Dietary Quality and Associated Factors among Adults Living in the State of São Paulo, Brazil

Association between modified youth healthy eating index and nutritional status among Iranian children in Zabol city: a cross-sectional study

Diet quality in childhood and adolescence can affect health outcomes such as physical and cognitive growth and preventing chronic diseases in adulthood. This study aimed to evaluate the relationship between diet quality using the modified youth healthy eating index (MYHEI) with socioeconomic factors and nutrition status in 7-12-year-old children in Iran. This descriptive-cross-sectional study was performed on 580 students in Zabol, Iran, selected through multistage cluster sampling. The diet was assessed through the 168-item food frequency questionnaire (FFQ) and eating behaviors. Then, the MYHEI scoring system was used to calculate the diet quality. In addition, we used the WHO growth indices, such as weight to age, height to age, and body mass index (BMI) to age ratios, to evaluate nutrition status. The mean total MYHEI score in children was 56.3 ± 11.2. Among children with the highest MYHEI score quartile, the number of girls was significantly higher than boys (p = 0.001). The prevalence of underweight, stunting, and wasting was 25.3%, 17.4%, and 21.7%, respectively. The prevalence of underweight (OR: 2.2; 95% CI  1.26, 3.90, p = 0.001) and stunting (OR: 3.2; 95% CI   1.65, 6.14, p = 0.006) were significantly lower in the higher MYHEI score quartile compared to the lower quartile. The overall diet quality of most children should be modified. Therefore, to improve the children's health and nutrition status, it is necessary to perform nutritional interventions such as training and promotional programs, especially in schools.

Global Trends in the Availability of Dietary Data in Low and Middle-Income Countries

Individual-level quantitative dietary data can provide suitably disaggregated information to identify the needs of all population sub-groups, which can in turn inform agricultural, nutrition, food safety, and environmental policies and programs. The purpose of this discussion paper is to provide an overview of dietary surveys conducted in low- and middle-income countries (LMICs) from 1980 to 2019, analyzing their key characteristics to understand the trends in dietary data collection across time. The present study analyzes the information gathered by the Food and Agriculture Organization of the United Nations/World Health Organization Global Individual Food consumption data Tool (FAO/WHO GIFT). FAO/WHO GIFT is a growing repository of individual-level dietary data and contains information about dietary surveys from around the world, collected through published survey results, literature reviews, and direct contact with data owners. The analysis indicates an important increase in the number of dietary surveys conducted in LMICs in the past four decades and a notable increase in the number of national dietary surveys. It is hoped that this trend continues, together with associated efforts to validate and standardize the dietary methods used. The regular implementation of dietary surveys in LMICs is key to support evidence-based policies for improved nutrition.

Shifts towards healthy diets in the US can reduce environmental impacts but would be unaffordable for poorer minorities

Environmental implications of food choice are the focus of increasingly extensive research, but less is known about the impacts of dietary patterns of different socio-economic groups of a country, and the trade-offs between nutritional quality and environmental impacts of diet within those groups. We evaluate the impacts of US household dietary patterns on greenhouse gas emissions, blue water footprint, land use and energy consumption across supply chains using an environmentally extended input-output analysis. We compare the nutritional quality of these dietary patterns using healthy eating index scores across individuals' income and other socio-economic characteristics. Individuals with higher income or education levels are more likely to adopt healthier diets but are also responsible for larger environmental impacts of diet primarily due to a higher consumption of dairy and livestock products, seafood and items with lower energy density but higher nutrient density. Our optimization shows that a healthy diet with lower environmental impacts is achievable within current food budgets for almost 95% of people, and results in average decreases of 2% in food-related greenhouse gas emissions, 24% in land use and 4% in energy consumption, but a 28% increase in blue water consumption. However, such dietary patterns are unaffordable for 38% of Black and Hispanic individuals in the lowest income and education groups. Policies that affect income and food prices making nutritious food more affordable would be needed to achieve better nutrition and improved environmental outcomes simultaneously, particularly for more vulnerable socio-economic groups.

Social determinants, lifestyle and diet quality: a population-based study from the 2015 Health Survey of São Paulo, Brazil

Objective:

To investigate the association among social determinants, lifestyle variables and diet quality in São Paulo, Brazil.

Design:

Cross-sectional study, 2015 Health Survey of São Paulo (Inquérito de Saúde de São Paulo (2015 ISA-Capital)) with Focus on Nutrition Study (2015 ISA-Nutrition).

Setting:

Population-based study, with a representative sample of adults living in São Paulo, Brazil.

Participants:

Adults (aged 20–59 years, n 643) and older adults (aged ≥60 years, n 545).

Results:

We observed differences in the Brazilian Healthy Eating Index-Revised (BHEI-R) by education, income, occupation, sex and race. Whole grains (0·63 points, 12·6 % of the maximum score), sodium (2·50 points, 25·0 %) and solid fat, alcohol and added sugars (9·28 points, 46·4 %) components had the lowest BHEI-R scores. Factors positively associated with diet quality included the presence of one disease or more (e.g. diabetes mellitus, hypertension, cancer, hypercholesterolaemia: β = 0·636, P < 0·001), income (middle income: β = 0·478, P < 0·001; high income: β = 0·966, P < 0·001) and occupation (other: β = 1·418, P < 0·001). Energy (β = –0·001, P < 0·001), alcohol consumption (β = –0·207, P = 0·027), education level (middle education: β = –0·975, P < 0·001; high education: β = –1·376, P < 0·001), races other than white (β = –0·366, P < 0·001) and being unemployed (β = –0·369, P < 0·046) were negatively associated with diet quality.

Conclusions:

Groups affected by socio-economic inequalities need better diet quality. Governmental actions should be implemented to reduce the consumption of energy-dense and sodium-rich foods, facilitate access and information on healthy eating, and conduct nutritional education.

[Critical analysis of the diet quality of the Brazilian population according to the Healthy Eating Index: a systematic review]

In light of the importance of studying instruments that assess the food quality of the population, this study sought to conduct a systematic review of the quality of the diet of the Brazilian population using the Healthy Eating Index (HEI) and duly analyzing its methodology and results. The major electronic databases were used for the selection of studies. After the searches with the key words, 32 articles were included in this review. The growing interest of the scientific community in addressing this issue was observed, with recent studies using this instrument in Brazil. Methodological issues of articles were evaluated and discussed taking into consideration the revised versions and adaptations of the HEI. Some common results were highlighted among the studies such as low consumption of fruit, vegetables and/or dairy products, and the wider consumption of meat and eggs, cholesterol, total fat and saturated fat. Among the articles that address the HEI and socioeconomic aspects it was seen that quality of diet improves both in accordance with the increasing level of education of parents and with the family income in the population studied. The HEI can be used to monitor changes in dietary patterns and also as a nutrition education and health promotion tool.

Aspectos metodológicos da avaliação da qualidade da dieta no Brasil: revisão sistemática

Resumo Esta revisão sistemática objetivou analisar metodologias de estudos brasileiros que utilizam índices para avaliação da qualidade da dieta. Realizou-se busca sistemática em bases eletrônicas de dados (Lilacs, Medline, SciELO e Scopus), sem fazer restrição ao ano de publicação dos estudos. Foram selecionados artigos originais, nacionais, que avaliassem a qualidade da dieta pelo Healthy Eating Index (HEI) ou suas versões revisadas. Utilizou-se os descritores: qualidade da dieta, índice de alimentação saudável, índice de qualidade da dieta e respectivos termos em inglês. Foram selecionados 45 artigos, dos quais, 60% analisaram a qualidade da dieta por instrumento denominado índice de alimentação saudável e o restante por índice de qualidade da dieta. Dos estudos analisados, 68,9% classificaram a qualidade da dieta. A maioria dos estudos utilizou 10 itens para avaliação da qualidade da dieta e não apresentaram padronização quanto às metodologias. Dos estudos, 33,3% relacionaram o índice com fatores socioeconômicos e demográficos, itens alimentares e condições de saúde. Diferenças de nomeação e metodologias dificultam comparações entre os estudos de avaliação da qualidade da dieta.

Consumo de frutas, legumes e verduras na Região Centro-Oeste do Brasil: prevalência e fatores associados

Resumo Estudo transversal, baseado em dados do sistema de monitoramento por inquérito telefônico – VIGITEL, com o objetivo de estimar a prevalência e os fatores associados ao consumo recomendado de frutas, legumes e verduras (FLV) em 6696 indivíduos com idade ≥ 18 anos, de ambos os sexos, residentes na Região Centro-Oeste do Brasil, em 2012. O consumo recomendado foi a variável dependente e variáveis sociodemográficas, comportamentais e relacionadas à saúde foram as independentes. A prevalência do consumo recomendado de FLV foi de 26,3%, sendo maior entre as mulheres (RPaj = 1,44; IC95% = 1,29–1,62). A regressão de Poisson entre o desfecho e as variáveis independentes mostrou maior prevalência do consumo recomendado entre as mulheres residentes no Distrito Federal, casadas e que consideravam seu estado de saúde como bom/muito bom. Em ambos os sexos, observou-se associação direta do desfecho com a escolaridade, idade e prática de atividade física e associação inversa com o consumo de alimentos não saudáveis. Devido à baixa prevalência do consumo recomendado de FLV na população da Região Centro-Oeste do Brasil no ano de 2012, propõe-se que as estratégias de intervenção para melhorar o consumo desses alimentos sejam feitas de forma globalizada.

Dairy products consumption in Brazil is associated with socioeconomic and demographic factors: Results from the National Dietary Survey 2008-2009

ABSTRACT Objective: To estimate the consumption of dairy products in the Brazilian population. Methods: Data from two non-consecutive food records from 34,003 individuals (aged ³10 years) in the first Brazilian nationally representative dietary survey (2008-2009) were used to estimate the dairy products intake. Dairy products were divided into four major subgroups: cow's milk, cheese, yogurt and other dairy products. Absolute and relative frequencies of individuals in the population who reported consumption of dairy products in at least one of the two-day food record according to sex, age, geographic region and levels of per capita monthly family income were calculated. Moreover, the mean consumption of dairy products, as well as their nutritional contribution in total energy, protein, calcium, phosphorus and magnesium intake was estimated. Results: It was observed that only 43.0% of the population reported consuming dairy products, being the milk subgroup the most frequently consumed (21.1%). The prevalence of consumption was higher among females, elderly, residents of the South region, and among individuals from higher per capita monthly family income. The nutritional contribution of dairy products was less than 10.0% of total energy intake and for most nutrients and the mean daily consumption are justified was 101.8g. Conclusion: Therefore, in view of the low intake of dairy products by Brazilian population and the nutritional benefits associated with this food group, public health strategies to increase dairy consumption are justified.

Cohort profile: the Baependi Heart Study-a family-based, highly admixed cohort study in a rural Brazilian town

PURPOSE

Cardiovascular disease (CVD) is a major challenge to global health. The same epidemiological transition scenario is replayed as countries develop, but with variations based on environment, culture and ethnic mixture. The Baependi Heart Study was set up in 2005 to develop a longitudinal family-based cohort study that reflects on some of the genetic and lifestyle-related peculiarities of the Brazilian populations, in order to evaluate genetic and environmental influences on CVD risk factor traits.

PARTICIPANTS

Probands were recruited in Baependi, a small rural town in the state of Minas Gerais, Brazil, following by first-degree and then increasingly more distant relatives. The first follow-up wave took place in 2010, and the second in 2016. At baseline, the study evaluated 1691 individuals across 95 families. Cross-sectional data have been collected for 2239 participants.

FINDINGS TO DATE

Environmental and lifestyle factors and measures relevant to cardiovascular health have been reported. Having expanded beyond cardiovascular health outcomes, the phenotype datasets now include genetics, biochemistry, anthropometry, mental health, sleep and circadian rhythms. Many of these have yielded heritability estimates, and a shared genetic background of anxiety and depression has recently been published. In spite of universal access to electricity, the population has been found to be strongly shifted towards morningness compared with metropolitan areas.

FUTURE PLANS

A new follow-up, marking 10 years of the study, is ongoing in 2016, in which data are collected as in 2010 (with the exception of the neuropsychiatric protocol). In addition to this, a novel questionnaire package collecting information about intelligence, personality and spirituality is being planned. The data set on circadian rhythms and sleep will be amended through additional questionnaires, actimetry, home sleep EEG recording and dim light melatonin onset (DLMO) analysis. Finally, the anthropometric measures will be expanded by adding three-dimensional facial photography, voice recording and anatomical brain MRI.

Eating patterns in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): an exploratory analysis

The food consumption of 15,071 public employees was analyzed in six Brazilian cities participating in the baseline for Brazilian Longitudinal Study of Adult Health (ELSA-Brasil, 2008-2010) with the aim of identifying eating patterns and their relationship to socio-demographic variables. Multiple correspondence and cluster analysis were applied. Four patterns were identified, with their respective frequencies: "traditional" (48%); "fruits and vegetables" (25%); "pastry shop" (24%); and "diet/light" (5%) The "traditional" and "pastry shop" patterns were more frequent among men, younger individuals, and those with less schooling. "Fruits and vegetables" and "diet/light" were more frequent in women, older individuals, and those with more schooling. Our findings show the inclusion of new items in the "traditional" pattern and the appearance of the "low sugar/low fat" pattern among the eating habits of Brazilian workers, and signal socio-demographic and regional differences.

Identification of common content between the questionnaire of the Health Survey (ISA-SP) and the International Classification of Functionality, Disability, and Health

The purpose of this paper was to identify the common contents between São Paulo's Health Survey Questionnaire (Physical Disability and Emotional Health Blocks) and the International Classification of Functionality, Disability, and Health. The first stage of the research consisted of the search for the modules of São Paulo's Health Survey, which addressed the issue of disability, and the passages about this theme were highlighted and inserted into a new file. In the second stage, the significant contents were extracted. In the last one, these contents were codified to the codes of the International Classification of Functionality, Disability, and Health by two independent researchers. For the descriptive statistical analysis, crude numbers, percentages, and simple frequencies were used. The degree of agreement between the two professionals was calculated using Kappa's coefficient and the confidence interval. The most common domains were those about functions and body structures and about activities and participation, in which the domain of environmental factors presented a lower frequency of approach.

The diet quality index evaluates the adequacy of energy provided by dietary macronutrients

Objective To investigate the relationship between macronutrient intake adequacy and the national diet quality index score. Methods The study analyzed a representative sample of 1,662 individuals from the municipality of São Paulo who participated in a cross-sectional study called Health Survey-Capital (2008/2009). Two 24-hour recalls were collected. Habitual intake was determined by the Multiple Source Method. The Brazilian index was calculated as suggested, and macronutrient adequacy was given by the World Health Organization and Food and Agriculture Organization recommendations. A generalized linear model verified the relationship between the Brazilian index and macronutrient adequacy. All analyses with a descriptive level below 0.05 were considered significant. The analyses were performed by the software Stata 12.0, survey mode. Results The vast majority (91%) of the population had inappropriate macronutrient intakes, and the total median Brazilian index score was 61.3 points (interquartile range=10.1). The total Brazilian index score of individuals with high lipid intake was worse than that of individuals with proper lipid intake (β=0,96; p=0,004), while those with high protein intake had a better score (β=1,10; p=0,003) than those with proper protein intake. Conclusion The revised Brazilian Healthy Eating Index assesses diet quality properly regarding high lipid intake, but it has some limitations regarding high protein intake according to the World Health Organization and Food and Agriculture Organization recommendations. New studies should investigate the possibility of adapting this index to the World Health Organization and Food and Agriculture Organization recommendations.

Daily intake of dairy products in Brazil and contributions to nutrient intakes: a cross-sectional study

Objective

Dairy products are sources of protein and micronutrients important in a healthy diet. The purpose of the present analysis was to estimate consumption of dairy products by Brazilians and identify contributions of dairy products to nutrient intakes.

Design

Dairy consumption data were obtained from 24 h dietary records. Dairy products were defined as milk (including flavoured), cheese and yoghurt. Estimates of dairy product intakes were generated for all individuals, individuals in urban and rural households and for age groups 10–18 years, 19–59 years and ≥60 years. Contributions to nutrient intakes were estimated for the total sample and sub-populations.

Setting

Nationwide cross-sectional survey, 2008–2009.

Subjects

Nationally representative sample of individuals aged ≥10 years in the Individual Food Intake survey, a component of the Brazilian Household Budget Survey (n 34 003).

Results

Among individuals aged ≥10 years, per capita intake of dairy products was 142 (se 2·1) g/d. Dairy product intake was higher among individuals in urban compared with rural areas and among groups 10–18 years and ≥60 years compared with adults aged 19–59 years. Dairy products accounted for 6·1 % of daily energy intake, 7·3 % of protein, 16·9 % of saturated fat, 11·1 % and 4·3 % of total and added sugars, respectively, and 10·2–37·9 % of daily Ca, vitamin D, P, vitamin A and K.

Conclusions

Dairy products were substantial contributors to daily intakes of selected nutrients of concern in Brazil, although mean daily dairy product consumption was less than a typical portion. Education efforts in Brazil to raise awareness about the nutritional role of dairy foods may serve to improve overall diet quality.

Programa Bolsa-Família: qualidade da dieta de população adulta do município de Curitiba, PR

Este estudo avaliou a qualidade da dieta da população beneficiária do Programa Bolsa-Família, em Curitiba, PR. Estudo transversal, de base populacional, realizado no período de julho de 2006 a julho de 2007. Foram entrevistados 747 beneficiários, a partir dos 19 anos de idade, de ambos os sexos. Para avaliação da qualidade da dieta foi aplicado recordatório de 24 horas, e o Índice de Qualidade da Dieta (IQD) foi utilizado como parâmetro para classificação do grupo em níveis de consumo. Estatística descritiva foi utilizada para descrever a qualidade da dieta da população. Para a comparação de médias do índice segundo as variáveis socioeconômicas foram realizados o teste t de Wald e a análise de variância ANOVA, considerando-se um nível de significância de 5%. A amostra foi constituída por 91,4% de mulheres e 8,6 % de homens. A média de idade da população foi de 36,4 ± 13,3 anos, com cerca de 75 % possuindo o ensino fundamental incompleto. A média do IQD foi de 51 pontos, o que caracteriza uma dieta que precisa de ajustes. A população possui uma dieta monótona, com um consumo adequado de leguminosas, porém baixo para frutas, verduras e produtos lácteos. Na comparação entre as categorias de qualidade da dieta dos indivíduos, todos os componentes, com exceção do sódio, apresentaram medianas de pontuação estatisticamente diferentes (p < 0,01). Estudos que avaliem a qualidade da dieta são fundamentais para subsidiar a implantação de programas de educação alimentar direcionados para o cerne do problema nas populações estudadas.

Índice de qualidade da dieta de mulheres usuárias de um programa de atividade física regular "Academia da Cidade", Aracajú, SE

OBJETIVO: Avaliar a qualidade da dieta de mulheres praticantes de atividades físicas do Programa Academia da Cidade segundo idade e estado nutricional, Aracajú, Sergipe. MÉTODOS: Foram coletados dados sociodemográficos, antropométricos e dietéticos de 169 mulheres. O Índice de Qualidade da Dieta foi obtido a partir da média de aplicação de dois recordatórios de 24 horas. Os dados do Índice de Qualidade da Dieta total e de seus componentes foram analisados de acordo com o índice de massa corporal (obesos e não obesos) e a faixa etária (adultos jovens e adultos velhos). Foram realizadas análise estatística descritiva e Análise de Variância para a comparação das médias de pontuação do Índice de Qualidade da Dieta entre os grupos. RESULTADOS: Na população estudada, com idade média de 49,2 anos, 24,85% das mulheres foram consideradas obesas, e 43,20% com obesidade abdominal. A pontuação média do Índice de Qualidade da Dieta foi 66,64 pontos, com 90,60% da população apresentando dieta com necessidade de modificações. No componente hortaliças, as obesas apresentaram menor consumo do que as não obesas. Com relação à idade, aos componentes hortaliças, leite e derivados, à variedade da dieta e à pontuação final, obtiveram-se notas maiores entre adultos velhos. CONCLUSÃO: A população apresentou hábitos alimentares inadequados principalmente entre as mais novas e as com excesso de peso. Assim, frisa-se a importância de estratégias educacionais voltadas à nutrição na efetivação de uma vida saudável.

Excessive meat consumption in Brazil: diet quality and environmental impacts

OBJECTIVE

To evaluate red and processed meat intake, and the impact meat consumption has on diet quality and the environment.

DESIGN

A large cross-sectional health survey performed in São Paulo, Brazil.

SETTING

Diet was assessed by two 24 h dietary recalls. Usual intakes were calculated using the Multiple Source Method. The World Cancer Research Fund recommendation of an average of 71.4 g/d was used as the cut-off point to estimate excessive red and processed meat consumption. To investigate the relationship between meat consumption and diet quality we used the Brazilian Healthy Eating Index Revised. The environmental impact was analysed according to estimates of CO2 equivalent emissions from meat consumption.

SUBJECTS

Brazilians (n 1677) aged 19 years and older were studied.

RESULTS

The mean red and processed meat intake was 138 g/d for men and 81 g/d for women. About 81% of men and 58% of women consumed more meat than recommended. Diet quality was inversely associated with excessive meat intake in men. In Brazil alone, greenhouse gas emissions from meat consumption, in 2003, were estimated at approximately 18,071,988 tonnes of CO2 equivalents, representing about 4% of the total CO2 emitted by agriculture.

CONCLUSIONS

The excessive meat intake, associated with poorer diet quality observed, support initiatives and policies advising to reduce red and processed meat intake to within the recommended amounts, as part of a healthy and environmentally sustainable diet.

Frequency of metabolic syndrome and the food intake patterns in adults living in a rural area of Brazil

INTRODUCTION

Metabolic syndrome (MetS), a risk factor for atherosclerosis and coronary heart disease, is related to an inadequate food intake pattern. Its incidence is increasing among Brazilian adults, including those living in rural areas. Our aim was not only to describe the frequency of MetS in adults with or without MetS but also to compare their food intake pattern as assessed by the healthy eating index (HEI) and serum albumin and C reactive protein (CRP) levels.

METHODS

Men and women (n = 246) living in a small village in Brazil were included. MetS was characterized according to the adult treatment panel (ATP III) criteria. Groups were compared by chi-square, student t or Mann-Whitney tests.

RESULTS

MetS was diagnosed in 15.4% of the cases. The MetS group showed higher CRP (1.8±1.2 vs. 1.0±0.9 mg/dl) and lower albumin (4.3±0.3 vs. 4.4±0.3 g/dl) serum levels compared to the control group. Additionally, the MetS group showed lower scores (median[range]) in the HEI compared to the control group (53.5[31.2-78.1] vs 58[29.7-89.5], respectively). The MetS group also had decreased scores for total fat and daily variety of food intake.

CONCLUSIONS

The results suggest that adults with MetS displayed chronic mild inflammation and a poorer food intake pattern than the control group.

Discrepancies among ecological, household, and individual data on fruits and vegetables consumption in Brazil

Information on fruits and vegetables consumption in Brazil in the three levels of dietary data was analyzed and compared. Data about national supply came from Food Balance Sheets compiled by the FAO; household availability information was obtained from the Brazilian National Household Budget Survey (HBS); and actual intake information came from a large individual dietary intake survey that was representative of the adult population of São Paulo city. All sources of information were collected between 2002 and 2003. A subset of the HBS, representative of São Paulo city, was used in our analysis in order to improve the quality of the comparison with actual intake data. The ratio of national supply to household availability of fruits and vegetables was 2.6 while the ratio of national supply to actual intake was 4.0. The discrepancy ratio in the comparison between household availability and actual intake was smaller, 1.6. While the use of supply and availability data has advantages, as lower cost, must be taken into account that these sources tend to overestimate actual intake of fruits and vegetables.

Diet quality index adjusted for energy requirements in adults

This study aimed to develop a diet quality index (DQI-a) adjusted for energy requirement. Dietary intake of adults was assessed using 24-hour food recall. The DQI was developed for scores evenly distributed across ten items characterizing different aspects of diet: food groups, nutrients, and variety. The components categorized under the food groups from the Dietary Guide for Brazilians were adjusted according to the estimated energy requirements of the population studied. Index consistency and correlation with nutrients of the diet was analyzed by Cronbach's alpha. A total of 737 individuals were assessed and energy requirements ranged from 1,800 to 2,500kcal among women and 2,500 to 3,400kcal in men. The food group with greatest variation in total portions was cereals and tubers. Cronbach's alpha of the DQI-a was 0.643 and the index correlated with most of the nutrients. The DQI-a can be considered a valuable instrument for assessing diet quality of the Brazilian population.

Edentulism, use of dentures and consumption of fruit and vegetables in south Brazilian community-dwelling elderly

There is evidence suggesting that edentulous older persons modify their diet, avoiding foods that are difficult to chew, such as fruit and vegetables; meanwhile, the consumption of these foods is associated with prevention of chronic diseases. However, few studies evaluated whether a poor oral status without prosthetic rehabilitation is associated with a reduction in the consumption of fruit and vegetables in community-dwelling older persons. We evaluated the association of oral status with emphasis on complete dentures use with the daily consumption of at least 400 g of fruit and vegetables, following the recommendations of the WHO. A random sample of 282 south Brazilians ≥60 years of age was evaluated. Measurements included a questionnaire to assess sociodemographic, behaviour, and health data; consume of fruit and vegetables by means of a 24-h diet recall, and oral status assessment, by means of oral examinations assessing the number of teeth and use of dental prosthesis. Multivariate Poisson regression showed that the only variable significantly associated with inadequate consumption of fruit and vegetables was edentulism with the use of only one denture [PR=1·75 (1·11-2·74)]. Edentulous participants wearing only one denture were less likely to consume at least 400 g day(-1) of fruit and vegetables. These results indicate that, in edentulous community-dwelling elderly, oral health rehabilitation might play an important role in the maintenance of consumption of adequate amounts of fruit and vegetables, which is an important component of a healthy diet and also in the prevention of chronic diseases.

Associations between healthy eating patterns and indicators of metabolic risk in postmenopausal women

BACKGROUND

Since human diets contain many components that may work synergistically to prevent or promote disease, assessing diet quality may be informative. The purpose of this study was to investigate the association between quality diet, by using Healthy Eating Index (HEI), and metabolic risk indicators in postmenopausal women.

METHODS

This cross-sectional study included a total of 173 Brazilian women, aged 45-75 years, seeking healthcare at a public outpatient center. Food consumption assessed by 24 h-recall food inquiry was used to calculate HEI scores: >80 implied diet good, 80-51 diet "needed improvement", and <51 diet poor. Anthropometric data included: body mass index (BMI = weight/height(2)), waist-circumference (WC), body fat (%BF) and lean mass (%LM). Data on total cholesterol (TC), high density lipoprotein cholesterol (HDLC), low density lipoprotein cholesterol (LDLC), and triglycerides (TG) were also collected. Fisher's Exact test, and logistic regression method (to determine odds ratio, OR) were used in the statistical analysis.

RESULTS

Overweight and obesity were observed in 75.7% of the participants. Excessive %BF (> 35%) was observed in 56.1%, while %LM was reduced (< 70%) in 78.1%. WC was elevated (≥88 cm) in 72.3%. Based on HEI values, diet quality was good in 3% (5/173), needed improvement in 48.5% (84/173), and was poor in 48.5% (84/173) of the cases. In this group, 75% of women had high intakes of lipids (> 35%), predominantly saturated and monounsaturated fat. On average, plasma TC, LDLC, and TG levels were higher than recommended in 57.2%, 79.2% and 45.1% of the women, respectively, while HDLC was low in 50.8%. There was association between HEI scores and the %BF that it was higher among women with HEI score < 80 (p = 0.021). There were not observed significant risk associations between HEI and lipid profile.

CONCLUSION

Among the Brazilian postmenopausal women attending a public outpatient clinic, diet was considered to need improvement or to be of poor quality, attributed to high saturated fat ingestion, which probably caused a negative impact on metabolic risk indicators, namely body composition.

Adherence to dietary recommendations and risk of metabolic syndrome: Tehran Lipid and Glucose Study

The "Dietary Guidelines for Americans Adherence Index (DGAI) 2005" was developed based on the latest dietary recommendations to assess the contribution of dietary patterns to chronic diseases. The objective of the study was to evaluate the association of dietary patterns as measured by the modified DGAI 2005 with both the prevalence of metabolic syndrome (MetS) and the MetS risk factors. In this population-based cross-sectional study, 2504 adults (1120 men and 1384 women), aged 19 to 70 years, were randomly selected from the third phase of the Tehran Lipid and Glucose Study. Usual dietary intake was assessed using a food frequency questionnaire, and the DGAI score was calculated for all participants. Metabolic syndrome was defined according to Adult Treatment Panel III diagnostic criteria. Generally, mean values for waist circumference, triglyceride, and blood pressure were significantly higher among male compared with female participants (P < .05). Low high-density lipoprotein cholesterol was the most prevalent MetS risk factor among both men (65.4%) and women (72.5%). After mutual adjustment for confounding variables, those in the highest quartile category of DGAI had a 21% lower prevalence of MetS risk factors clustering than those in the lowest quartile (odds ratio [OR], 0.79; confidence interval [CI], 0.63-0.92; P for trend = .02). Being in the highest quartile category of DGAI score was shown to significantly reduce the prevalence of hyperglycemia (OR, 0.64; CI, 0.47-0.86; P for trend < .001), hypertension (OR, 0.76; CI, 0.70-0.93; P for trend = .05), and low high-density lipoprotein cholesterol (OR, 0.69; CI, 0.54-0.94; P for trend < .001). Consuming a diet consistent with new dietary guidelines was associated with lower risk of MetS prevalence and some of its risk factors. Preventive interventions for MetS risk reduction should focus on the overall dietary pattern.

Health, agricultural, and economic effects of adoption of healthy diet recommendations

Transition to diets that are high in saturated fat and sugar has caused a global public health concern, as the pattern of food consumption is a major modifiable risk factor for chronic non-communicable diseases. Although agri-food systems are intimately associated with this transition, agriculture and health sectors are largely disconnected in their priorities, policy, and analysis, with neither side considering the complex inter-relation between agri-trade, patterns of food consumption, health, and development. We show the importance of connection of these perspectives through estimation of the eff ect of adopting a healthy diet on population health, agricultural production, trade, the economy, and livelihoods,with a computable general equilibrium approach. On the basis of case-studies from the UK and Brazil, we suggest that benefits of a healthy diet policy will vary substantially between different populations, not only because of population dietary intake but also because of agricultural production, trade, and other economic factors.

Dietary consumption of antioxidant nutrients and risk of incident cervical intraepithelial neoplasia

OBJECTIVE

Women with human papillomavirus (HPV) infections are at risk for developing squamous intraepithelial lesions (SIL) of the cervix; however, other factors are required for infections to progress to SIL. We hypothesize that consumption of fruits and vegetables high in antioxidant nutrients may prevent, in part, the development of HPV-associated SIL.

METHODS

This study is a nested case-control study of 265 HPV-positive women (93 SIL cases and 172 cytologically normal controls) in the Ludwig-McGill Cohort Study, São Paulo, Brazil. Diet was assessed by a self-administered food frequency questionnaire. The association between food and nutrient intake of antioxidants and incident SIL was determined by logistic regression and multinomial regression when comparing LSIL and HSILs.

RESULTS

Higher reported consumption of papaya was inversely associated with risk of SIL (p trend=0.01) and strongest for >or=1 time/week (adjusted odds ratios (AORs)=0.19; 95%CI, 0.08-0.49). Risk of SIL was reduced among women reporting consumption of oranges >or=1 time/week (AOR=0.32; 95%CI, 0.12-0.87; p-trend=0.02). Nutrient intakes of ss-cryptoxanthin and alpha-carotene were marginally protective against SIL.

CONCLUSIONS

Frequent consumption of fruits high in antioxidant nutrients appears to be associated with reduced risk of incident SIL among Brazilian women.

Dietary quality index and associated factors among adolescents of the state of Sao Paulo, Brazil

OBJECTIVE

To assess dietary quality and associated factors in adolescents.

STUDY DESIGN

We conducted a population-based cross-sectional study in a sample of 1584 adolescents living in areas of the state of São Paulo, Brazil. Dietary intake was measured with the 24-hour recall method, and dietary quality was assessed by means of the Health Eating Index (HEI), adapted to fit to the local requirements. Linear regression analyses were performed to assess the association between the HEI and demographic, socioeconomic, and lifestyle variables.

RESULTS

A total of 97.1% of the adolescents studied had an inadequate diet or a diet that needed improvement. The mean overall HEI score was 59.7. Lower mean HEI scores were found for fruits, dairy products, and vegetables. Male adolescents who were physically active and lived in a house or apartment had higher HEI scores. The multiple regression analyses showed that the quality of the diet improved as age decreased. Adolescents who lived in houses or apartments had higher HEI scores than adolescents living in shacks or slums, regardless of age and energy intake.

CONCLUSIONS

Dietary quality is associated with income and age. A better understanding of the factors associated can provide input to the formulation of policies and development of nutritional actions.

Public health benefits of strategies to reduce greenhouse-gas emissions: food and agriculture

Agricultural food production and agriculturally-related change in land use substantially contribute to greenhouse-gas emissions worldwide. Four-fifths of agricultural emissions arise from the livestock sector. Although livestock products are a source of some essential nutrients, they provide large amounts of saturated fat, which is a known risk factor for cardiovascular disease. We considered potential strategies for the agricultural sector to meet the target recommended by the UK Committee on Climate Change to reduce UK emissions from the concentrations recorded in 1990 by 80% by 2050, which would require a 50% reduction by 2030. With use of the UK as a case study, we identified that a combination of agricultural technological improvements and a 30% reduction in livestock production would be needed to meet this target; in the absence of good emissions data from Brazil, we assumed for illustrative purposes that the required reductions would be the same for our second case study in São Paulo city. We then used these data to model the potential benefits of reduced consumption of livestock products on the burden of ischaemic heart disease: disease burden would decrease by about 15% in the UK (equivalent to 2850 disability-adjusted life-years [DALYs] per million population in 1 year) and 16% in São Paulo city (equivalent to 2180 DALYs per million population in 1 year). Although likely to yield benefits to health, such a strategy will probably encounter cultural, political, and commercial resistance, and face technical challenges. Coordinated intersectoral action is needed across agricultural, nutritional, public health, and climate change communities worldwide to provide affordable, healthy, low-emission diets for all societies.

Dietary factors in relation to daily activity energy expenditure and mortality among older adults

OBJECTIVES

To examine the association between dietary factors to daily activity energy expenditure (DAEE) and mortality among older adults.

DESIGN AND SETTING

A sub-study of Health, Aging, and Body Composition study.

PARTICIPANTS

298 older participants (aged 70-82 years) in the Health, Aging, and Body Composition Energy Expenditure sub-study.

MEASUREMENTS

Dietary factors, DAEE, and all-cause mortality were measured in 298 older participants. Dietary factors include dietary intake assessed by the Block Food Frequency Questionnaire (FFQ), Healthy Eating Index (HEI), and self-reported appetite and enjoyment of eating. DAEE was assessed using doubly labeled water. All-cause mortality was evaluated over a 9 year period.

RESULTS

Participants in the highest tertile of DAEE were more likely to be men and to report having a 'good' appetite; BMI among men, proportion married, IL-6 and CRP levels and energy intake were also higher. Fewer black participants were in the 'good' HEI category. Participants in the 'good' HEI category had higher cognitive scores and a higher education level. Participants who reported improvement in their appetite as well as participants who reported a 'good' appetite were at lower risk for mortality (HR (95% CI): 0.42 (0.24-0.74) and 0.50 (0.26-0.88), respectively) even after adjusting for DAEE, demographic, nutritional and health indices.

CONCLUSIONS

We showed an association between DAEE and appetite and mortality among well-functioning, community-dwelling older adults. These findings may have some practical use for the health providers. Inclusion of a question regarding appetite of an elderly patient may provide important information regarding risk for health deterioration and mortality.

Diet quality of persons living with HIV/AIDS on highly active antiretroviral therapy

BACKGROUND

This study sought to assess the diet quality of individuals living with HIV/AIDS who were receiving antiretroviral therapy in São Paulo, Brazil.

METHODS

This cross-sectional study involved 56 HIV-infected adults. Demographic and anthropometric data were collected, and diet quality was measured using the Healthy Eating Index (HEI), modified for Brazilians, which included ten components: adequacy of intake of six different food groups, total fat, cholesterol, dietary fibre and dietary variety.

RESULTS

Among the individuals assessed, 64.3% of the participants had a diet needing improvement, while 8.7% had a poor diet. The overall HEI score was 68.3 points (SD = 14.9). Mean scores were low for fruits, vegetables, dairy products and dietary fibre; and high for meats and eggs, total fat and cholesterol. The overall HEI score was higher among individuals who were not overweight (P = 0.003), who were also more likely to achieve dietary goals for dairy products (P = 0.039) and grains (P = 0.005).

CONCLUSION

Most of these adults living with HIV/AIDS had diets that required improvement, and being overweight was associated with poorer diet quality. Nutritional interventions aimed at maintaining healthy body weight and diet should be taken into account in caring for HIV-infected people.

Adaptação do índice de alimentação saudável ao guia alimentar da população brasileira

OBJETIVO: Adaptar o Índice de Alimentação Saudável norte-americano de acordo com as recomendações do Guia Alimentar da População Brasileira e da Pirâmide Alimentar Adaptada. MÉTODOS: Foi realizada avaliação do consumo alimentar de 502 indivíduos, de ambos os sexos (54, desvio-padrão=10 anos), na cidade de Botucatu (SP) ano de 2006. O método utilizado para estimar a ingestão foi o questionário recordatório de 24 horas e os alimentos relatados foram convertidos em porções, pelo valor energético, de acordo com os grupos alimentares da Pirâmide Alimentar Adaptada. Além disso, foram avaliados os nutrientes (colesterol, gordura total e saturada) e variedade da dieta. Foi realizada análise estatística descritiva e os valores intermediários da pontuação dos componentes foram calculados por razão e proporção. RESULTADOS: Foram alterados os números das porções alimentares conforme as estabelecidas na Pirâmide Alimentar Adaptada, além da inclusão dos grupos das leguminosas, doces e açúcares, óleos e gorduras na pontuação do Índice de Alimentação Saudável adaptado e exclusão do item sódio. Para os nutrientes a variedade da dieta foi estabelecida pontuação intermediária. O Índice de Alimentação Saudável adaptado pontuou 12 componentes no total, classificando as dietas em boa qualidade (boa qualidade: superior a 100 pontos), precisando melhorar (precisando melhorar: 71-100 pontos) e má qualidade (má qualidade: inferior a 71 pontos). A proporção de indivíduos classificados com dieta de boa qualidade 15%, precisando melhorar 71% e de má qualidade 14%. CONCLUSÃO: O Índice de Alimentação Saudável adaptado é um instrumento que pode ser utilizado para avaliar os hábitos alimentares populacionais, porém específico para a população brasileira adulta. Contudo, se faz necessário que estes índices sejam constantemente revisados e adequados às novas recomendações nutricionais.

Inquéritos domiciliares de saúde: potencialidades e desafios

É apresentada uma síntese do desenvolvimento das medidas de estado de saúde de populações e do reconhecimento da necessidade de inquéritos populacionais periódicos para a geração dos novos indicadores. Traça-se um breve histórico sobre o desenvolvimento dos inquéritos, apontando conjunturas favoráveis no Brasil para o estabelecimento de uma matriz de diferentes modalidades de inquéritos que passem a integrar de forma consistente o sistema de informação em saúde do país. Destacam-se algumas questões metodológicas relativas aos inquéritos e aponta-se o acúmulo de investimento já feito no país em validação e avaliação de instrumentos e escalas e em desenhos amostrais, entre outros aspectos. É enfatizado que a monitorização da equidade em saúde deve ser uma atribuição central dos inquéritos nacionais, considerando o patamar prevalente de concentração da renda, o que implica um conjunto de definições e escolhas de variáveis e indicadores. Ressalta-se que as linhas de pesquisa relativas aos inquéritos e à sua aplicação na análise das desigualdades em saúde podem constituir espaços significativos para o desenvolvimento de teorias epidemiológicas e de uma prática afinada com o campo da Saúde Coletiva.

Dietary quality 1 year after diagnosis of coronary heart disease

OBJECTIVE

The purpose of this ancillary study is to determine the quality of diets in patients with documented coronary heart disease (CHD).

DESIGN

Dietary data were originally collected using a 24-hour dietary recall in 555 patients with CHD, 1 year after a diagnostic coronary angiography. Data used for this investigation were collected between March 2001 and November 2003.

SUBJECTS/SETTING

Patients were participants in a clinical trial to improve adherence to lipid-lowering medications. The Alternate Healthy Eating Index, an instrument designed to evaluate the degree to which a diet has the potential to prevent cardiovascular disease, measured dietary quality.

MAIN OUTCOME MEASURES

Linear regression models were used to assess the association of dietary quality with patients' sociodemographic and clinical characteristics.

RESULTS

Mean age of participants was 61 years, with an average body mass index of 30 (calculated as kg/m(2)). Sixty percent were men. Average daily caloric intake was 1,775 kcal, with 50% of calories derived from carbohydrates, 18% from protein, and 32% from total fat. Average Alternate Healthy Eating Index score was 30.8 out of a possible maximum score of 80. Only 12.4% of subjects met the recommended consumption of vegetables, 7.8% for fruit, 8% for cereal fiber, and 5.2% for trans-fat intake. Lower dietary quality was associated with lower total caloric intake, as well as with smoking, obesity, and lower educational level.

CONCLUSIONS

A high proportion of patients reported poor dietary quality 1 year after experiencing a coronary event. Our data support continued efforts to enhance healthful dietary changes over time for secondary prevention of CHD. Dietary change should be emphasized with CHD patients who are less educated, smokers, or obese.