, Brazil. / Consumo alimentar segundo o grau de processamento e características sociodemográficas: Estudo Pró-Saúde.

OBJECTIVE: To investigate the food consumption according to the degree of processing and associations with sociodemographic characteristics. METHODS: A cross-sectional study of the Estudo Pró-Saúde (Pro-Health Study), with 520 civil servants of university campuses, Rio de Janeiro, 2012-13. A food frequency questionnaire was used to classify food consumption: 1) in natura, minimally processed, food preparations based on these foods; 2) processed foods; 3) ultra-processed foods. The relative energy contribution of each group was determined, and a seemingly unrelated equations regression (SUR) regression model was used to estimate associations with sociodemographic characteristics. RESULTS: The in natura food group (1) contributed with 59% of the energy consumption and was directly associated with age [45-49 years (ß = 1.8 confidence interval of 95% - 95%CI -1.2; 4.8); 50-54 (ß = 1.5 95%CI -1.5; 4.5); 55-59 (ß = 2.9 95%CI -0.4; 6.3) and ≥ 60 (ß = 4.6 95%CI 1.1; 8.2)], compared to age ≤ 44. In contrast, the group of ultra-processed foods contributed 27% and were inversely associated with age [45-49 (ß = -1.7 95%CI -4.3; 0.9); 50-54 (ß = -1.8 95%CI -4.3; 0.9); 55-59 (ß = -4.9 95%CI -8.0; -2.0); ≥ 60 (ß = -4.5 95%CI -7.6; -1.5)]. Gender, income and schooling were not associated with food consumption. CONCLUSION: Younger adults had higher consumption of ultra-processed foods, indicating the need for interventions mainly in this age group. The absence of association with other sociodemographic characteristics may be due to the influence of contextual factors.

OBJETIVO: Investigar o consumo alimentar segundo o grau de processamento e associações com características sociodemográficas. MÉTODOS: Estudo transversal de subamostra do Estudo Pró-Saúde, com 520 funcionários públicos de campi universitários, Rio de Janeiro, 2012-13. Questionário de frequência alimentar foi utilizado para classificar o consumo alimentar: 1) in natura, minimamente processados, preparações culinárias à base desses alimentos; 2) alimentos processados; 3) alimentos ultraprocessados. Determinou-se a contribuição energética relativa de cada grupo, e foi utilizado modelo de regressão seemingly unrelated equations regression (SUR) para estimar associações com as características sociodemográficas. RESULTADOS: O grupo de alimentos in natura (1) contribuiu com 59% do consumo energético e foi diretamente associado à idade [45-49 anos (ß = 1,8 intervalo de confiança de 95% - IC95% -1,2; 4,8); 50-54 (ß = 1,5 IC95% -1,5; 4,5); 55-59 (ß = 2,9 IC95% -0,4; 6,3) e ≥ 60 (ß = 4,6 IC95% 1,1; 8,2)], comparado à idade ≤ 44. Em contraste, ultraprocessados contribuíram com 27% e foram inversamente associados à idade [45-49 (ß = -1,7 IC95% -4,3; 0,9); 50-54 (ß = -1,8 IC95% -4,3; 0,9); 55-59 (ß = -4,9 IC95% -8,0; -2,0); ≥ 60 (ß = -4,5 IC95% -7,6; -1,5)]. Sexo, renda e escolaridade não foram associados ao consumo alimentar. CONCLUSÃO: Adultos mais jovens apresentaram maior consumo de ultraprocessados, indicando a necessidade de intervenções principalmente nessa faixa etária. A ausência de associação com demais características sociodemográficas pode ser por conta da influência de fatores contextuais.

Evolution of household availability of regional foods in Amazonas / Evolução da disponibilidade domiciliar de alimentos regionais no Amazonas

ABSTRACT OBJECTIVE To evaluate the evolution of household availability of regional foods in the state of Amazonas, their distribution according to sociodemographic characteristics, and potential differences when compared to the remaining areas of Brazil. METHODS Data on food acquisition for home consumption from the 2002-2003, 2008-2009, and 2017-2018 Pesquisa de Orçamentos Familiares (POFs - Consumer Expenditure Surveys) were analyzed, covering, respectively, 48,470, 55,970, and 57,920 households in Brazil, of which 1,075, 1,344, and 1,833 are in Amazonas. Foods were categorized into three groups: cassava and its derivatives, freshwater fish, and regional fruits. The study analyzed the amount of regional food purchased, expressed in relative household caloric share, for the entire area of Amazonas. Additionally, the data was stratified and analyzed according to sociodemographic variables, with differences assessed through the overlapping of 95% confidence intervals. FINDINGS The household caloric share of the total regional foods in Amazonas was 22.54% in 2002-2003, 18.18% in 2008-2009, and 6.49% in 2017-2018. Across Brazil, those percentages were much lower in the same period: 3.67%, 3.34%, and 1.82%, respectively. Changes in Amazonas were primarily attributed to the steep drop in the cassava and derivatives group, which decreased from 14.30% in 2002-2003 to 12.74% in 2008-2009 and further declined to 3.09% in 2017-2018. Additionally, there was a gradual decline in household availability of freshwater fish, decreasing from 7.30% in 2002-2003 to 4.85% in 2008-2009 and reaching 2.90% in 2017-2018. Households in rural areas and with lower per capita income presented a higher proportion of calories from total regional foods; this particular stratum also experienced the most significant reductions in their consumption. CONCLUSION During the study period, there was a significant decrease in the consumption of regional foods in Amazonas, particularly in lower income households in rural areas. Among them, the family reference person was typically a younger male with a lower educational background.

RESUMO OBJETIVO Avaliar a evolução da disponibilidade domiciliar de alimentos regionais no Amazonas, sua distribuição segundo características sociodemográficas e potenciais diferenças em relação ao restante do Brasil. MÉTODOS Foram analisados dados de aquisição de alimentos para consumo domiciliar das Pesquisas de Orçamentos Familiares (POFs) de 2002-2003, 2008-2009 e 2017-2018, que estudaram, respectivamente, 48.470, 55.970 e 57.920 domicílios no Brasil, dos quais 1,075, 1.344 e 1.833 estão no Amazonas. Os alimentos foram reunidos em três grupos: macaxeira e derivados, peixes de água doce, e frutos regionais. A quantidade de alimento regional adquirido, expressa em participação calórica relativa domiciliar, foi analisada para o Amazonas como um todo e segundo variáveis sociodemográficas (diferenças avaliadas pela sobreposição dos intervalos de confiança de 95%). RESULTADOS A participação calórica domiciliar do total de alimentos regionais no Amazonas foi de 22,54% em 2002-2003, 18,18% em 2008-2009 e 6,49% em 2017-2018. No Brasil, estes percentuais foram bem menores no mesmo período: 3,67%, 3,34% e 1,82%, respectivamente. As mudanças no Amazonas ocorreram, principalmente, pela drástica redução do grupo de macaxeira e derivados (de 14,30% em 2002-2003 para 12,74% em 2008-2009 e 3,09% em 2017-2018) e pelo declínio gradativo da disponibilidade domiciliar de peixes de água doce (de 7,30% em 2002-2003 para 4,85% 2008-2009 e 2,90% em 2017-2018). Domicílios do meio rural e com menor renda per capita tiveram maior participação calórica do total de alimentos regionais, estratos que também tiveram as maiores reduções. CONCLUSÃO Houve redução significativa da presença de alimentos regionais no Amazonas no período estudado, atingindo principalmente os domicílios da zona rural e com menor renda, cuja pessoa de referência da família era do sexo masculino, mais jovem e com menor escolaridade.

Effective strategies for prevention, control, and treatment of obesity in primary health care setting for adolescents, adults, and elderly people: A protocol for systematic review and meta-analysis.

BACKGROUND: It is unquestionable that obesity is a global epidemic and one of the main public health problems in the world. The management of obesity in Primary Health Care has an important role if being considered the magnitude and serious consequence of this problem. Despite this, there is no effective standard protocol for the treatment of this disease. Studies that synthesize and assess the effectiveness of strategies for prevention, control, and treatment of obesity in Primary Health Care setting are still scarce. The objective of this study is review and synthesize study evidence for obesity management strategies among adolescents, adults and elderly developed at the Primary Health Care worldwide. METHODS: Seven electronic databases (Medline, Lilacs, Embase, Psycinfo, Cochrane, WHOLIS and Open Gray) will be searched with no date limit for identification of clinical trials examining the effectiveness of prevention, control and treatment of obesity in Primary Health Care. As primary outcome will be changes in body weight. As secondary outcomes will be body mass index, body adiposity, waist circumference, and waist-hip ratio. Two independent authors will perform the selection of studies, data extraction, and the assessment of risk of bias. RESULTS: The results will be published in a peer-reviewed journal. CONCLUSION: This systematic review will be first to synthesize scientific evidence for obesity management strategies at Primary Health Care among adolescents, adults, and elderly. The review will benefit healthcare professionals and policymakers. ETHICS AND DISSEMINATIONS: Ethical approval is not required in this study because the data used include peer-reviewed publications, which do not comprise any information that could identify subjects. TRIAL REGISTRATION NUMBER: PROSPERO (CRD42018092416).