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

Background

Diet quality is associated with psychobiological, psychological, biological, and physiological factors of individuals, and in the context of prolonged stress, such as the COVID-19 pandemic, it can lead to a worsening of the quality of food for undergraduates. This study aimed to analyze diet quality and associated factors in Brazilian undergraduates.

Methods

Data were collected from 4,799 undergraduate students from all Brazilian regions, from August 2020 to February 2021. The online questionnaire contained socioeconomic variables, the ESQUADA scale to assess diet quality, self-referred changes in weight, the Brazilian food insecurity scale (EBIA), sleep assessment and the perceived stress scale. Unconditional multiple logistic regression analysis was performed to study variables associated with poor and very poor diet quality.

Results

Most of participants presented a good diet quality (51.7%), while 9.8% had a poor or very poor diet quality and only 1.1% had an excellent diet quality. 58.2% of undergraduates reported to have an increase in weight during the pandemic and 74.3% of the students presented elevated stress during the pandemic. Logistic regressions showed students who gained weight during the pandemic presented the highest AOR = 1.56 (95% CI = 1.12-2.20) for poor or very poor diet quality. The elevated perceived stress was also associated with a higher AOR = 2.85 (95% CI = 1.71-4.74) for poor or very poor diet quality.

Conclusion

Most of the studied undergraduates presented a good diet quality. Nevertheless, poor/very poor diet quality was associated with higher perceived stress and weight gain. Our study indicated that policies should beaimed at the socioeconomically most vulnerable undergraduates, those in a situation of food and nutritional insecurity, high perceived stress, and who gained weight during the pandemic.

Instrument for measuring home cooking skills in primary health care

OBJECTIVE

To develop and validate an instrument for measuring the home cooking skills of health professionals involved with guidelines for promoting adequate and healthy food in primary health care.

METHODS

This is a methodological study with a psychometric approach, carried out in the city of São Paulo between January and November 2020, to develop and validate a self-applied online instrument. The data of the 472 participants were presented by descriptive statistics. Content validation was performed by expert judgment using the two round Delphi technique and empirical statistics for consensus evidence. Exploratory factor analysis was used for construct validation and reliability analysis, and the model adjustment rates and composite reliability were analyzed.

RESULTS

The instrument presented satisfactory content validity for CVRc indices and 𝜅 in the two rounds of the Delphi technique. After the factor analysis, the final model of the Primary Health Care Home Cooking Skills Scale presented 29 items with adequate factorial loads (> 0.3). Bartlett's and Kaiser-Meyer-Olkin's (KMO) tests of sphericity performed in exploratory factorial analysis suggested interpretability in the correlation matrix, the parallel analysis indicated four domains and explained variance of 64.1%. The composite reliability of the factors was adequate (> 0.70) and the H-index suggested replicable factors in future studies. All adjustment rates proved to be adequate.

CONCLUSIONS

The Primary Health Care Home Cooking Skills Scale presented evidence of validity and reliability. It is short and easy to apply and will make it possible to reliably ascertain the need for qualification of the workforce, favoring the planning of actions and public policies of promotion of adequate and healthy food in primary health care.

Desenvolvimento e validação de indicadores de desempenho da gestão do Programa Nacional de Alimentação Escolar

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

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

OBJECTIVE

To describe the methodological aspects of the Piauí home healthcare survey (ISAD-PI) and assess the relation between sampling plan, precision, and design effects, assuming that population health surveys are relevant instruments for health monitoring.

METHODS

ISAD-PI was a population-based cross-sectional study that analyzed the living conditions and health status of the population residing in urban areas in the municipalities of Teresina and Picos, in Piauí. Sampling was carried out by conglomerates in two stages: Primary Sampling Units and households. To calculate the sample size, we considered the stratification of the population in both cities, according to the age of the individuals. We evaluated the “non-response” rate (NRR) and estimated the proportions according to sex and age, as well as the prevalence of social determinants of health in order to assess the compliance of the sampling plan. Analyses related to the precision according to the coefficient of proportion variation of the standard error (Cv-pˆ) and the design effect (deff). Cv-pˆ less than 20% and deff less than 1.5 were considered adequate. The total NRR of households was 38.2% in Teresina and 38.3% in Picos. We carried out twenty-four proportion estimates in relation to age and sex and 48 prevalence of social and health determinants estimates, totaling 72 estimates. Among them, 71 had Cv-pˆ less than 20% and 61 had deff less than or equal to 1.5.

CONCLUSION

Data generated from the ISAD-PI may contribute to the assessment of health and morbidity conditions in the population. Furthermore, methodological aspects employed in this research may serve as a basis for studies carried out in other cities in Brazil.

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

OBJECTIVE

Assess two validity evidences of the diet quality scale (ESQUADA) for the selection of items with better discrimination of the Brazilians’ diet quality and propose a description in score levels.

METHODS

Brazilian adolescents and adults residing in the country (n = 2,059) answered an online questionnaire with 52 items, shared on social networks and email lists between March and April 2018. Statistical tests were applied to analyze the validity and reliability of the instrument’s evidence. Factor analysis was applied to study the dimensionality of the questionnaire items. Item response theory was applied to identify the discrimination and location of items on the continuum, construct the scale and assess the differential item functioning in terms of sex and age.

RESULTS

Among the 52 items of the questionnaire, 25 had greater measurement accuracy, with adequate adjustment and reliability. The item on the habit of eating ultra-processed foods at home showed the best discrimination of diet quality. No item showed differential functioning regarding sex and age. In the construction of the ESQUADA, five diet quality levels were identified: very poor, poor, good, very good and excellent. It was observed that while breakfast cereals and/or cereal bars are more frequently consumed by individuals with “very poor” diet quality; nuts and/or walnuts are most often consumed by those individuals with “excellent” diet quality.

CONCLUSION

The ESQUADA consists of 25 precise items with no differential functioning to assess the quality of Brazilians’ diet. The construction of the ESQUADA made it possible to recognize food consumption and dietary practices characteristic of each level of diet quality.

Nutritional status and metabolic risk in adults: association with diet quality as assessed with ESQUADA

OBJECTIVE

To analyze the association between diet quality assessed with the Diet Quality Scale (ESQUADA) and the nutritional status and metabolic risk in adults.

METHODS

The data included 1,147 adults aged 20 to 59, from the population-based study with complex sampling. Weight, height, tricipital (TSF) and subscapular (SSF) skinfolds, and waist (WC) and mid-arm (MAC) circumferences were measured. Body mass index (BMI) and mid-arm muscle circumference (MAMC) were calculated. Nutritional status and metabolic risk were classified considering BMI and WC values, respectively. Diet quality was assessed with ESQUADA. Data were collected at household using the Epicollect5 application. Diet quality (in scores) was analyzed as continuous data and later categorized. The confidence interval was used for comparison between groups, Fisher's exact test for an association study. Adjusted multiple linear regression models were also estimated. P < 0.05 was adopted for statistical significance.

RESULTS

Overweight prevailed in 60.33% of individuals, especially among women (60.73%). High or very high metabolic risk was more frequent among women with "very good or excellent" diet quality. Higher diet quality score was associated with a reduction in TSF (β = -0.07; 95%CI -0.13 - -0.01) and an increase in MAMC (β = 0.09; 95%CI 0.00 - 0,18) in men and the reduction in weight (β = -0.04; 95%CI -0.07 - -0.01), SSF (β = -0.07; 95%CI -0.13 - -0,00) and WC in women (β = -0.06; 95%CI -0.09 - -0.02).

CONCLUSION

A better diet quality is positively associated with lean mass in men, and negatively with fat mass in men and women.

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

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

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

OBJECTIVE

To develop a scale to assess health motivation influencing food choices and to explore its performance in the associations with food intakes and nutritional biomarkers.

DESIGN

Psychometric study using cross-sectional self-report questionnaires and nutritional biomarkers.

SETTING

Multi-centre investigation conducted in ten European cities.

PARTICIPANTS

2954 adolescents who were included in the HELENA study and completed the Food Choices and Preferences (FCP) questionnaire.

RESULTS

Nineteen out of 124 items of the FCP questionnaire were in the same dimension. Sixteen presented adequate parameters for the Scale of evaluatiOn of Food choIcEs (SOFIE). The scores were positively associated with the intakes of cereals, dairy products, meats and eggs, and fish, as well as with blood concentrations of vitamin C, β-carotene, n-3 fatty acids, cobalamin, holo-transcobalamin and folate; scores were negatively associated with the intake of alcohol.

CONCLUSIONS

SOFIE can improve the assessment of motivation influencing food choices based on items with the best performance and is proposed as a new measure to health-related studies.

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

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

Dietary intake of adolescents compared with the Brazilian Food Guide and their differences according to anthropometric data and physical activity

OBJECTIVE

To assess the dietary intake of adolescents compared with the Brazilian Food Guide and to explore their differences according to anthropometric data and physical activity.

METHODS

A total of 476 adolescents from public schools of Piracicaba, SP, Brazil participated in this study. A semi-quantitative food frequency questionnaire was used to estimate food group intake of adolescents. Height, weight and waist circumference of all participants were measured. Physical activity pattern was determined by questioning about participation in regular sport activities.

RESULTS

The prevalence of overweight was 36.1% and 60% were not physically active. 7.8, 7.1, 6.3, and 0.2% of adolescents consumed vegetables, fruits, milk and derivatives, and cereals, respectively, according to recommendations. About 55 and 79% of adolescents consumed excessively oils/fats and sugar/sweets, respectively. Physically active adolescents consumed more cereals, fruits, vegetables, milk and derivatives, and meats and eggs.

CONCLUSION

Most adolescents did not follow the food group recommendations and those who were physically active have healthier food habits.

Dietary patterns: a literature review of the methodological characteristics of the main step of the multivariate analyzes

OBJECTIVE

To describe the solutions adopted in the multiple steps of the use of multivariate techniques to obtain a dietary pattern (DP) concerning: the objective of the studies, the selection of the method for measuring food intake, the criteria for grouping the foods, the number of food groups used, the number of DP obtained, and the nomenclature criteria.

METHODS

The articles were selected from MEDLINE and Lilacs scientific databases using the following keywords: "dietary patterns" versus "factor analysis"; "principal components analysis"; "cluster analysis" and "reduced regression rank." The initial search resulted in 1,752 articles. After inclusion and exclusion criteria, 189 publications were selected.

RESULTS

The following aspects were relevant among the studies: the prevalence of the principal component analysis (PCA); the prevalence of the use of 4 to 5 DPs in the studies of association with health outcomes; the use of 30 or more food groups from the food frequency questionnaire (FFQ); the prevalence of studies that associated DPs with health outcomes and socioeconomic factors; and the heterogeneity of criteria used throughout the analytical stages of the multivariate techniques.

CONCLUSION

The heterogeneity between the publications concentrates on the criteria for food grouping, the nomenclature, and the number of dietary patterns calculated, which varied depending on the number of food groups present in these analyses. To understand, apply, and explore in full, the multivariate techniques has become necessary in order to improve the reliability of the results and, consequently, to improve the relationships with health outcomes and socioeconomic factors.

Liver abscess secondary to an endoscopic tattoo in the colon

Introduction Endoscopic tattooing of colonic lesions has been used safely for their localization. CASE HISTORY We report a 61-year-old female who had left hemicolectomy in 2006 for adenocarcinoma of the left colon (pT3, pN0, M0). Cancer in the transverse colon was discovered during annual colonoscopy surveillance. The lesion was tattooed 5cm proximal to the lesion. Twenty-four days after tattooing, she was admitted to the emergency department with increased levels of inflammatory markers. CT showed an abscess in the left lobe of the liver adjacent to the tattoo site. The abscess was drained under ultrasound guidance. She had antibiotic treatment for 3 weeks and made a full recovery. CONCLUSION Endoscopic tattooing of colonic lesions is safe but this case report highlights the possibility of a rare (but serious) complication that must be taken into consideration.

Communication: On the stability of ice 0, ice i, and I(h)

Using ab initio methods, we examine the stability of ice 0, a recently proposed tetragonal form of ice implicated in the homogeneous freezing of water [J. Russo, F. Romano, and H. Tanaka, Nat. Mater. 13, 670 (2014)]. Vibrational frequencies are computed across the complete Brillouin Zone using Density Functional Theory (DFT), to confirm mechanical stability and quantify the free energy of ice 0 relative to ice I(h). The robustness of this result is tested via dispersion corrected semi-local and hybrid DFT, and Quantum Monte-Carlo calculation of lattice energies. Results indicate that popular molecular models only slightly overestimate the stability of ice zero. In addition, we study all possible realisations of proton disorder within the ice zero unit cell, and identify the ground state as ferroelectric. Comparisons are made to other low density metastable forms of ice, suggesting that the ice i structure [C. J. Fennel and J. D. Gezelter, J. Chem. Theory Comput. 1, 662 (2005)] may be equally relevant to ice formation.

Estimates of self-reported dietary behavior related to oral health among adolescents according to the type of food

Objective

To compare estimates of food behavior related to oral health obtained through a self-report measure and 24 hour dietary recalls (R24h).

Method

We applied three R24h and one self-report measure in 87 adolescents. The estimates for eleven food items were compared at individual and group levels.

Results

No significant differences in mean values were found for ice cream, vegetables and biscuits without filling. For the remaining items, the values reported by the adolescents were higher than the values estimated by R24h. The percentage of adolescents who reported intake frequency of 1 or more times/ day was higher than the value obtained through R24h for all food items except soft drinks. The highest values of crude agreement between the instruments, individually, were found in the biscuits without filling (75.9%) and ice cream (72.4%).

Conclusion

The results suggest that adolescents tend to report a degree of exposure to the food items larger than what they actually experience in their daily lives.

Ingestão de água e bebidas por adolescentes: comparação de uma medida autoaplicável com recordatórios de 24 horas

A frequência da ingestão de água e bebidas pode representar exposição de grande importância para a saúde bucal e há carência de instrumentos para sua mensuração em nível populacional. O objetivo do artigo foi comparar uma medida autoaplicável sobre ingestão de água e bebidas por adolescentes com recordatórios de 24 horas. As estimativas produzidas pelo instrumento foram comparadas com os dados dos R24h e usados como padrão de referência, concluindo que, enquanto instrumentos mais acurados não estejam disponíveis, recomenda-se que as estimativas produzidas por medida autoaplicável semelhante à teste.

Ingestão de água e bebidas por adolescentes: comparação de uma medida autoaplicável com recordatórios de 24 horas

A frequência da ingestão de água e bebidas pode representar exposição de grande importância para a saúde bucal e há carência de instrumentos para sua mensuração em nível populacional. O objetivo do artigo foi comparar uma medida autoaplicável sobre ingestão de água e bebidas por adolescentes com recordatórios de 24 horas. As estimativas produzidas pelo instrumento foram comparadas com os dados dos R24h e usados como padrão de referência, concluindo que, enquanto instrumentos mais acurados não estejam disponíveis, recomenda-se que as estimativas produzidas por medida autoaplicável semelhante à teste.

Variation in dietary intake and physical activity pattern as predictors of change in body mass index (BMI) Z-score among Brazilian adolescents

OBJECTIVE

To assess whether changes in dietary intake and physical activity pattern are associated with the annual body mass index (BMI) z-score change among adolescents.

METHODS

The study was conducted in public schools in the city of Piracicaba, Sao Paulo, Brazil, with a probabilistic sample of 431 adolescents participating in wave I (2004) (hereafter, baseline) and 299 in wave II (2005) (hereafter, follow-up). BMI, usual food intake, physical activity, screen time, sexual maturation and demographic variables were assessed twice. The association between annual change in food intake, physical activity, screen time, and annual BMI z-score changes were assessed by multiple regression.

RESULTS

The study showed a positive variation in BMI z-score over one-year. Among variables related to physical activity pattern only playing videogame and using computer increased over the year. The intake of fruits and vegetables and sugar-sweetened beverages increased over one year, while the others variables showed a reduction. An increased consumption of fatty foods (β = 0.04, p = 0.04) and sweetened natural fruit juices (β = 0.05, p = 0.03) was positively associated with the rise in BMI z-score.

CONCLUSIONS

Unhealthy dietary habits can predict the BMI z-score gain more than the physical activity pattern. The intake of fatty foods and sweetened fruit juices is associated with the BMI z-score over one year.

Assessment of the usability of a nutritional epidemiology computerized system

INTRODUCTION: Epidemiological research has been adhering to new technologies, such as computer systems, and using the Internet as a tool. Usability is a characteristic of a specific product concerning the facility to use it, its speed and the facility to learn how to use it. It should also not present errors, or these must be easy to solve, in case they occur, thus providing high satisfaction to users. OBJECTIVE: To evaluate the usability of the "System of health and nutrition monitoring - nutrition of school children" (NUTRISIM). METHODS: A sample of 17 Information Technology professionals evaluated the system and answered the "Questionnaire for System Usability", which determines the level of usability of systems by the Fuzzy Logic. The questionnaire contains 30 questions, which are divided into six metrics. The usability of the system determines six usability criteria in a large Fuzzy scale. RESULTS: With the exception of the metric "error control", all metrics were analyzed as "very good". The metrics "error control", "efficiency" and "satisfaction" presented medium amplitude, which is a better result in relation to the metrics "easy to learn", "easy to remember" and "effectiveness", which was assessed as "high". CONCLUSION: The study showed that the system is easy to be learned and used, but the answers are scattered. The instrument proved to be a useful tool to monitor and evaluate health and dietary intake in epidemiologic studies.

Variance sources and ratios to estimate energy and nutrient intakes in a sample of adolescents from public schools, Natal, Brazil

OBJECTIVE: The aim of this study was to describe the sources of dietary variance, and determine the variance ratios and the number of days needed for estimating the habitual diet of adolescents. METHODS: Two 24 hour food recalls were used for estimating the energy, macronutrient, fatty acid, fiber and cholesterol intakes of 366 adolescents attending Public Schools in Natal, Rio Grande do Norte, Brazil. The variance ratio between the intrapersonal and interpersonal variances, determined by Analysis of Variance, was calculated. The number of days needed for estimating the habitual intake of each nutrient was given by the hypothetical correlation (r)>0.9 between the actual and observed nutrient intakes. RESULTS: Sources of interpersonal variation were higher for all nutrients and in both genders. Variance ratios were <1 for all nutrients and higher in women. Two 24 hour dietary recalls were enough to assess energy, carbohydrate, fiber and saturated and monounsaturated fatty acid intakes accurately. However, the accurate assessment of protein, lipid, polyunsaturated fatty acid and cholesterol intakes required three 24 hour recalls. CONCLUSION: Interpersonal dietary variance in adolescents was greater than intrapersonal variance for all nutrients, resulting in a variance ratio of less than 1. Two to three 24 hour recalls, depending on gender and the study nutrient, are necessary for estimating the habitual diet of this population.

[Estimate of corrected values and the effect of correction for measurement error in dietary data obtained by the Food Frequency Questionnaire for Adolescents (AFFQ)]

The scope of this study was to estimate calibrated values for dietary data obtained by the Food Frequency Questionnaire for Adolescents (FFQA) and illustrate the effect of this approach on food consumption data. The adolescents were assessed on two occasions, with an average interval of twelve months. In 2004, 393 adolescents participated, and 289 were then reassessed in 2005. Dietary data obtained by the FFQA were calibrated using the regression coefficients estimated from the average of two 24-hour recalls (24HR) of the subsample. The calibrated values were similar to the the 24HR reference measurement in the subsample. In 2004 and 2005 a significant difference was observed between the average consumption levels of the FFQA before and after calibration for all nutrients. With the use of calibrated data the proportion of schoolchildren who had fiber intake below the recommended level increased. Therefore, it is seen that calibrated data can be used to obtain adjusted associations due to reclassification of subjects within the predetermined categories.

Intervention based exclusively on stage-matched printed educational materials regarding healthy eating does not result in changes to adolescents' dietary behavior

PURPOSE

To assess the impact of a six-month stage-based intervention on fruit and vegetable intake, regarding perceived benefits and barriers, and self-efficacy among adolescents.

DESIGN

Randomized treatment-control, pre-post design.

SUBJECTS/SETTING

Schools were randomized between control and experimental groups. 860 adolescents from ten public schools in Brasília, Federal District, Brazil were evaluated at baseline; 771 (81%) completed the study.

INTERVENTION

Experimental group received monthly magazines and newsletters aimed at promotion of healthy eating.

MEASURES

Self-reported fruit and vegetable intake, stages of change, self-efficacy and decisional balance scores were evaluated at baseline and post-intervention in both groups.

ANALYSIS

The effectiveness of the intervention was evaluated using the analysis of covariance model (ANCOVA) and repeated measurement analysis by means of weighted least squares. Comparison between the proportions of adolescents who advanced through the stages during the intervention was performed using the Mantel-Haenszel chi-square test.

RESULTS

After adjusting for sex and age, study variables showed no modifications through the proposed intervention. There was no statistical difference in participant mobility in the intervention and control groups between the stages of change, throughout the study.

CONCLUSION

A nutritional intervention based exclusively on distribution of stage-matched printed educational materials was insufficient to change adolescents' dietary behavior.

Prevalência de excesso de peso e seus fatores associados em adolescentes da rede de ensino público de Piracicaba, São Paulo

OBJETIVO: Estimar a prevalência de excesso de peso e os fatores associados à sua ocorrência em adolescentes da rede de ensino público da cidade de Piracicaba, São Paulo. MÉTODOS: Estudo transversal de 269 adolescentes de ambos os sexos, com idades entre dez a 14 anos. Foram aplicados questionários para obtenção do consumo alimentar, maturação sexual, nível de atividade física e características demográficas. Para a análise estatística utilizou-se a regressão logística univariada e múltipla. RESULTADOS: A prevalência de excesso de peso foi de 35,7% entre os meninos e 26,2%, entre as meninas. Os fatores associados foram observados somente entre as meninas, mostrando-se protetor ao excesso de peso o 2º tercil de consumo de carboidrato (OR ajustada 0,28) e a fase de aceleração/pico do crescimento (OR ajustada 0,37). CONCLUSÕES: A prevalência de excesso de peso nos adolescentes é preocupante. A fase de aceleração/pico do crescimento e o alto consumo de carboidrato foram relacionados como fatores protetores para o excesso de peso entre as meninas. Sugere-se ainda que este último fator seja analisado com cautela, dado que tal associação não foi observada em outros estudos.

Large variation of vacancy formation energies in the surface of crystalline ice

Resolving the atomic structure of the surface of ice particles within clouds, over the temperature range encountered in the atmosphere and relevant to understanding heterogeneous catalysis on ice, remains an experimental challenge. By using first-principles calculations, we show that the surface of crystalline ice exhibits a remarkable variance in vacancy formation energies, akin to an amorphous material. We find vacancy formation energies as low as ~0.1-0.2 eV, which leads to a higher than expected vacancy concentration. Because a vacancy's reactivity correlates with its formation energy, ice particles may be more reactive than previously thought. We also show that vacancies significantly reduce the formation energy of neighbouring vacancies, thus facilitating pitting and contributing to pre-melting and quasi-liquid layer formation. These surface properties arise from proton disorder and the relaxation of geometric constraints, which suggests that other frustrated materials may possess unusual surface characteristics.

Validation of a food frequency questionnaire to assess the consumption of carotenoids, fruits and vegetables among adolescents: the method of triads

The aim of this study was to validate the intake of carotenoids, fruits and vegetables estimated by the Food Frequency Questionnaire for Adolescents (FFQA) using the method of triads. Blood samples were collected from 80 elementary school adolescents to assess serum levels of β-carotene. Partial correlation coefficients (r) were calculated between an estimated intake of carotenoids, fruits and vegetables and the serum levels of β-carotene. Validity coefficients were calculated using the method of triads. With the exception of carotenoids, partial r from the food frequency questionnaire (FFQ) were greater than those of the 24-hour recall (24hR). The fruit/vegetable group showed the highest partial r for the FFQ (r = 0.235) and the 24hR (r = 0.137). The highest validity coefficient was obtained for the vegetable group, as assessed by the FFQ (r = 0.873). On average, the validity coefficient values for the FFQ were greater than those obtained for the 24hR or the β-carotene serum levels. The FFQA is an accurate tool for estimating the intake of carotenoids, fruits and vegetables in this population group.

Estudo de calibração do Questionário de Frequência Alimentar para Adolescentes (QFAA)

Para determinar fatores de calibração do Questionário de Frequência Alimentar para Adolescentes (QFAA), participaram do estudo 74 adolescentes de Piracicaba (SP), com idades entre 10 e 14 anos. Dados de consumo alimentar foram levantados por meio de um QFAA e dois recordatórios de 24 horas ajustados pela energia. Foram realizadas análises descritivas, análise de variância com um fator de classificação, coeficientes de correlação de Pearson e regressão linear. A média dos dois recordatórios foi utilizada como referência para calibrar os dados. Os coeficientes de calibração variaram de -0,07 (ferro) a 0,40 (vitamina C), mostrando substancial erro no método de inquérito dietético testado, mas sendo semelhantes aos observados na literatura. Devido ao fato de se apresentarem baixos, indicam a necessidade de reformulação do instrumento para alguns nutrientes, sendo desaconselhada sua aplicação para corrigir informações de ferro e retinol. A metodologia utilizada é capaz de considerar nas análises os erros de mensuração quando suas pressuposições são respeitadas, uma vez que violações desses pressupostos podem levar ao surgimento de outros erros de difícil predição.

[Obesity in adolescence and its main determinants]

The objective of this paper was to discuss the main environmental factors determining overweight and obesity in adolescents, based on a critical review of the subject. The main national and international health databases, Medline/PubMed, Web of Science, SciELO, and Lilacs were searched including publications from 1975 to 2009. The following key-words and respective MeSH terms were used: "overweight", "obesity", "adolescence", "adolescents", "physical activity", "food intake". The findings showed that changes in dietary patterns in recent decades as the increased consumption of simple sugars, processed foods, and inadequate intake of fruits and vegetables have contributed directly to the weight gain in this population. In addition, the progressive reduction in physical activity associated with increased time spent with low-intensity activities like television viewing, playing computer and video games has contributed to the weight gain of adolescents. In conclusion, variables related to dietary pattern and physical activity should be prioritized interventions directed toward the prevention of obesity among adolescents.

Determinantes do índice de massa corporal em adolescentes de escolas públicas de Piracicaba, São Paulo

O objetivo do presente estudo foi verificar os fatores determinantes do índice de massa corporal (IMC) de adolescentes matriculados nas escolas públicas de Piracicaba, São Paulo. A amostra foi constituída por 328 adolescentes de ambos os sexos, com idade mínima de dez anos. Verificou-se peso, estatura, maturação sexual, atividade física e consumo alimentar. Foi usado um modelo de regressão linear múltipla para verificar a associação entre as variáveis independentes e o IMC. Enquanto as meninas consideradas fisicamente ativas apresentaram maior média de IMC do que as insuficientemente ativas, a média do IMC dos meninos não apresentou diferença estatística quando comparada entre meninos ativos e insuficientemente ativos. A maturação sexual foi determinante do IMC, para ambos os sexos, reforçando a ideia de que é fundamental levar em consideração essa variável em estudos que avaliam o estado nutricional em adolescentes. Acredita-se que os métodos utilizados no presente estudo, os quais são normalmente utilizados em pesquisas semelhantes, apresentaram importantes limitações para avaliar a influência do nível de atividade física e do consumo alimentar sobre o IMC dos adolescentes. Dessa forma, ressalta-se a necessidade de aprimoramento desses métodos para adoção em futuros estudos.

Validity and reliability of self-reported weight and height measures for the diagnoses of adolescent's nutritional status

PURPOSE: To assess the validity and reliability of self-reported height, weight, and Body Mass Index (BMI) to diagnose the nutritional status of adolescents. METHODS: The study included 360 public school students of both genders, with ages ranging from 10 to 15 years. Adolescents self-reported their weight and height, and these values were later obtained directly by interviewers. The validity of BMI based on self-reported measures was calculated using sensitivity and specificity indexes, and positive predictive value (PPV). Agreement between self-reported and measured BMI was evaluated using Kappa's weight coefficient, the Lin correlation coefficient, and Bland-Altman and Lin's plots. RESULTS: Both girls and boys underestimated their weight (-1.0 girls and boys) and height (girls - 1.2 and boys - 0.8) (p < 0.001). BMI presented moderate agreement between measured and self-reported values. Sensitivity of estimated BMI based on reported measures to classify obese subjects was higher for boys (87.5%) than it was for girls (60.9%), whereas specificity was higher for girls (92.7%) than it was for boys (80.6%). PPV was high only for classification of normal-weight adolescents. CONCLUSIONS: Self-reported measures of weight and height in adolescents do not present valid measures; therefore, they should not be used to replace measured values. Additionally, we observed that 10% of obese boys and 40% of obese girls could have remained unidentified if we had used only self-reported measures, emphasizing the effects of the low reliability of self-reporting.

A alimentação saudável na ótica dos adolescentes: percepções e barreiras à sua implementação e características esperadas em materiais educativos

Este estudo visou avaliar percepções, barreiras e características de materiais educativos de promoção de alimentação saudável descritas por adolescentes. Realizaram-se quatro grupos focais com 25 adolescentes com perguntas sobre: percepção e motivação para modificar a dieta; conceito de alimentação saudável e barreiras para sua adoção; e características de impressos para a promoção de práticas alimentares saudáveis. Observou-se uma freqüente indecisão quanto a classificar a dieta como saudável. Os adolescentes referiram não se sentir confiantes para modificar a dieta, mas relataram conceitos adequados sobre alimentação saudável. As principais barreiras citadas foram focadas em aspectos pessoais e sociais, como: a tentação, o sabor dos alimentos, a influência dos pais e a falta de tempo e de opções de lanches saudáveis na escola. Para os jovens, materiais educativos de promoção de alimentação saudável devem reforçar seus benefícios imediatos e destacar mensagens alarmantes sobre os riscos à saúde advindos de uma alimentação inadequada.

[Validity and reproducibility of Escala de Evaluación da Insatisfación Corporal para Adolescentes]

OBJECTIVE

To validate a body dissatisfaction scale for adolescents.

METHODS

The study included 386 female and male adolescents aged 10 to 17 years enrolled in a private elementary and middle school in the city of São Bernardo do Campo, southeastern Brazil, in 2006. 'Escala de Evaluación da Insatisfación Corporal para Adolescentes' (body dissatisfaction scale for adolescents) was translated and culturally adapted. The Portuguese instrument was evaluated for internal consistency using Cronbach's alpha, factor analysis with Varimax rotation, discriminant validity by comparing score means according to nutritional status (low weight, normal weight, and at risk of overweight and obesity) using the Kruskal-Wallis test. Concurrent validity was assessed using Spearman's rank correlation coefficient between scores and body mass index, waist-hip ratio and waist circumference. Reproducibility was evaluated using Wilcoxon test, and intraclass correlation coefficient.

RESULTS

The translated and back-translated scale showed good agreement with the original one. The translated scale had good internal consistency in all subgroups studied (males and females in early and intermediate adolescence) and was able to discriminate adolescents according to their nutritional status. In the concurrent analysis, all three measures were correlated, except for males in early adolescence. Its reproducibility was ascertained.

CONCLUSIONS

The 'Escala de Evaluación da Insatisfación Corporal para Adolescentes' was successfully translated into Portuguese and adapted to the Brazilian background and showed good results. It is recommended for the evaluation of the attitudinal component of body image in adolescents.

Perception of eating practices and stages of change among Brazilian adolescents

OBJECTIVE

To evaluate the perception of eating practices and the stages of change among adolescents.

METHODS

Cross-sectional study involving a representative sample of 390 adolescents from 11 public schools in the city of Piracicaba, Brazil, in 2004. Food consumption was identified by a food frequency questionnaire and the perception of eating practices evaluation was conducted by comparing food consumption and individual classification of healthy aspects of the diet. The participants were classified within stages of change by means of a specific algorithm. A reclassification within new stages of change was proposed to identify adolescents with similar characteristics regarding food consumption and perception.

RESULTS

Low consumption of fruit and vegetables and high consumption of sweets and fats were identified. More than 44% of the adolescents had a mistaken perception of their diet. A significant relationship between the stages of change and food consumption was observed. The reclassification among stages of change, through including the pseudo-maintenance and non-reflective action stages was necessary, considering the high proportion of adolescents who erroneously classified their diets as healthy.

CONCLUSION

Classification of the adolescents into stages of change, together with consumption and perception data, enabled identification of groups at risk, in accordance with their inadequate dietary habits and non-recognition of such habits.

Within- and between-person variations as determinant factors to calculate the number of observations to estimate usual dietary intake of adolescents

This cross-sectional study describes the variation in the dietary intake of energy and macronutrients based on estimated coefficients of within- and between-person variation and intends to calculate the number of days required to evaluate the dietary intake of adolescents in Piracicaba, Brazil. The sample was made up by ninety-two adolescents aged between eleven and sixteen years. Interviews were performed to assess demographic, anthropometric and dietary variables, which were evaluated by the answers obtained through two 24-hour recalls. Descriptive analyses were performed and variances and Coefficients of variation within- and between-person were obtained by results of one-way ANOVA. The mean energy intake observed was 2,326.2 kilocalories; mean macronutrient intake came to 89.0 grams of fatty acids, 305.3 grams of carbohydrates and 82.2 grams of proteins. Coefficients of within-person variation ranged from 36% to 45%, while between-person coefficients varied from 26% to 31%. Variance ratios ranged from 1.35 (carbohydrate) to 2.62 (protein). The lowest number of observations required to correctly evaluate the usual diet calculated (r = 0.90) was six days, for carbohydrates while the highest was eleven, for proteins. Coefficients of variation were similar to those observed in international studies. We conclude that, in this study, two observations were sufficient to obtain reasonable correlations. However, six evaluations are necessary for these adolescents in order to obtain excellent correlations.

Validação do Questionário de Freqüência Alimentar para Adolescentes (QFAA) por grupos de alimentos em uma população de escolares

OBJETIVO: Verificar a validade do Questionário de Freqüência Alimentar para Adolescentes para avaliar o consumo de grupos de alimentos entre escolares de Piracicaba, São Paulo. MÉTODOS: Participaram do estudo 94 adolescentes, com idade entre 11 e 15 anos, matriculados em uma escola da rede pública. O consumo alimentar foi avaliado pelo Questionário de Freqüência Alimentar para Adolescentes (QFAA) e a média de dois Recordatórios de 24 horas (R24h) foi utilizada como método de referência. Os itens alimentares foram classificados em 18 grupos. Foram realizadas análises descritivas, teste t-Student pareado e de Wilcoxon, coeficientes de correlação de Pearson e de Spearman. Foram também utilizadas análise de quartis e estatística Kappa ponderado. Os coeficientes de correlação foram corrigidos pela variância intrapessoal dos R24h, estimada a partir de ANOVA com um fator de classificação. RESULTADOS: Não foram verificadas diferenças significativas entre os instrumentos para o arroz, massas, carnes, refrigerantes e sucos artificiais. Os coeficientes de correlação corrigidos pela variabilidade intrapessoal variaram de -0,26 a 0,78. A concordância de classificação dos indivíduos no mesmo quartil de consumo para ambos os métodos variou de 22% (massas) a 50% (feijão). Para quartis opostos, os grupos que tiveram mais de 10% dos indivíduos classificados incorretamente foram massas (19%), carnes (13%) e gorduras (11%). Os valores de Kappa ponderado variaram de - 0,15 (massas) a 0,56 (feijão). O QFAA superestimou o consumo de quase a totalidade dos grupos alimentares e subestimou os grupos dos óleos, feijão, carnes e refrigerantes. CONCLUSÃO: O instrumento apresentou boa validade para feijão, verduras e legumes, leite e derivados, biscoitos recheados e para o arroz.

Reproducibility of a food frequency questionnaire for adolescents

To assess the reproducibility of a validated 76-item food frequency questionnaire designed to estimate diet in adolescents (Adolescent Food Frequency Questionnaire--AFFQ) in the city of Sao Paulo, Brazil, a test-retest study was conducted (n = 49). Intraclass correlation coefficient (ICC), weighted kappa, and percentage of agreement were used in both crude and energy-adjusted nutrient intakes. Bland Altman plots were used to examine the limits of agreement for energy and macronutrients. The ICC ranged from 0.48 (carbohydrates) to 0.65 (vitamin C) in crude values and from 0.25 (total fat) to 0.58 (vitamin C) in adjusted values. Kappa values ranged from 0.28 (protein and fiber) to 0.56 (unsaturated fat). Bland Altman showed a trend towards larger difference in energy according to increased intake values and a bias towards extreme values for fat intake. The percent of individuals classified in the same category on the two occasions was on average 54.2%. By conclusion, the Adolescent Food Frequency Questionnaire showed reasonable reproducibility and can be used in studies that aim to classify groups into intake categories.

Pseudomyxoma peritonei: a rare presentation as an umbilical nodule

BACKGROUND

Umbilical nodules are rare and may be the sole presenting sign of an advanced intra-abdominal malignancy associated with poor prognosis. Metastatic involvement of umbilicus was first described in 1846 by Sister Mary Joseph, who established the correlation between carcinomas and umbilical nodes.

AIM

We aim to describe a case report of Pseudo Myxoma Peritonei in a 31-year-old man who presented with subcutaneous non tender umbilical nodule. We also aim to emphasize the importance of differential diagnosis, when one encounters the presence of mucoid material in unusual sites such as the umbilicus.

METHOD

Patient's clinical notes, operative findings, imaging studies, laboratory investigations including histopathology and immunohistochemistry were reviewed. A literature search was done to look into the incidence, pathophysiology, presentation and treatment options for this neoplastic process.

CONCLUSION

PMP should be considered as one of the differential diagnosis when one encounters mucinous collection in unusual sites such as the umbilicus.

Abordagem do modelo transteórico no comportamento alimentar

O estudo do comportamento alimentar tem despertado grande interesse por se tratar de um elemento importante para o sucesso de intervenções nutricionais. Considerando-se a complexidade do tema e as inúmeras influências a que está submetido, sugere-se que o aprofundamento de pesquisas sobre os determinantes do comportamento alimentar possibilite maior impacto nas ações de promoção de práticas alimentares saudáveis. A adoção cada vez mais freqüente de uma alimentação inadequada no Brasil e no mundo leva a um questionamento sobre o impacto das intervenções nutricionais tradicionalmente utilizadas em âmbito populacional. Diversas estratégias de educação nutricional são atualmente descritas na literatura; contudo, alcançar a motivação da população para uma mudança efetiva do padrão alimentar ainda é um dos grandes desafios para a saúde pública. A aplicação do modelo transteórico parece ter um papel promissor em relação à melhor compreensão da mudança de comportamento alimentar, almejada nas intervenções nutricionais. Estratégias que envolvam o direcionamento para cada estágio de mudança de comportamento, identificado segundo essa teoria, podem ser mais eficazes quanto à motivação dos indivíduos a adotar práticas alimentares mais saudáveis.

Consumo alimentar e excesso de peso de adolescentes de Piracicaba, São Paulo

OBJETIVO: Este estudo avaliou o consumo alimentar e a prevalência de excesso de peso entre adolescentes de Piracicaba, São Paulo. MÉTODOS: Estudo observacional transversal com amostra representativa de adolescentes maiores de 10 anos de 11 escolas públicas de Piracicaba. Realizou-se auto-avaliação da maturação sexual por planilhas dos estágios de Tanner. Pelo Questionário de Freqüência Alimentar Semi-Quantitativo, investigou-se o consumo de energia, macronutrientes, frutas, hortaliças e doces. Foram aferidos peso e altura para avaliação do perfil antropométrico pelos percentis de Índice de Massa Corporal e índice de altura-para-idade. RESULTADOS: Foram avaliados 390 adolescentes, com média de idade de 12,4 anos, sendo 46,4% meninos e 78,7% púberes. O consumo médio de energia foi de 3.645kcal (56,2%, 12,8% e 33,5% provenientes de carboidratos, proteínas e lipídios, respectivamente). Observou-se que 77,9% da amostra ingeria alto teor de gordura. O consumo médio de frutas, hortaliças e doces foi de 2,3, 2,4 e 4,5 porções diárias, respectivamente. Foi encontrado 21,0% de excesso de peso, 4,4% de baixo peso e 1,8% de déficit de altura-para-idade. CONCLUSÃO: Expressivo percentual de adolescentes apresentava reduzido consumo de frutas e hortaliças e consumo lipídico e de doces acima do recomendado, podendo haver relação com o elevado número de participantes com excesso de peso. Adolescentes devem ser alvo de programas que enfatizem a adoção de alimentação saudável, para diminuir risco e incidência de obesidade e prevenir futuros agravos à saúde.

[Development and validation of a physical activity assessment questionnaire for adolescents]

OBJECTIVE

To develop a physical activity questionnaire aimed at Brazilian adolescents and to assess its validity and reproducibility.

METHODS

A total of 94 adolescents (30 males and 64 females) aged 11-16 years were included in the study, which was conducted in 2004. The questionnaire comprised 17 questions on habitual physical activity in the last 12 months (15 questions on sports and physical exercise and two on transportation physical activity), and was standardized to yield final scores for weekly and yearly activity. As a reference, we used the multistage 20-meter shuttle run test, measuring variables maximum time in minutes, maximum speed, maximum oxygen uptake and maximum heart rate. For validity analysis, we used the Spearman coefficient and age-adjusted correlation. For reproducibility analysis, we repeated evaluations after 15 days and measured the intraclass correlation coefficient.

RESULTS

For the weekly score, the highest correlations were obtained for maximum time for the entire sample (r=0.19), maximum speed for males (r=0.20), and both maximum oxygen uptake and maximum time for females (r=0.17). For the yearly score, the highest correlations were obtained for maximum time for the entire sample (r=0.30), maximum heart rate for males (r=0.22), and maximum time for females (r=0.23). In reproducibility analyses, correlations were 0.61 for weekly score and 0.68 for yearly score.

CONCLUSIONS

The questionnaire was valid and reproducible. Its use is recommended for the evaluation of physical activity in epidemiological studies with adolescents.

Post-radiation pulmonary epithelial regeneration from transplanted adult stem cells

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Background: Pneumonitis and pulmonary damage are common toxicities of chest radiation therapy (RT), which may be reduced by transplantation of stem cells that differentiate into pulmonary epithelium. Multipotent Adult Progenitor Cells (MAPC) are adult bone marrow (BM) derived cells, which after IV injection in NOD-SCID mice, differentiate into epithelial and hematopoietic tissues (Nature 418:41). Here we tested the ability of mouse (m) MAPC to regenerate epithelia after RT, in Fanconi Anemia C (FAC) mouse model, which inherently has DNA repair defects and is over sensitive to DNA-cross linking agents. Methods: One million, enhanced-green fluorescent protein (eGFP)- expressing, wild-type mMAPC were injected IV in FAC mice, 4–24 hours after 7.5 Gy (followed by mitomycin C {MMC} 0.1mg/kg/week X 4 in a subset) or 11 Gy RT. Non-eGFP expressing BM was co-transplanted after myeloablative (11 Gy) RT. BM, lungs, intestine and liver of the recipients were analyzed 3–10 months post-transplant for eGFP+ cells and epithelial (CK+) or hematopoietic (CD45+) differentiation using flowcytometry (BM) & immunohistochemistry. Control FAC mice were identically treated but without MAPC. Results: MAPC engraftment (>1% eGFP+ cells) was absent in all control mice. Following 7.5 Gy RT, autologous BM recovery occurred in all (N=10) mice and 1 mouse had 2.7% donor-derived hematopoietic (eGFP+/CD45+) cells after MMC. In both recipients of 11Gy RT, analyzed 9–10 months post-transplant, 5–7% of all CD45+ BM cells were donor MAPC-derived. No donor MAPC-derived epithelial cells were seen in the intestine or liver. However, lungs of most recipients had clusters of donor MAPC-derived epithelial cells, estimated to comprise 1–8% of all pulmonary epithelial cells, consistent with homing of MAPC in lungs following IV injection and their epithelial differentiation in the post-radiation, regenerative, pulmonary micro- environment. The highest degree of MAPC-derived pulmonary regeneration was seen following 11Gy RT that was persistent at 10 months post- transplant. Conclusions: Following radiation, IV injected mMAPC differentiate into hematopoietic and pulmonary epithelial cells that persist long-term. MAPC transplantation has the potential for reducing radiation-induced pulmonary toxicity.

No significant financial relationships to disclose.

Aplicação de regressão linear para correção de dados dietéticos

OBJETIVO: Estratégias metodológicas vêm sendo desenvolvidas para minimizar o efeito do erro de medida da dieta. O objetivo do estudo foi descrever a aplicação de uma estratégia para correção da informação dietética pelo erro de medida. MÉTODOS: Foram obtidos dados de consumo alimentar pela aplicação do Questionário de Freqüência Alimentar a 79 adolescentes do Município de São Paulo em 1999. Os dados dietéticos obtidos foram corrigidos por meio de regressão linear, após o ajuste pela energia usando-se o método dos resíduos. O método de referência utilizado foi o recordatório de 24 horas, aplicado em três momentos distintos. RESULTADOS: Os valores corrigidos aproximaram-se dos valores de referência. O fator de correção lambda foi de 0,89 para energia. Para os macronutrientes, os fatores foram de 0,41; 0,22 e 0,20, para carboidratos, lipídios e proteínas, respectivamente. CONCLUSÕES: As médias e desvios-padrão dos valores corrigidos denotam que houve uma correção do erro de medida. Apesar disso, debate-se o desempenho desses métodos, que são notoriamente imperfeitos quando seus pressupostos teóricos não são atendidos, o que é comum nos estudos da dieta que usam instrumentos de medida baseados no relato dos indivíduos.

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

This study sought to analyze dietary quality and associated factors among adults living in regions of the State of São Paulo, Brazil. It was a cross-sectional population-based study of a sample of 3,454 adults ages 20 years and over who were included in the Household Health Survey. Dietary intake was measured by means of the 24-hour recall method, and dietary quality was assessed by means of the Healthy Eating Index (HEI), adapted to local realities. Probabilistic samples were obtained via multistage cluster samples from four regions in the State of São Paulo. Linear regression analyses were performed to evaluate the relationships between the HEI and the demographic, socioeconomic, and lifestyle variables. Among the individuals assessed, 5% had a good diet, 74% a diet that needed some degree of improvement, and 21% a poor diet. The means for HEI components were lowest for vegetables, fruits, and dairy products. The highest HEI scores were obtained by individuals who were nonsmokers, practiced physical activity, were retired, lived in houses or apartments, and had adequate living conditions surrounding them. In the multiple regression analysis, the variables of numbers of consumer durable goods, schooling of the head of the family, energy intake, and age had a positive association with the HEI. However, the association was inverse for the variables of smoking and body mass index. Higher dietary quality is associated with higher income, higher schooling level, better nutritional status, and being a nonsmoker. Knowledge of these factors is important for implementing programs for preventive nutrition or intervention.