Lymphocytes mitochondrial physiology as biomarker of energy metabolism during fasted and fed conditions

Mitochondria are central coordinators of energy metabolism, and changes of their physiology have long been associated with metabolic disorders. Thus, observations of energy dynamics in different cell types are of utmost importance. Therefore, tools with quick and easy handling are needed for consistent evaluations of such interventions. In this paper, our main hypothesis is that during different nutritional situations lymphocytes mitochondrial physiology could be associated with the metabolism of other cell types, such as cardiomyocytes, and consequently be used as metabolic biomarker. Blood lymphocytes and heart muscle fibers were obtained from both fed and 24 h-fasted mice, and mitochondrial analysis was assessed by high-resolution respirometry and western blotting. Carbohydrate-linked oxidation and fatty acid oxidation were significantly higher after fasting. Carnitine palmitoil transferase 1 and uncouple protein 2 contents were increased in the fasted group, while the glucose transporters 1 and 4 and the ratio phosphorylated AMP-activated protein kinase/AMPK did not change between groups. In summary, under a nutritional status modification, mitochondria demonstrated earlier adaptive capacity than other metabolic sensors such as glucose transporters and AMPK, suggesting the accuracy of mitochondria physiology of lymphocytes as biomarker for metabolic changes.

O censo escolar como estratégia de busca de crianças e adolescentes em estudos epidemiológicos

Alternativas de baixo custo que possibilitem o acompanhamento de grupos populacionais constituem estratégias importantes na condução de estudos de coorte. Este trabalho apresenta os procedimentos para o uso do censo escolar como instrumento de busca de crianças e adolescentes em estudos de seguimento. O estudo foi realizado entre os estudantes adolescentes que frequentaram os postos de saúde de Cuiabá, Estado de Mato Grosso, Brasil, para vacinação em 1999. Foram localizados 86,8% de adolescentes com o uso do censo escolar e 0,2% pelo Sistema de Informações sobre Mortalidade. Dentre os adolescentes localizados, foram entrevistados 1.716, representando uma taxa de seguimento de 71,4%. Neste estudo, o censo escolar mostrou ser um método efetivo na busca de estudantes.

Insulin resistance predicts the effectiveness of different glycemic index diets on weight loss in non-obese women

OBJECTIVE

The present study aimed to evaluate whether baseline insulin resistance (IR) modify weight change associated to glycemic index (GI) of the diet.

METHOD

This is a secondary analysis of a randomized GI intervention according to baseline HOMA-IR. Middle-aged (25-45 years), non-obese (BMI 23-29.9 kg/m²) women were randomized to low or high GI diets matched on total energy, macronutrient composition, and fiber content. Both groups received dietary counseling based on a small energy restriction (100-300 kcal/day). Women were classified in two groups according to their baseline HOMA-IR: IR (n = 64) and non-IR (n = 121).

RESULTS

At baseline, IR and non-IR groups had similar BMI (26.7 vs. 26.3 kg/m²; p = 0.21), but the IR group presented with higher waist circumference (82.7 vs. 80.8 cm; p = 0.02) and showed greater weight loss after 12 months of follow-up (-1.6 vs. -1.1 kg; p = 0.01), mainly among those in a high-GI diet (-2.1 vs. -1.0 kg; p = 0.005) compared to the non-IR group (-1.4 vs. -0.8 kg; p = 0.04).

CONCLUSIONS

The high-GI group showed statistically significant higher reduction in body weight, mainly among those women with baseline IR . Low-GI diet did not facilitate weight loss neither in IR women nor in non-IR women.

Regional and socioeconomic distribution of household food availability in Brazil, in 2008-2009

OBJECTIVE

To describe the regional and socioeconomic distribution of household food availability in Brazil.

METHODS

Data from the 2008-2009 Household Budget Survey on food and beverage acquisition for household consumption, conducted by the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics), were analyzed. The amounts of foods, recorded during seven consecutive days in the 55,970 sample households, were converted into calories and nutrients. Food quality indicators were constructed and analyzed according to the regional and socioeconomic strata of the Brazilian population.

RESULTS

The amount of energy from protein was adequate in all regional and socioeconomic strata. On the other hand, an excess of free sugars and fats was observed in all regions of the country, especially in the Southern and Southeastern regions. The proportion of saturated fats was high in urban areas and consistent with the greater contribution of animal-derived products. Limited availability of fruits and vegetables was found in all regions. An increase in the fat content and reduction in carbohydrate content of the diet were observed with the increase in income.

CONCLUSIONS

The negative characteristics of the Brazilian diet observed at the end of the first decade of the 21st century indicate the need to prioritize public policies for the promotion of healthy eating.

Appetite-related hormone levels in obese women with and without binge eating behavior

OBJECTIVE: The aim of this study was to evaluate serum levels of appetite-related hormones (peptide YY3-36, total ghrelin, leptin and insulin) before and after consumption of a meal in obese women with and without binge eating episodes and normal weight women. METHODS: Twenty-five women aged 32-50 years were invited to participate in this study, including 9 normal weight women without binge eating episodes (20-25kg/m², group 1), 9 obese women with binge eating episodes (³30kg/m², group 2), and 7 obese women without binge eating episodes (group 3). Four blood samples were collected from each participant, one being 60 minutes before and three being 15, 45 and 90 minutes after a meal. The composition of the meal was 55% carbohydrates, 15% protein and 30% lipids. RESULTS: Group 3 presented increased HOMA-IR (M=2.5, SD=1.04) when compared with group 1 (M=1.5, SD=0.53) and group 2 (M=1.8, SD=0.58), p=0.04. Body mass index (p<0.0001), leptin (p<0.0001) and insulin (p=0.01) were higher in group 3 than in the other groups before and after the meal. Additionally, total ghrelin (p=0.003) and PYY3-36 (p=0.02) levels were lower in group 2 than in the other groups before and after the meal. After adjustment for body mass index, only the lower PYY3-36 level of group 2 remained statistically different from the other groups (p=0.01). CONCLUSION: Our study suggests that lower levels of PYY 3-36 are associated with binge eating in obese women.

Avaliação dos marcadores de consumo alimentar do VIGITEL (2007-2009)

OBJETIVO: Avaliar as questões marcadoras de consumo alimentar do Sistema Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico e sua evolução temporal. MÉTODOS: Foram avaliados 135.249 indivíduos de 27 cidades brasileiras, entrevistados nos anos de 2007 - 2009. Os marcadores de consumo alimentar foram descritos a partir da frequência de consumo de frutas, hortaliças, feijão, leite integral e desnatado, refrigerante normal e diet/light, e consumo de gordura aparente das carnes e a pele do frango. Avaliou-se a evolução temporal desses marcadores e, adicionalmente, testou-se a elaboração de um escore de alimentação saudável e a identificação de padrões alimentares por meio da análise de cluster. RESULTADOS: Observou-se aumento estatisticamente significativo nas frequências de consumo de feijão, leite integral e refrigerante normal e diminuição no consumo de leite desnatado. Mesmo com aumento de 11 para 13% de indivíduos que referiram consumir feijão diariamente, esses percentuais são baixos; assim como o consumo recomendado de 3 porções de frutas e 3 porções de hortaliças por dia, que foi referido por menos de 15% da população em todos os anos, com queda de 5 para 3% para as hortaliças. O refrigerante não diet foi o item com maior aumento no consumo, passando de 60 para 67%. Os itens avaliados apresentaram fraca correlação e não configuram um constructo único de alimentação saudável. CONCLUSÃO: A qualidade da dieta dos brasileiros tem piorado e é necessária melhor qualificação dos marcadores alimentares considerados de risco para doenças crônicas não-transmissíveis.

Dietary availability patterns of the Brazilian macro-regions

Introduction

Epidemiological studies have raised concerns about the role of dietary patterns on the risk of chronic diseases and also in the formulation of better informed nutrition policies.

Objective

The development of a dietary availability patterns according to geographic regions in Brazil.

Methodology

The 2002-2003 Brazilian Household Budget Survey was conducted in 48,470 households. Dietary availability patterns were identified by Principal Component Analysis using as a unit of analysis the survey's Primary Sampling Units (PSUs) and purchased amounts for 21 food groups. Each of the extracted dietary availability patterns was regressed on socioeconomics categories.

Results

There were no differences in dietary availability patterns between urban and rural areas. In all regions, a rice and beans pattern was identified. This pattern explained 15% to 28% of the variance dependent on the region of the country. In South, Southeast and Midwest regions, a mixed pattern including at least 10 food groups explaining 8% to 16% of the variance. In the North region (Amazon forest included) the first pattern was based on fish and nuts and then it was designed as regional pattern. In multiple linear regression the rice and beans pattern was associated with the presence of adolescents in the households, except for North region, whereas the presence of adolescents was associated with the Regional pattern. A mixed patterns were associated with a higher income and education (p < 0.05), except in the South region.

Conclusion

The rice and beans and regional dietary availability patterns, both considered healthy eating patterns are still important in the country. Brazil has taken many actions to improve nutrition as part of their public health policies, the data of the Household Budget Survey could help to recognize the different food choices in the large regions of the country.

Association between serum TSH concentration within the normal range and adiposity

BACKGROUND

Overt hypothyroidism is clearly related to body weight gain and greater adiposity, but the range of hormonal change in serum TSH concentration associated with weight gain remains a focus of debate.

AIM

The aim of this review was to assess studies that evaluated the relationship between anthropometric measures and serum TSH concentration in euthyroid subjects.

METHODS

Studies held on the Ovid MEDLINE database were searched and original articles published from 2000 to 2010 were included. The literature search was restricted to studies conducted in humans aged 18 years or older and written in English, Spanish, or Portuguese. Studies that evaluated the association between anthropometric measures and serum TSH within the normal range as the primary objective, as well as additional analysis, were included.

RESULTS

A total of 29 studies met the inclusion criteria. Of the 29 studies, 18 showed a positive relationship between measures of adiposity and serum TSH. Despite the plausibility of this association, only two studies reported longitudinal findings. The influence of smoking on the association between serum TSH and anthropometric measures was evaluated in only three studies and remains unclear.

CONCLUSION

Thus, further longitudinal studies are needed to better understand the mechanisms by which TSH concentration might impact body weight.

Insulin resistance influences weight loss in non-obese women who followed a home-based exercise program and slight caloric restriction

This study aimed to evaluate the influence of insulin resistance status on weight changes in non-obese women who followed a home-based exercise program and slight caloric restriction over a period of 12 months. Middle-aged (25-45 year), non-obese (body mass index of 23-29.9 kg/m(2)) women were randomly assigned to control (CG) or home-based exercise group (HB). The HB group received a booklet explaining the physical exercises to be practiced at home at least three times per week (40 min/session). Both groups were required to follow a small energy restriction of 100-300 calories per day. For the analysis, women were stratified in two groups according to baseline insulin sensitivity: NIR (non-insulin resistant; n = 121) and IR (insulin resistant; n = 64). Women classified as IR at baseline had greater weight loss after 12 months of follow-up (-1.6 kg vs. -1.1 kg; p = 0.01), and HB exercise helped to reduce weight only among NIR women (-1.5 vs. -0.7; p = 0.04); no differences were observed between intervention groups for IR women (-1.5 vs. -1.7; p = 0.24). There were no differences between IR and NIR groups for lipid profile after adjustment for weight changes. Insulin resistance facilitated weight loss, and home-based exercise promoted greater weight loss only in non-insulin resistance women.

Relationship between body mass index and thyrotropin in euthyroid women: differences by smoking, race and menopausal status

OBJECTIVE

To evaluate potential effect modifications on the association between BMI and thyrotropin (TSH) by smoking, race, and menopausal status among euthyroid women.

METHODS

A cross-sectional population-based study was carried out in the city of Rio de Janeiro, Brazil, in 2004-2005. Households (1,500) were selected using three-stage probability sampling. A sample of 1,084 women aged 35 years or older and with TSH values within the reference range (0.3-4.0 mIU/l) was investigated. Weight and height were measured at household and blood collected for serum TSH and anti-thyroperoxidase (anti-TPO) antibody analysis.

RESULTS

Overall, BMI was positively and significantly associated with serum TSH (β = 0.87; p = 0.001). This association was modified by smoking, race, and menopausal status (p < 0.05). Adjusted regression coefficients were 1.78 versus 0.58 comparing smokers with non-smokers, 1.39 for Blacks compared to 0.79 for Non-Blacks, and 0.70 for women in menopause compared to 1.04 for premenopausal women. The percentage of high anti-TPO (greater than 35 UI/ml) was 8.8%, and the association between TSH and BMI was no longer significant in this group.

CONCLUSION

BMI was positively associated with serum TSH specifically in its normal range, but only for those women who tested negative for anti-TPO. Smoking and race are negatively associated with anti-TPO, possibly explaining the effect modification observed.

Household food diversity and nutritional status among adults in Brazil

BACKGROUND

The aims of this study were to evaluate whether a diversity of healthy foods in a household would decrease the availability of unhealthy foods and to evaluate the association between a healthy dietary diversity score (DDS) and nutritional status among adults.

METHODS

Data from the 2002-2003 Brazilian Household Budget Survey were used. This nationwide survey used a two-stage sampling technique: households were selected after selection of primary sample units (PSUs). Analyses were based on 3,393 PSUs, evaluating 659,816 records of food items purchased by 35,237 households. The DDS was based on the healthy food groups according to Brazilian food guidelines. Per capita acquisition of sugar, sweets, sugar-sweetened beverages and crackers, cookies and cakes (unhealthy food groups) in PSUs was also calculated. Individual weight and height were measured at household. Multivariate linear regression models estimated the association of underweight and overweight and obesity (excess weight) with the PSUs' DDS.

RESULTS

Greater acquisition of unhealthy food groups was associated with higher DDS. A high PSU's DDS was negatively associated with underweight (β = -0.38; p-value = 0.04) and positively associated with excess weight (β = 0.98; p-value = 0.05) after adjustment for availability of unhealthy food groups and socioeconomic variables.

CONCLUSIONS

Our data indicate that there was no replacement of unhealthy food groups by healthy food groups, therefore a healthy diet message for obesity prevention should be combined with a message focused on eating less.

Prevalence of metabolic syndrome and of its specific components among adolescents from Niterói City, Rio de Janeiro State, Brazil

OBJECTIVE: To compare the prevalence of metabolic abnormalities (MA) and metabolic syndrome (MS) assessed by different criteria among Brazilian adolescents. SUBJECTS AND METHODS: Weighted prevalence of MA and MS were estimated using criteria adapted from the International Diabetes Federation (IDF), National Cholesterol Education Program, Adult Treatment Panel III (NCEP/ATP III), and the World Health Organization (WHO) in a probabilistic sample of 577 students aged 12-19. RESULTS: The most prevalent MA was low concentration of HDL-C as per IDF (32.5%) and NCEP/ATP III (41.6%) criteria and hypertension as per the WHO's criterion (12.4%). Prevalence of MS using the NCEP/ATP III criterion (6.04%) was five times higher than the WHO's (1.1%) and the IDF's (1.6%) criteria. As expected, MS was significantly higher among overweight than among non-overweight adolescents. CONCLUSION: Low prevalence of MS but high prevalence of some MA were found. These findings suggest that the diagnosis of MA is more relevant in clinical practice especially in overweight adolescents.

Characteristics and spending on out-of-home eating in Brazil

OBJECTIVE

To analyze the characteristics of out-of-home eating and spending on such consumption.

METHODS

A complex sample of 48,470 Brazilian households, selected from the 2002-2003 Household Budget Survey (HBS) was analyzed. Out-of-home eating was defined as the purchase of at least one type of food for consumption out of the home during seven days. Frequencies of out-of-home eating were estimated according to age, sex, level of education, monthly per capita household income, number of residents per household, Brazilian regions, situation of household (urban/rural) and capital/other city. A total of nine groups of foods were studied: alcoholic beverages, soft drinks, cookies, fruits, sweets, milk and dairy products, fast foods, sit-down meals and deep-fried snacks.

RESULTS

Frequency of out-of-home eating was 35%, being higher in the Southeast region (38.8%) and lower in the North region (28.1%) of Brazil. Frequency was higher in individuals aged between 20 and 40 years (42%), males (39% vs. 31%), with higher income (52%) and educational levels (61%). Foods most frequently consumed out of the home were as follows: soft drinks (12%), sit-down meals (11.5%), sweets (9.5%), deep-fried snacks (9.2%) and fast foods (7.2%). Consumption of food groups increased linearly with income, except for fruits and cookies. Values of weekly mean spending were lower for cookies (R$ 1.79 or US$ 0.54) and sweets (R$ 2.02 or US$ 0.67) and higher for sit-down meals (R$ 21.56 or US$ 6.53).

CONCLUSIONS

Out-of-home eating is frequent in all Brazilian regions. Public policies must incorporate this dimension when proposing healthy eating strategies.

Avaliação de programa de prevenção de obesidade em adolescentes de escolas públicas

OBJETIVO: Avaliar os efeitos de um programa de prevenção de obesidade sobre práticas alimentares de adolescentes de escolas públicas. MÉTODOS: Intervenção com 331 estudantes de 11 a 17 anos de 5º e 6º anos de duas escolas públicas estaduais de Niterói, RJ, em 2005. As escolas foram classificadas em escola de intervenção (EI) e escola de controle (EC) para comparação. Práticas alimentares foram abordadas em questionários auto-respondidos antes e após o período de intervenção: consumo de fast food, consumo de refrigerantes, substituição de refeições por lanches, consumo de frutas, verduras e legumes e tipo de alimentação consumida nos intervalos das aulas. Testes qui-quadrado e McNemar foram aplicados para comparar proporções, considerando valor de p < 0,05. RESULTADOS: Na linha de base participaram 185 estudantes da EI (82,2% dos elegíveis) e 146 estudantes da EC (70,5% dos elegíveis). Na fase pós-intervenção houve perda de 10,3% dos adolescentes da EI e 27,4% da EC. Não se observaram mudanças significativas nas práticas alimentares na EC. Na EI aumentou a proporção de estudantes que relataram não consumir lanches vendidos por ambulantes (de 36,7% para 50,6%; p = 0,02) e dos jovens que relataram não substituir almoço (de 44,5% para 65,2%; p < 0,01) e jantar (de 38,4% para 54,3%; p < 0,01) por lanches. A principal mudança favorável foi a redução na freqüência de consumo de lanches fast food na EI comparada à EC (72,7% vs 54,4%; p = 0,001). CONCLUSÕES: Mudanças favoráveis nas práticas alimentares dos adolescentes foram encontradas e estimulam a implantação de programas dessa natureza; contudo, intervenções de maior duração precisam ser implementadas e avaliadas quanto a sua efetividade.

Assessment of protein intake during pregnancy using a food frequency questionnaire and the effect on postpartum body weight variation

The aim of this study was to investigate the effect of protein intake during pregnancy on postpartum weight variation. This was a prospective cohort study with 421 women interviewed at 15 days (baseline) and 2, 6, and 9 months postpartum. Data on diet were obtained using the food frequency questionnaire, focusing on the second and third trimesters. Protein intake was considered adequate when women consumed ≥ 1.2g of protein per kg body weight, and inadequate when < 1.2g/kg. The study adopted the mixed effects model for repeated measurements over time. The results showed a mean postpartum weight loss of 0.409kg/month (±0.12) (p < 0.01). Women with adequate protein intake during pregnancy lost an additional 0.094kg/month (±0.04) during postpartum (p = 0.03) when compared to women with inadequate intake. The model was adjusted for energy, % body fat, stature, age, schooling, skin color, and smoking. Recommended protein intake during pregnancy favored postpartum weight reduction.

Dietary recommendations: comparing dietary guidelines from Brazil and the United States

The Brazilian dietary guidelines are based in part on mainstream United States' recommendations, in spite of the criticisms and shortcomings of the American guidelines. In this paper, Brazilian food guidelines are summarized and discussed in comparison with the USA recommendations. American and Brazilian dietary recommendations are quite similar in many aspects, particularly those related to variety in the diet, the importance of physical activity and weight management. Different to American guidelines, those from Brazil advise people to choose fresh foods, to prefer healthier types of fat, to limit trans fat intake and to eat good sources of protein, but does not recommend the consumption of whole grains. Besides the challenges related to their implementation, indicators for the evaluation of the effectiveness of these guidelines should be established from the beginning, particularly those related to changes in dietary habits and the prevalence of obesity.

Desenvolvimento de Questionário de Frequência Alimentar para adultos em amostra de base populacional de Cuiabá, Região Centro-Oeste do Brasil

OBJETIVO: Descrever a construção de um Questionário de Frequência Alimentar (QFA) para utilização em estudos que visem à obtenção de dados sobre o consumo alimentar de adultos de Cuiabá, MT. MÉTODOS: Um inquérito recordatório de 24 horas (R24h) foi aplicado em uma subamostra de 104 indivíduos, de ambos os sexos, selecionados aleatoriamente a partir de uma amostra probabilística de estudo de base populacional. Considerando-se frequência de citação e contribuição para o consumo de energia e nutrientes dos alimentos citados nos R24h foram selecionados 81 itens alimentares e as respectivas porções de referência, que foram aquelas mais frequentemente relatadas nos R24h. A lista do QFA foi gerada com oito categorias de resposta para a frequência de consumo. RESULTADOS: Os itens alimentares citados por mais de 50% da amostra foram o açúcar, café, feijão, arroz, carne, pão e refrigerante, sendo que os quatro últimos também foram os que mais contribuíram para o consumo energético. Não se observaram diferenças entre homens e mulheres nos alimentos que mais contribuíram para a ingestão de macro e micronutrientes. CONCLUSÃO: O QFA foi desenvolvido com a inclusão dos itens alimentares de maior relevância para a dieta da população adulta de Cuiabá, Mato Grosso. Comprovadas sua validade e reprodutibilidade, este instrumento será útil em investigações epidemiológicas e clínicas sobre o possível papel da dieta no desenvolvimento de enfermidades nessa população.

A randomized clinical trial of home-based exercise combined with a slight caloric restriction on obesity prevention among women

OBJECTIVE

The study investigated the effectiveness of home-based exercise combined with a slight caloric restriction on weight change during 12 months in non-obese women.

METHODS

A randomized clinical trial with a factorial design was conducted from 2003 to 2005. Two hundred three middle-aged women (Rio de Janeiro/Brazil), 25-45 years, were randomly assigned to one of two groups: control (CG) and home-based exercise (HB). The HB group received a booklet on aerobic exercise that could be practiced at home (3 times/week-40 min/session), in low-moderate intensity, during 12 months. Both groups received dietary counseling aimed at a slight energy restriction of 100-300 calories per day.

RESULTS

The HB experienced a greater weight loss in the first 6 months (-1.4 vs. -0.8 kg; p=0.04), but after 12 months there was no differences between groups (-1.1 vs. -1.0; p=0.20). Of the serum biochemical markers, HDL cholesterol showed major change, with an increase at month 12 of 18.3mg/dl in the HB compared to 9.5 in the CG (p<0.01).

CONCLUSION

Home-based exercise promoted greater weight reduction during the first 6 months after which no further benefits are observed. Continuous favorable changes in HDL cholesterol after 1 year suggest that home-based exercise promote health benefits.

Consumo alimentar de crianças menores de três anos residentes em área de alta prevalência de insegurança alimentar domiciliar

O objetivo deste artigo foi descrever a associação entre insegurança alimentar e consumo alimentar de crianças no Município de Duque de Caxias, Rio de Janeiro, Brasil. Trata-se de estudo transversal de base populacional, com amostra probabilística de domicílios; com 402 famílias compostas por crianças de 6 e 30 meses de idade. Insegurança alimentar foi avaliada com base na Escala Brasileira de Insegurança Alimentar (EBIA) e o consumo alimentar das crianças foi estimado por dois recordatórios de 24 horas. Comparou-se o consumo dos grupos de alimentos, de energia e de nutrientes entre as categorias de insegurança alimentar. O consumo de doces e de gorduras foi elevado, independentemente do grau de insegurança alimentar, e o consumo de café foi significativamente maior entre crianças com insegurança alimentar. No modelo de regressão linear ajustado por energia, o consumo de proteínas associou-se de forma inversa com a EBIA (p = 0,005). Os resultados encontrados sugerem que a insegurança alimentar das famílias compromete a qualidade da dieta infantil, reduzindo o consumo de alimentos protéicos, aumentando o consumo de café e de alimentos de alta densidade energética.

Elaboração de questionário de frequência alimentar semiquantitativo para adolescentes da região metropolitana do Rio de Janeiro, Brasil

OBJETIVO: Descrever a elaboração de um questionário de frequência alimentar para adolescentes do Rio de Janeiro, Brasil. MÉTODOS: Para seleção dos itens alimentares incluídos no questionário de frequência alimentar, utilizaram-se dados de três dias de registro alimentar obtidos em uma amostra de 430 estudantes, na faixa etária de 12 a 19 anos, da rede de ensino estadual de Niterói, Rio de Janeiro. Foram incluídos os itens alimentares mais citados nos registros e que contribuíram com 95% do consumo de energia e nutrientes dos registros alimentares. As porções de referência foram as mais frequentemente referidas nos registros do estudo de base. As opções de frequência foram definidas de forma diferenciada para os diversos itens do questionário. RESULTADOS: Nos registros foram listados 306 alimentos, dos quais 249 itens foram incluídos no questionário, isoladamente ou agrupados, compondo uma lista de 90 itens. Os 14 itens alimentares mais consumidos por adolescentes do Rio de Janeiro, nesse estudo e em estudo anterior, foram associados a oito opções de frequência de consumo; 18 itens alimentares foram acoplados a sete opções de frequência e para 58 itens foram definidas cinco opções de frequência. CONCLUSÃO: O estudo permitiu a elaboração do questionário de frequência alimentar para adolescentes da Região Metropolitana do Rio de Janeiro, o qual será submetido às análises de reprodutibilidade e validade. Este questionário representa um instrumento valioso para pesquisas epidemiológicas que investiguem o consumo alimentar de adolescentes.

High-protein diet promotes a moderate postpartum weight loss in a prospective cohort of Brazilian women

OBJECTIVE

Whether a high-protein (HP) diet promotes body weight loss (BWL) when compared with a low-protein (LP) diet is still unclear. Therefore, we evaluated the effects of an HP diet on BWL during postpartum.

METHODS

A food-frequency questionnaire with 81 items was applied at 6 mo after delivery to evaluate the diet of 430 postpartum women aged 18-45 y. Body weight was measured approximately at 0.5, 2, 6, and 9 mo after delivery. Body weight loss was modeled by comparing an HP diet (> or =1.2g . kg(-1) . d(-1)) with an LP diet (<1.2g . kg(-1) . d(-1)) using mixed-effects linear regression models adjusted for energy intake, percentage of body fat at baseline, stature, age, race, smoking, and schooling.

RESULTS

Usual energy intake was higher in the HP than in the LP diet group (2623 versus 1791kcal, P<0.0001). Daily mean protein intakes were 1.54+/-0.32g . kg(-1) . d(-1) for the HP group and 0.83+/-0.20g . kg(-1) . d(-1) for the LP group. A multivariate model showed that women in the HP group lost 316+/-0.062g of body weight more per month (P<0.01) when compared with the LP group.

CONCLUSION

A reported higher protein intake may improve moderate postpartum body weight loss. Further studies should evaluate the long-term consequences of an HP diet postpartum.

Reduction of IGF-binding protein-3 as a potential marker of intra-uterine growth restriction

BACKGROUND

Growth factor-binding proteins influence the growth of infants starting in utero. Adaptation of the fetus to an adverse uterine environment is associated with changes in the growth hormone-growth factor-insulin axis.

AIMS

To evaluate serum levels of IGF-I and IGFBP-3 in small and appropriate for gestational age newborn infants.

METHODS

Fifty-four newborn infants, small (SGA, n=28) or appropriate (AGA, n=26) for gestational age were matched by gestational age and sex. Blood was collected on the first day of life, and anthropometric measurements were taken at birth. The serum levels of IGF-I and IGFBP-3 were compared, and correlated with the anthropometric measurements.

RESULTS

On the first day of life, mean serum IGFBP-3 levels were significantly lower in SGA babies and correlated with weight, length, head circumference, and ponderal index (weight/length 3) (P<0.0001). In contrast, no associations were found between IGF-I serum levels and these anthropometric measurements.

CONCLUSION

Our data show that SGA babies have significantly reduced IGFBP-3 concentrations at birth.

Leptin/adiponectin ratio in obese women with and without binge eating disorder

BACKGROUND

Adipose tissue-derived hormones are involved in the pathophysiology of eating disorders and other mental disorders. Studies have suggested that the serum leptin/adiponectin ratio is highly correlated with BMI. Furthermore, it is associated with a number of metabolic processes and inflammatory markers that are involved in obesity and mental disorders, such as the physiopathology of binge eating disorder (BED). We investigated whether variations in leptin and adiponectin serum concentrations differed between adult women with and without BED before and after a meal.

METHODS

The study group was composed of 8 normal weight women (20-25 kg/m2) without BED, 8 obese women (>/=30 kg/m2) with BED, and 7 obese women without BED (non-BED). Blood samples were collected before and after the consumption of a meal composed of 55% carbohydrates, 15% protein, and 30% lipids.

RESULTS

Body mass index (p<0.0001), leptin (p<0.0001) and the leptin/adiponectin ratio (p<0.0001) were higher in obese non-BED women than in obese BED and normal weight groups. Adiponectin (p=0.01) concentrations were lower in the obese BED group than in the other groups before and after the meal.

CONCLUSIONS

The hypoadiponectinemia followed by the altered levels of leptin in obese BED woman may predispose these subjects to an inadequate energy balance, which could promote weight gain and an increased food intake in woman that may contribute to obesity and binge eating in these subjects.

Associação entre consumo de refrigerantes, sucos e leite, com o índice de massa corporal em escolares da rede pública de Niterói, Rio de Janeiro, Brasil

Avaliou-se a associação entre o consumo de refrigerantes, sucos e leite, com o índice de massa corporal (IMC) em 1.423 estudantes, entre 9 e 16 anos, de escolas públicas de Niterói, Rio de Janeiro, Brasil. O consumo de bebidas foi avaliado por meio do recordatório alimentar de 24 horas e questionário de freqüência de consumo alimentar. Peso e estatura foram coletados para o cálculo do IMC. As análises de regressão linear foram estratificadas por sexo e ajustadas por atividade física, idade e efeito do conglomerado (classes). Verificou-se associação positiva entre freqüência de consumo de refrigerante e idade (p = 0,05) e negativa entre consumo de leite e idade (p = 0,004). Apenas para as meninas, o IMC associou-se positivamente com o consumo de sucos (β = 0,02; p = 0,03). Para as outras bebidas não foram encontradas associações entre IMC e freqüência usual de consumo. O consumo de refrigerantes e sucos representou cerca de 20% do total de energia média consumida diariamente. Os resultados indicam que esforços para reduzir a ingestão de energia por meio de bebidas devem enfatizar também os sucos.

Análise multinível das variações no índice de massa corporal entre adultos, Brasil, 2006

OBJETIVO: Analisar variações do índice de massa corporal (IMC) entre adultos segundo fatores individuais e características ambientais das cidades. MÉTODOS: Foram utilizados dados de 2006 do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL). Trata-se de inquérito baseado em entrevistas telefônicas realizadas em amostras probabilísticas da população com idade >18 anos nas 26 capitais estaduais brasileiros e no Distrito Federal. A análise de fatores associados incluiu variáveis socioeconômicas e demográficas, individuais e ambientais da cidade referentes a 49.395 participantes do VIGITEL. O consumo alimentar foi avaliado por escore de alimentação saudável e pelo consumo de frutas e hortaliças cinco ou mais vezes por dia. Atividade física foi avaliada pela freqüência e duração de exercícios, e pela presença local de equipamentos para realizá-los. As associações foram testadas em modelos lineares multinível (p<0,05). RESULTADOS: As associações do IMC com as variáveis explicativas individuais diferiram entre os sexos. Escolaridade associou-se positivamente ao IMC em homens e negativamente em mulheres. Consumo de frutas e hortaliças associou-se positivamente ao IMC em homens. Para ambos, a existência de localidades para realizar exercícios associou-se negativamente com o IMC. CONCLUSÕES: Embora haja grande discrepância nas médias de IMC entre as cidades brasileiras, a existência de local para atividade física, características econômicas e de consumo alimentar pouco explicaram a variação no IMC.

Mudanças no consumo alimentar de mulheres do Município do Rio de Janeiro, Brasil, 1995-2005

Compara-se o consumo alimentar de mulheres de 35 anos e mais investigado em dois estudos transversais de base populacional desenvolvidos no Rio de Janeiro, Brasil, em 1995-1996 (n = 1.014) e 2004-2005 (n = 1.001). Utilizou-se questionário de freqüência do consumo de alimentos para estimar o consumo de alimentos e o índice de massa corporal (IMC = peso/estatura²) para avaliar o estado nutricional. A prevalência da obesidade (IMC 30kg/m²) aumentou no período de 10 anos (16,6% para 24%). O consumo de diversos alimentos com alta densidade energética sofreu incremento, como: biscoitos salgados, doces, bacon, lingüiça/salsicha e hambúrguer. Outros foram relatados com menor freqüência: manteiga/margarina, maionese, batata frita ou chips, e açúcar. Frutas, leite, feijão, raízes e tubérculos, e carnes tiveram redução do consumo. Mulheres com escolaridade elevada apresentaram maior redução no consumo de frutas e carnes. As mudanças na prevalência da obesidade parecem estar relacionadas com as modificações do consumo de alimentos e dependentes do grau de escolarização.

Análise das práticas de alimentação de prematuros em maternidade pública no Rio de Janeiro

OBJETIVO: Analisar as práticas precoces de alimentação e o tipo de dieta de prematuros na alta hospitalar. MÉTODOS: Estudo descritivo, a partir de uma coorte retrospectiva de dois anos, com 203 prematuros com peso menor que 1 500g, na maternidade do Hospital Geral de Bonsucesso, Rio de Janeiro. Foram avaliadas as seguintes práticas: dias para início de dieta enteral, dias para atingir a dieta enteral plena, dias para início e tempo de uso de nutrição parenteral e o tipo de dieta na alta hospitalar. RESULTADOS: O tempo médio para início de dieta enteral foi de 6,5 dias (IC95% 6,0-7,2), enquanto para atingir a dieta enteral plena levou-se, em média, 18,9 dias (IC95% 17,6-20,3). A média de dias para início de nutrição parenteral foi de 2,8 dias (IC95% 2,6-3,0) e o tempo de uso de nutrição parenteral foi de 10,8 dias (IC95% 9,7-11,9). As práticas se associaram, sendo encontrada a maior correlação entre dias para atingir dieta plena e dias de uso de nutrição parenteral (Pearson=0,69). Quanto menor o peso de nascimento, maior o tempo para início de dieta enteral, para atingir a dieta enteral plena e de uso de nutrição parenteral. Para o início de nutrição parenteral, não foi observada esta tendência. Na alta, o tipo de dieta mais freqüente foi o aleitamento complementado (61,6%), seguido da alimentação artificial (26,1%) e do aleitamento materno exclusivo (12,3%). CONCLUSÃO: Este estudo revelou que há demora em iniciar a alimentação de prematuros. A proporção total de aleitamento na alta foi de 74%. Esforços merecem ser envidados para alimentar precocemente e promover o aleitamento materno nestes pacientes.

Depression symptoms and hypothyroidism in a population-based study of middle-aged Brazilian women

BACKGROUND

Overt hypothyroidism is often recognized as an important cause of depression, but in sub-clinical cases, results are inconsistent and most prior studies have involved small samples.

METHODS

We evaluated the association between hypothyroidism and depressive symptoms (PRIME-MD) in a population-based study of 1298 middle-aged women living in a large metropolitan city in Brazil.

RESULTS

45.7% presented depressive symptoms, and 12.3% presented hypothyroidism. Multiple logistic regression analysis adjusting for age, race, smoking and body mass index showed that women with TSH>10 mUI/ml had a threefold chance of presenting depressive symptoms compared to those with normal levels of TSH. Among those with clinical hypothyroidism the adjusted OR was 8.7.

CONCLUSION

High levels of TSH were associated to an increased chance of developing depression in the general population. Therefore, depressive symptoms must be considered in patients with thyroid dysfunction and depressed patients should be tested for TSH.

Ten-year increase in the prevalence of obesity and reduction in fat intake in Brazilian women aged 35 years and older

BACKGROUND

Data from two population-based surveys conducted in 1995 and 2005 in the city of Rio de Janeiro, Brazil were examined to determine changes in the prevalence of obesity and macronutrient intake among women according to socio-economic level.

METHODS

Weight and height were measured, and food intake was based on a food-frequency questionnaire. A probabilistic sample of about 1000 women aged 35 years or older participated in each survey.

RESULTS

Prevalence of obesity (BMI>30 kg/m(2)) increased in the 10-year period (17-24%), as well as energy intake (2.408-2.912 kcal) (p<0.0001). These changes were largely dependent on education, but not on income. Over the 10-year period, there was an increase in carbohydrate intake adjusted for energy, although lipid intake decreased among those women of low education but not among the more educated women. An overall reduction in the intake of cholesterol was also observed (273 mg vs 212 mg; p<0.001).

CONCLUSION

In line with an advertised reduction in fat intake, Brazilian women at greatest risk of obesity had a reduction in fat intake and cholesterol, and increased intake of carbohydrate. This group needs to be given a clear message regarding energy reduction in order to curb the obesity epidemic.

Determinantes nutricionais e sóciodemográficos da variação de peso no pós-parto: uma revisão da literatura

Trata-se de um estudo de revisão sobre os fatores nutricionais e sócio-demográficos da variação de peso no pós-parto. Foi realizada uma busca bibliográfica nas bases de dados eletrônicas Scientific Eletronic Library On-line (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Medical Literature Analysis and Retrieval System Online (MEDLINE) referente a literatura publicada na última década (1997-2008). Treze artigos, um informe técnico e dois livros considerados relevantes sobre o assunto e publicados anteriormente ao ano 1997 foram citados na revisão. A revisão priorizou estudos de ensaios clínicos randomizados e de seguimento realizados com gestantes e mulheres no pós-parto. Os resultados obtidos mostram como principais fatores associados com a variação de peso no pós-parto o ganho de peso gestacional acima das recomendações do Institute of Medicine, Índice de Massa Corporal Pré-Gestacional > 25 kg/m2, dieta, tempo e intensidade do aleitamento materno e os fatores sócio-demográficos: raça negra, primiparidade, idade materna, baixa renda e baixa escolaridade. A prática regular de atividade física é recomendada como uma estratégia para evitar o ganho de peso excessivo e melhorar a perda de peso durante o pós-parto. No Brasil não existe uma estratégia nacional para prevenir o ganho de peso excessivo e garantir a adequada perda de peso nesse período. Durante o pós-parto, a maioria das ações de saúde visa basicamente garantir o aleitamento materno.

Tabagismo no domicílio e desnutrição em lactentes

OBJETIVO:Verificar o efeito da exposição à fumaça do tabaco sobre o crescimento de lactentes. MÉTODOS: Foi realizado um estudo transversal, de base populacional, com crianças atendidas nos postos de saúde de Cuiabá (MT) para imunização. Foram sorteados 10 postos e entrevistados os responsáveis por, aproximadamente, 200 crianças em cada posto. Neste estudo foram analisadas crianças menores de dois anos, perfazendo um total de 1.437 participantes. Peso e estatura foram medidos no momento da vacinação. Para análise multivariada foram construídos dois modelos, tendo como resposta as variáveis contínuas, peso para idade e comprimento para idade, os quais utilizaram a modelagem hierárquica. RESULTADOS:Aprevalência de baixo comprimento foi de 4,7% e de baixo peso foi de 3,0%. Do total de crianças estudadas, 35,8% eram expostas à fumaça do cigarro dos moradores. Após ajustes para variáveis sócio-demográficas e para as variáveis biológicas da criança, apenas o tabagismo da mãe mostrou efeito independente sobre o estado nutricional da criança, sendo que o tabagismo gestacional manteve-se associado ao indicador comprimento para idade (β =-0,226; p=0,02) e o tabagismo atual da mãe, ao indicador peso para idade (β=-0,235; p=0,02). O tabagismo do pai e dos demais moradores do domicílio não se mostrou associado a nenhum dos desfechos estudados. CONCLUSÃO:O tabagismo gestacional mostrou efeito independente sobre o indicador comprimento para idade e o tabagismo atual da mãe ao indicador peso para idade dos lactentes.

Body mass index for predicting hyperglycemia and serum lipid changes in Brazilian adolescents

OBJECTIVE: To determine the best cut-offs of body mass index for identifying alterations of blood lipids and glucose in adolescents. METHODS: A probabilistic sample including 577 adolescent students aged 12-19 years in 2003 (210 males and 367 females) from state public schools in the city of Niterói, Southeastern Brazil, was studied. The Receiver Operating Characteristic curve was used to identify the best age-adjusted BMI cut-off for predicting high levels of serum total cholesterol (>150mg/dL), LDL-C (>100mg/dL), serum triglycerides (>100mg/dL), plasma glucose (>100mg/dL) and low levels of HDL-C (< 45mg/dL). Four references were used to calculate sensitivity and specificity of BMI cut-offs: one Brazilian, one international and two American. RESULTS: The most prevalent metabolic alterations (>50%) were: high total cholesterol and low HDL-C. BMI predicted high levels of triglycerides in males, high LDL-C in females, and high total cholesterol and the occurrence of three or more metabolic alterations in both males and females (areas under the curve range: 0.59 to 0.67), with low sensitivity (57%-66%) and low specificity (58%-66%). The best BMI cut-offs for this sample (20.3 kg/m² to 21.0 kg/m²) were lower than those proposed in the references studied. CONCLUSIONS: Although BMI values lower than the International cut-offs were better predictor of some metabolic abnormalities in Brazilian adolescents, overall BMI is not a good predictor of these abnormalities in this population.