Technological tools for assessing children's food intake: a scoping review

Technological innovations can standardise and minimise reporting errors in dietary assessment. This scoping review aimed to summarise the characteristics of technological tools used to assess children's food intake. The review followed the Joanna Briggs Institute's manual. The main inclusion criterion was studied that assessed the dietary intake of children 0-9 years of age using technology. We also considered articles on validation and calibration of technologies. We retrieved 15 119 studies and 279 articles were read in full, after which we selected 93 works that met the eligibility criteria. Forty-six technologies were identified, 37 % of which had been developed in Europe and 32⋅6 % in North America; 65⋅2 % were self-administered; 27 % were used exclusively at home; 37 % involved web-based software and more than 80 % were in children over 6 years of age. 24HR was the most widely used traditional method in the technologies (56⋅5 %), and 47⋅8 % of the tools were validated. The review summarised helpful information for studies on using existing tools or that intend to develop or validate tools with various innovations. It focused on places with a shortage of such technologies.

Association between the consumption of sugar-sweetened beverages and food markers: National Dietary Survey 2008-2009

We aimed to analyze the association between sugar-sweetened beverage (SSB) consumption with healthy food markers (HFM) and unhealthy food markers (UFM) as well as their impact on these markers in the Brazilian population's diet. Food consumption during two nonconsecutive days of food records of individuals aged ten years or over were investigated in the National Dietary Survey 2008-2009 (n = 32,900) and the caloric contributions of HFM and UFM were distributed according to the categories of SSB consumption. Multiple linear regression was applied to analyze the associations between the consumption of SSB and the impact of a 50% reduction in portion size and dietary markers. The contribution of energy from HFM was higher among individuals who did not consume SSB. A 50% reduction in the average portion of SSB in the population would imply a 6% decrease in energy contribution to the diet and 12% decrease in total energy from added sugar. It would increase the consumption of HFM and dietary fiber by 7g and 4g, respectively. A 50% reduction in SSB serving size is a strategy that could improve the quality of the diet, increase the consumption of HFM and fiber and reduce the consumption of sugar and UFM.

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

OBJECTIVE

To assess the evolution of energy and nutrient intake and the prevalence of inadequate micronutrients intakes according to sociodemographic characteristics and Brazilian regions.

METHODS

The food consumption of 32,749 individuals from the National Dietary Survey of the Household Budget Survey 2008-2009 was analyzed by two food registries, as well as 44,744 subjects from two 24-hour recalls in 2017-2018. Usual intake and percentage of individuals with consumption below the average recommendation for calcium, magnesium, phosphorus, copper and zinc, vitamins A, C, D, E, thiamine, riboflavin, pyridoxine and cobalamin were estimated. Sodium intake was compared to the reference value to reduce the risk of chronic diseases. Analyses were stratified by sex, age group, region and income.

RESULTS

Mean daily energy intake was 1,753 kcal in 2008-2009 and 1,748 kcal in 2017-2018. The highest prevalence of inadequacy (> 50%) in the two periods were calcium; magnesium; vitamins A, D and E; pyridoxine and, only among adolescents, phosphorus. There was an increase in the prevalence of inadequate vitamin A, riboflavin, cobalamin, magnesium, and zinc among women, and riboflavin among men. The prevalence of inadequacy decreased for thiamine. Sodium intake was excessive in approximately 50% of the population in both periods. The highest variations (about 50%) in the prevalence of inadequacy between the lowest and highest income (< 0.5 minimum wage and > 2 minimum wages per capita) were observed for vitamin B12 and C in both periods. The North and Northeast regions had the highest prevalence of inadequacy.

CONCLUSION

Both surveys found high prevalence of inadequate nutrient intake and excessive sodium intake. The inadequacy varies according to income strata, increasing in the poorest regions of the country.

Technology in Health: Brazilian version of the GloboDiet program for dietary intake assessment in epidemiological studies

The 24-hour recall (R24h) has been the method for dietary assessment in surveys. Technological advances have allowed the development of a program for the collection of R24h data. International Agency for Research on Cancer-World Health Organization (IARC-WHO) developed a standardized interview and computer-based 24-hour dietary recall program called GloboDiet, aimed at using it in research and nutrition surveillance. Brazil was included in a project for the global expansion of this methodology for developing and adapting a version for national use. The adaptation followed the procedures established by the IARC-WHO that considered the translation and adaptation of approximately 70 databases. For the development of the food list, national databases of food consumption from national surveys were consulted obtaining a final list of 2113 foods and recipes. GloboDiet program guides an interview in five steps: general information of the participant; quick list of foods and recipes; details of food / recipes and quantities consumed using mainly a picture book; control of the amount of food and nutrients; and information on dietary supplements. The Brazilian version of the GloboDiet program will provide a more accurate assessment of food intake based on a standardized method for nutrition surveillance and investigation of the relationship between diet and health outcomes, as well as comparisons of dietary intakes within and between countries.

Are there differences in nutrient intake of Brazilian adults according to weight status?

It was assessed the intake and prevalence of inadequate nutrient intake according to weight status among Brazilian adults from urban areas (n=16,198) evaluated in the Brazilian National Dietary Survey (NDS - 2008-2009), that obtained food records from two non-consecutive days. The prevalence of inadequate nutrient intake according to weight status was estimated based on Brazilian and international recommendations, in which usual intake was estimated applying the National Cancer Institute method. From 14 nutrients evaluated, six differed according to weight status in men, and only two among women. For men, the mean proportion of energy derived from lipids and saturated fat and mean intake of cholesterol, zinc, and vitamin B12 were greater among those with excess weight compared to those with normal weight; the inverse was observed for dietary fiber. Mean sodium intake was greater and proportion of energy from added sugar intake was lower among obese women compared to overweight ones. Strategies to encourage food consumption with high micronutrient density should be targeted to adult population regardless of their weight status.

High protein diet promotes body weight loss among Brazilian postpartum women

There is evidence in the general population that adhering to a high protein and low carbohydrate diet may help in losing weight. However, there is little evidence among postpartum women. The aim of this study is to evaluate the effect of a high protein diet on weight loss among postpartum women. A parallel-randomized controlled trial with 94 postpartum women was conducted in a maternity ward in Mesquita county (recruitment from February 2009 to December 2010) and in a polyclinic in Rio de Janeiro city (recruitment from December 2010 to December 2011). Women were randomized to the intervention group (IG) or control group (CG), and both groups received an isocaloric diet (1,800 kcal). Additionally, the IG received approximately 25 g of protein obtained from 125 g per week of sardine to increase daily dietary protein content and was advised to restrict carbohydrate intake. The CG received nutritional counselling to follow the national nutrition guidelines (15% protein, 60% carbohydrates, and 25% lipids). A linear mixed-effects model was used to test the effect of high protein intake and macronutrient intake on weight loss during the postpartum period. Body weight decreased in the IG compared with the CG (ß = -0.325; p = 0.049) among overweight and obese postpartum women. The percentage of energy intake from lipid (ß = -0.023; p = 0.050) was negatively associated with body weight, and carbohydrate intake (ß = 0.020; p = 0.026) was positively associated with body weight over time among all women. Protein intake and lower carbohydrate intake may be used as a dietary strategy to improve body weight loss during the postpartum period.

Validade relativa de questionário de frequência alimentar com suporte de imagens

Resumo O objetivo do presente estudo foi avaliar a validade relativa de questionário de frequência alimentar (QFA), desenvolvido para adolescentes. O estudo envolveu amostra de 106 adolescentes (57% meninas) de 11 a 18 anos de idade. O QFA foi aplicado em entrevistas pessoais com o suporte de fotografias dos 93 itens alimentares. As médias deatenuadas da ingestão de energia e nutrientes de três recordatórios de 24 horas (R24h) foram consideradas como referência e foram comparadas com aquelas estimadas pelo QFA com o uso do coeficiente de correlação de Spearman, kappa ponderado para a concordância da categorização em quartis, e limites de concordância de Bland-Altman. Os coeficientes de correlação variaram de 0,27 a 0,49 (média = 0,43), o kappa ponderado variou de 0,28 a 0,51 (média = 0,40), e a concordância média estimada variou de 109 a 159% (média = 130%). Aproximadamente 30% das estimativas foram classificados de forma exata em um mesmo quartil e cerca de 90% em quartis iguais ou adjacentes. Resultados obtidos com a aplicação do QFA com o suporte de fotografias foram mais favoráveis do que os observados para o questionário isoladamente. O QFA foi considerado apropriado para categorizar adolescentes segundo gradientes de consumo energia e nutrientes.

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

OBJECTIVE

To verify associations of income and education with nutrient intakes in Brazilian adults.

DESIGN

Data from the population-based National Dietary Survey conducted in 2008-2009. Family per capita income and education levels were categorized into quartiles. Prevalences of inadequate nutrient intakes and excessive intakes of saturated fat and Na were calculated by using the method prescribed by the National Cancer Institute. The Estimated Average Requirement was used as a reference for micronutrient intake. Linear regression models for both the independent and the mutually adjusted associations of education and income with nutrient intakes were tested. Interaction between education and income was tested.

SETTING

Households (n 13 569) selected using a two-stage cluster sampling design.

SUBJECTS

Food records for two non-consecutive days were obtained for 21 003 Brazilian adults (aged 20-59 years).

RESULTS

For most of eleven nutrients, the prevalence of inadequate intake declined with increasing income and education levels; however, it remained high across all income and education quartiles. Excessive intake of saturated fat and low fibre intake increased with both variables. Most nutrients were independently associated with income and education in both sexes. Fe, vitamin B12 and Na intakes among women were associated only with education. There was an interaction between income and education for Na intake in men, P intake in women and Ca intake in both sexes.

CONCLUSIONS

Education is one important step to improve nutrient intakes in Brazil. Emphasis should be laid on enhancing dietary knowledge and formulating economic strategies that would allow lower-income individuals to adopt a healthy diet.

Macronutrient consumption and inadequate micronutrient intake in adults

OBJECTIVE

To estimate energy and nutrient intake and prevalence of inadequate micronutrient intake among Brazilian adults.

METHODS

Data from the National Dietary Survey, from the 2008-2009 Household Budget Survey, were used. Food consumption was evaluated through food record on two non-consecutive days. A total of 21,003 individuals (52.5% women), between 20-59 years old, participated in the survey. Usual nutrient intake was estimated according to the National Cancer Institute method. The Estimated Average Requirement (EAR) cut-off points were used to determine the prevalence of inadequate micronutrient intake. For manganese and potassium, the Adequate Intake (AI) was used as cut-off. Sodium intake was compared with the Tolerable Upper Intake Level (UL). The probability approach was used to determine the prevalence of inadequate iron intake. The data were analyzed according to the location of the household (urban or rural) and macro regions of Brazil.

RESULTS

The mean energy intake was 2,083 kcal among men and 1,698 kcal among women. Prevalence of inadequacy equal to or greater than 70% were observed for calcium among men and magnesium, vitamin A, and sodium among both men and women. Prevalence equal to or greater than 90% were found for calcium in women and vitamins D and E in both genders. Prevalence lower than 5% were found for iron in men and for niacin in men and women. In general, prevalence of inadequate intake was higher in the rural area and in the Northeast region.

CONCLUSIONS

Energy intake was higher among individuals who live in urban areas and in the North region. The greatest risk groups of inadequate micronutrient intake were women and those living in rural areas and in the Northeast region.

Procedimentos empregados na estimativa das medidas de massa e de volume de alimentos selecionados pelo Inquérito Nacional de Alimentação 2008-2009

OBJETIVO: Descrever os procedimentos utilizados para estimar as medidas de massa e de volume dos itens mais consumidos no Brasil e apresentar propostas que possam ser adotadas para o aprimoramento do cálculo das quantidades ingeridas nos inquéritos alimentares no Brasil. MÉTODOS: Foram utilizados os dados do Inquérito Nacional de Alimentação 2008-2009 para descrever as frequências brutas das unidades de medida referidas para os cinco itens mais consumidos no Brasil (arroz, feijão, café, pão e carne bovina frita), exemplificouse a construção da base de dados utilizada no Inquérito Nacional de Alimentação e discutiramse as principais dificuldades encontradas nesse processo. RESULTADOS: Foram citadas aproximadamente 11.800 unidades de medidas associadas a cerca de 2.000 alimentos/preparações. A colher de servir foi a medida mais citada para o arroz (57%); a concha, para o feijão (80%); a xícara de café, para café (36%); unidade, para pão de sal (88%) e bife, para carne bovina frita (54%). Medidas equivocadas ou incompatíveis com os alimentos e unidades de medida que dificilmente podem ser dimensionadas foram citadas e uma unidade de medida padrão foi utilizada para estimar a quantidade consumida nessas situações. CONCLUSÃO: Na estimativa das quantidades relatadas no Inquérito Nacional de Alimentação foram adotados procedimentos no intuito de minimizar os erros de mensuração. Esforços para melhorar a quantificação dos alimentos consumidos em inquéritos nacionais se justificam uma vez que a padronização das medidas referidas em inquéritos nutricionais possibilita comparações nacionais e internacionais e contribui para elaboração de recomendações e guias de alimentação e nutrição.

How many 24-hour recalls or food records are required to estimate usual energy and nutrient intake?

For dietary intake assessments, one needs to know the minimum 24-hour recall or food record replications that are required to estimate usual energy and nutrient intake and to classify subjects correctly according to their nutrient intake. Data from two different studies on dietary intake that were carried out with 300 adults and 169 adolescents in the Rio de Janeiro Metropolitan area, Brazil, were analyzed. To estimate the number of replications two methods were applied: one based on the variances ratio, the other based on the within-subject variance alone. The most important results found were the requirement for 14 replications for boys and men, 15 for girls, and 23 for women in order to estimate energy intake with a precision of 90%. Also four replications for boys and seven for men, girls and women are required to classify individuals' energy intake with a correlation coefficient of 0.9. Due to the within variance in food intake, a larger number of replications is required to obtain estimates of usual intakes than is needed to classify subjects according to levels of dietary intake.

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

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

A continuous fluorescent assay for the determination of plasma and tissue angiotensin I-converting enzyme activity

A continuous assay using internally quenched fluorescent peptides with the general sequence Abz-peptidyl-(Dnp)P-OH (Abz = ortho-aminobenzoic acid; Dnp = 2,4-dinitrophenyl) was optimized for the measurement of angiotensin I-converting enzyme (ACE) in human plasma and rat tissues. Abz-FRK(Dnp)P-OH, which was cleaved at the Arg-Lys bond by ACE, was used for the enzyme evaluation in human plasma. Enzymatic activity was monitored by continuous recording of the fluorescence (lambda ex = 320 nm and lambda em = 420 nm) at 37 degrees C, in 0.1 M Tris-HCl buffer, pH 7.0, with 50 mM NaCl and 10 microM ZnCl2. The assays can be performed directly in the cuvette of the fluorimeter and the hydrolysis followed for 5 to 10 min. ACE measurements in the plasma of 80 healthy patients with Hip-His-Leu and with Abz-FRK(Dnp)P-OH correlated closely (r = 0.90, P < 0.001). The specificity of the assay was demonstrated by the complete inhibition of hydrolysis by 0.5 microM lisinopril or captopril. Abz-FRK(Dnp)P-OH cleavage by ACE was monitored in rat lung, kidney, heart, and liver homogenates in the presence of a cocktail of inhibitors containing trans-epoxy-succinyl-L-leucylamido-(4-guanido)-butene, pepstatin, phenyl-methylsulfonyl fluoride, N-tosyl-L-phenylalanyl-chloromethyl ketone, and N-tosyl-lysyl-chloromethyl ketone to prevent undesirable hydrolysis. ACE activity in lung, heart and kidney homogenates, but not in liver homogenates, was completely abolished by 0.5 microM lisinopril or captopril. The advantages of the method are the procedural simplicity and the high sensitivity providing a rapid assay for ACE determinations.

Brain abscess by citrobacter diversus in infancy: case report

Citrobacter diversus is closely related to brain abscess in newborn infants. We describe a case of brain abscess by this bacteria in a newborn infant and his clinical and cranial computed tomographic evaluation until the fourth month of life and discuss therapeutic management of this patient.

Peptidase specificity characterization of C- and N-terminal catalytic sites of angiotensin I-converting enzyme

Quenched fluorescence peptides were used to investigate the substrate specificity requirements for recombinant wild-type angiotensin I-converting enzyme (ACE) and two full-length mutants bearing a single functional active site (N- or C-domain). We assayed two series of bradykinin-related peptides flanked by o-aminobenzoic acid (Abz) and N-(2,4-dinitrophenyl)ethylenediamine (EDDnp), namely, Abz-GFSPFXQ-EDDnp and Abz-GFSPFRX-EDDnp (X = natural amino acids), in which the fluorescence appeared when Abz/EDDnp are separated by substrate hydrolysis. Abz-GFSPFFQ-EDDnp was preferentially hydrolyzed by the C-domain while Abz-GFSPFQQ-EDDnp exhibits higher N-domain specificity. Internally quenched fluorescent analogues of N-acetyl-SDKP-OH were also synthesized and assayed. Abz-SDK(Dnp)P-OH, in which Abz and Dnp (2,4-dinitrophenyl) are the fluorescent donor-acceptor pair, was cleaved at the D-K(Dnp) bond with high specificity by the ACE N-domain (k(cat)/K(m) = 1.1 microM(-)(1) s(-)(1)) being practically resistant to hydrolysis by the C-domain. The importance of hydroxyl-containing amino acids at the P(2) position for N-domain specificity was shown by performing the kinetics of hydrolysis of Abz-TDK(Dnp)P-OH and Abz-YDK(Dnp)P-OH. The peptides Abz-YRK(Dnp)P-OH and Abz-FRK(Dnp)P-OH which were hydrolyzed by wild-type ACE with K(m) values of 5.1 and 4.0 microM and k(cat) values of 246 and 210 s(-)(1), respectively, have been shown to be excellent substrates for ACE. The differentiation of the catalytic specificity of the C- and N-domains of ACE seems to depend on very subtle variations on substrate-specific amino acids. The presence of a free C-terminal carboxyl group or an aromatic moiety at the same substrate position determines specific interactions with the ACE active site which is regulated by chloride and seems to distinguish the activities of both domains.

Internally quenched fluorogenic substrates for angiotensin I-converting enzyme

OBJECTIVE

Development of internally quenched fluorogenic substrates for sensitive and continuous assays of angiotensin I-converting enzyme (ACE).

DESIGN

We synthesized internally quenched fluorogenic bradykinin-related peptides introducing Abz (ortho-aminobenzoic acid) and EDDnp (N-[2,4-dinitrophenyl]-ethylenediamine) at their N- and C-terminal groups, respectively, and these were assayed as ACE substrates. We examined two series of peptides, Abz-GFSPFRX-EDDnp and Abz-GFSPFXQ-EDDnp (X, various amino acids).

METHODS

Hydrolysis of the fluorogenic substrates by ACE was followed by continuous recording of the rising fluorescence (lambda(em) = 420 nm and lambda(ex) = 320 nm). The peptides were obtained by solid-phase synthesis or by classical solution methods.

RESULTS

Despite of the blocked C-terminal sequences, the internally quenched bradykinin-related peptides were hydrolysed by ACE. The best substrates for plasma guinea pig ACE were Abz-GFSPFRA-EDDnp and Abz-GFSPFFQ-EDDnp, in which the fluorescence appeared after the first cleavage that occurred at R-A and F-Q bond, respectively. This ACE activity was sensitive to NaCl concentration and the optimum pH is greater than 8.0. Measurements of ACE activity with Hip-His-Leu and Abz-GFSPFFQ-EDDnp in the serum of 20 healthy patients correlated closely (r = 0.959). Complete inhibition of the hydrolysis of Abz-GFSPFFQ-EDDnp by human serum was observed with captopril and lisinopril.

CONCLUSIONS

We describe internally quenched fluorogenic substrates for ACE devoid of free C-terminal carboxyl group. They are convenient tools for ACE studies as they permit continuous fluorimetric measurements of the enzymatic activity, even in human serum.