Dietary patterns of Brazilian adults in 2008-2009 and 2017-2018

Dietary Total Antioxidant Capacity of Brazilian Adults and the Elderly: An Analysis Based on the Degree of Food Processing (NOVA Classification)

OBJECTIVE

This study aimed to estimate the dietary total antioxidant capacity (DTAC) of Brazilian adults and elderly and to identify the foods that contributed the most to antioxidant intake and their degree of processing.

METHODS

Data were collected from the National Dietary Survey of the 2017-2018 Household Budget Survey. DTAC was estimated using a database based on the Ferric-Reducing Ability Power (FRAP) assay, evaluating 1,335 food items consumed by Brazilians, and the degree of processing was identified according to the NOVA Classification.

RESULTS

The estimated average DTAC/1000Kcal was 4.27 mmol, and women (4.36mmol), elderly individuals (4.65mmol), black, mixed-race, and indigenous individuals (4.15mmol), residents in rural areas (4.61mmol), and those living in the South region (4.98mmol) had significantly higher DTAC when compared to other groups. DTAC decreased with the increase in income and education levels. Non-alcoholic beverages accounted for 58.84% of DTAC, followed by legumes (16.38%) and fruits (8.17%). Regarding the degree of processing, in natura and minimally processed foods contributed 92% of DTAC (3.93mmol), while ultra-processed foods accounted for 5.5% (0.235mmol).

CONCLUSIONS

The findings of this study reinforce the importance of consuming in natura and minimally processed foods, in the line with the Dietary Guidelines for the Brazilian Population, particularly with respect to antioxidant intake.

Comparison of Nutrient Intake Across Different Dietary Patterns in Brazilian Community-Dwelling Older Adults

BACKGROUND/OBJECTIVES

Dietary patterns are able to capture the complexity of the diet. The present study aimed to compare the nutrient intake across different dietary patterns in Brazilian community-dwelling older adults.

METHODS

Dietary patterns from 295 (predominantly women, 85%) of Brazilian community-dwelling older adults were identified using principal component analysis, based on a 24 h dietary recall (24HR). The following patterns were identified: the "traditional" pattern (consisting of in natura or minimally processed food); the "modified" pattern (consisting of processed foods, confectionery), and the "snack" pattern (composed of coffee, whole milk, bread, toast, butter, or margarine). Participants were divided into three tertiles according to their scores in each pattern. A comparison of energy and nutrient intake across the tertiles of the three patterns was analyzed using the Kruskal-Wallis rank sum test. Then, the intake of energy and macro and micronutrients were analyzed.

RESULTS

Older adults with higher scores for the "traditional" pattern had significantly higher intakes of total energy, all macronutrients, beta-carotene, vitamin C, E and K, thiamine, pyridoxine, and total folate (p < 0.05). Participants with higher scores for the "modified" pattern had significantly higher intakes of total energy, added sugar, total and animal protein, leucine, arginine, monounsaturated fat, cholesterol, niacin, and pyridoxine; the second tertile had lower vitamin A than the first tertile (p < 0.05). Finally, older adults with higher scores for the "snack" pattern had significantly lower intakes of total and insoluble fiber, animal and vegetable proteins, vitamins (A, E, and K), niacin, and pyridoxine (p < 0.05). The "Traditional" pattern exhibited the most appropriate dietary pattern regarding the availability of essential nutrients, resulting in a better quality of habitual intake and outcomes that are related to health promotion and reduction in the risk of non-chronic issues.

CONCLUSIONS

The results reinforce the importance of public policies that encourage the maintenance of the traditional Brazilian dietary pattern, which is in alignment with Brazilian Dietary Guidelines, especially in the older population.

Intake of Table Sugar and Their Corresponding Food Sources in Adults from the 2017-2018 Brazilian National Dietary Survey

Excessive intake of free sugars is associated with adverse health outcomes. Table sugar is one of the main dietary sources of free sugars; however, the amount added by Brazilian consumers in their culinary preparations is unknown. The aims were to estimate the daily intake of table sugar (g/day), its contribution to total energy intake (E%) and the main food groups that contribute to the intake of this sugar in a nationwide multi-ethnic sample of Brazilian adults (2017-2018 Brazilian National Dietary Survey). Based on two 24-h recalls adjusted for the within-person variation, the overall median table sugar intake was 14.3 g/day, corresponding to 3.2 E%. Males, individuals living in rural areas, with low income, low education and experiencing food insecurity had a higher intake of table sugar. The main food sources of table sugar were coffee (55.8%), juice (33.9%), milk-based preparations and smoothies (3.1%), powdered and processed juice (2.7%), whole milk (1.9%), and tea (1.6%). There are no recommendations regarding the limit of table sugar intake, but considering that the WHO limits the intake of free sugars to <10 E%, it is concluded that table sugar intake by Brazilians corresponds to about 30% of the upper recommended daily intake of free sugars.

Evolution of adolescents' dietary patterns in Northeast Brazil from 2008 to 2018

OBJECTIVE

To evaluate the evolution of the dietary patterns of adolescents in the northeast region of Brazil.

METHODS

Secondary analysis of data from the Pesquisa de Orçamentos Familiares (POF - Household Budget Surveys), collected by the Brazilian Institute of Geography and Statistics (IBGE) in the years 2008-2009 and 2017-2018. A total of 3,095 adolescents were evaluated in 2008-2009 and 3,015 in 2017-2018. Food consumption was assessed using two dietary records in 2008-2009 and two 24-hour recalls in 2017-2018, applied on non-consecutive days. Based on these data, principal components factor analysis (PCFA) was performed, followed by orthogonal rotation of the varimax type, to derive dietary patterns, stratified by sex. The results were described as means or percentage frequencies, with their respective 95% confidence intervals.

RESULTS

Three main dietary patterns were identified among adolescents from the northeast region of Brazil. Among boys, in 2008-2009, the patterns were called snacks, traditional Brazilian, and coffee; and in 2017-2018, traditional Brazilian, snacks, and mixed, in this order of representativeness of the group's eating habits. Among female adolescents, in 2008-2009, the patterns were snacks, traditional Brazilian, and coffee; and in 2017-2018, traditional Brazilian, snacks, and processed meats.

CONCLUSION

The dietary patterns identified in 2008-2009 and 2017-2018 were similar in both genders; however, the snacks pattern, which explained most of the data variability in 2008-2009, was replaced by the traditional Brazilian.

The Association between Dietary Pattern, Obesity, and Glycemic Control of Children and Adolescents with Type 1 Diabetes Mellitus

AIMS

To evaluate the association between dietary patterns, obesity, and glycemic control in children and adolescents with type 1 diabetes mellitus (T1DM).

METHODS

A cross-sectional study was carried out in 2015 at a diabetes reference center in Rio de Janeiro. Sociodemographic data and those related to outpatient follow-ups were obtained from the medical records. The assessment of food consumption was performed using a 24 h food recall. Obesity was defined as body mass index-for-age (BMI-for-age) ≥ +1 z-score. Glycemic control was assessed using glycated hemoglobin (HbA1c). Dietary patterns were generated by factorial analysis, and each individual's adherence to these dietary patterns was determined by the factor loadings and then classified into terciles.

RESULTS

The study population included 120 children and adolescents, among whom 5 dietary patterns were identified. The prevalence of obesity was 31.7% (n = 38), and 64.2% (n = 77) of the participants had inadequate glycemic control. We observed that individuals with higher adherence to dietary pattern five, characterized by a greater consumption of ultra-processed foods, had higher odds of having higher HbA1c levels (OR = 3.49; 95% CI = 1.18-11.16).

CONCLUSIONS

Higher consumption of ultra-processed foods can be detrimental to glycemic control in children and adolescents. Thus, food intake monitoring is of paramount importance as part of the multidisciplinary care of patients with T1DM.

Dietary iron intake over two post-fortification periods in Brazil: data from the National Dietary Surveys 2008-2009 and 2017-2018

We aimed to assess the dietary Fe intake and the prevalence of inadequate Fe intake over two post-fortification periods in Brazil. The intake was analysed according to sex, life stage, geographic region and stratum of family income per capita. Excluding pregnant and lactating women, this population-based study included 32 749 and 44 744 participants aged ≥ 10 years from the National Dietary Survey-Brazilian Household Budget Surveys 2008-2009 and 2017-2018, respectively. The National Cancer Institute method was used to predict usual dietary Fe intakes. The prevalence of Fe intake inadequacy was estimated following a probabilistic approach for women of childbearing age or with the Estimated Average Requirement cut-off point method. Over an interval of 10 years, the mean Fe intake remained almost unchanged for most sex-age groups, except for women of childbearing age. In this specific group, the prevalence of Fe intake inadequacy was > 20 % in 2008-2009 and have increased to > 25 % in 2017-2018, with the highest reductions in mean Fe intake found in the highest income strata and richest Brazilian regions. Meanwhile, the highest prevalence of Fe intake inadequacy (> 40 %) occurred among the poorest women aged 31-50 years from the lowest family income stratum, irrespective of the study period. Beans were the main Fe source, while fortified breads, pastas, pizzas, cakes and cookies contributed approximately 40 % of the Fe intake. The results provide important insights into the long-standing dietary impacts of food fortification, which can guide future (re)formulation of effective public health strategies to combat Fe deficiency.

EXPLORATORY ANALYSIS OF DIETARY PATTERNS OF PATIENTS WITH GASTRIC ADENOCARCINOMA: A CASE-CONTROL STUDY IN CENTRAL BRAZIL

BACKGROUND

Diet is one of the most important modifiable risk factors for the incidence of gastric cancer.

OBJECTIVE

To carry out an exploratory analysis on the dietary patterns of individuals with gastric adenocarcinoma (AdG) in the Central Brazil region.

METHODS

This is a case-control study carried out from April 2019 to July 2022, in three reference centers for cancer treatment in Goiânia-GO. The cases were patients diagnosed with AdG, the control 1 dyspeptic patients submitted to upper digestive endoscopy and the control 2 patients without gastric complaints. In the three groups, patients aged 18 to 75 years and of both sexes were recruited. To assess food consumption, a Food Frequency Questionnaire validated for the Brazilian population was used. Dietary patterns were identified by Exploratory Factor Analysis (EFA), using principal component analysis as the extraction method, followed by Varimax rotation.

RESULTS

The commonality values in the EFA for the foods/food groups consumed by the cases and controls were above 0.30 for all variables. The variance explained by the model was 66.7% for cases, 60.3% for control 1 and 59.7% for control 2. Three eating patterns were identified in cases, control 1 and control 2 that explained 34, 87%, 35.41% and 33.25% respectively of the total variance. The first pattern ("healthy") was characterized by the consumption of vegetables, fruits, meat and cheese; the second ("unhealthy") for sausages, pizzas, snacks, ketchup, sweet drinks and instant noodles and the third ("prudent") rice, beans, meat and fried fish and pasta.

CONCLUSION

This study identified three dietary patterns among patients with AdG and controls in the Central Brazil region. According to the identified patterns, it will be possible to establish a relationship between diet and other epidemiological measures aimed at the prevention of gastric cancer.

Bioactive Compounds Intake of the Brazilian Population According to Geographic Region

Studies have been conducted in order to estimate bioactive compound consumption across populations, with substantial disparities according to the origin of the cohort examined. In this sense, Brazil is a continental country with marked differences in food plant availability across geographic regions. We aimed to estimate the bioactive compound intake according to Brazilian geographic region, as well as to determine the major contributors. Data were obtained from the National Dietary Survey 2017-2018, a cross-sectional population-based study including data on the individual food intake of 46,164 subjects aged ≥10 years. The consumption of polyphenols (total and classes) was significantly higher in the South compared with other regions (p = 0.0001). Total carotenoid intake was higher in the Midwest, followed by the Southeast (p = 0.0001). Tea was the main supplier of total polyphenol intake in the South, whereas coffee contributed the most to total polyphenol intake in other Brazilian regions. Açaí, caja juice, mango and corn were important suppliers of carotenoid intake in the North and Northeast. Bioactive compound intake presented variations according to Brazilian region, and individuals living in the South, Midwest and Southeast may experience higher bioactive-dense diets. We highlight the potential of many food plants for sustained explorations to the development of marketable products, possibly increasing the bioactive compound intake.

Meal-specific dietary patterns and biomarkers of insulin resistance in a sample of Iranian adults: a cross-sectional study

Current research emphasizes the habitual dietary pattern without differentiating eating occasions. We aimed to assess meal-specific dietary patterns and insulin resistance indicators. This cross-sectional study was conducted on 825 Iranian adults. Dietary data were recorded by three 24-h dietary recalls. Dietary patterns were identified using principal component analysis (PCA) on main meals and an afternoon snack. Anthropometric measurements, blood pressure, and laboratory investigation, fasting plasma glucose (FPG), triglyceride, insulin, c-reactive protein (CRP) were done. Homeostatic model assessment for insulin resistance and sensitivity (HOMA-IR and HOMA-IS), Triglycerides and glucose (TyG-index), and Lipid accommodation product index were calculated. We used multivariate analysis of variance (MANOVA) analysis. Two major dietary patterns at the main meals and the afternoon were identified. Higher adherence to "Bread, vegetable, and cheese" dietary pattern at breakfast was related to lower FPG, and "Oil, egg, and cereals" showed a direct association with body mass index, FPG, and TyG-index at breakfast. The "Western" pattern in lunch and dinner directly related to waist circumference (WC) and body mass index, however, it was inversely related to HOMA-IS. This pattern at dinner was related to higher CRP. Higher adherence to "bread, cereals, and oil" pattern at afternoon snack was associated with a lower WC. These results indicated that unhealthy meal-specific dietary patterns are associated with a greater chance of obesity and insulin resistance risk. However, "Bread, vegetable, and cheese" dietary pattern at breakfast was related to lower FPG, and "bread, cereals, and oil" pattern in the afternoon was associated with lower WC.

Association between Diet and Adiposity in Adults: Influence of Sedentary Behavior Patterns

This study analyzed the influence of sedentary behavior (SB) on the association between dietary patterns and adiposity in community-dwelling adults. Eight hundred and forty-three adults (age: 56.5 ± 18.3 years) participated in this cross-sectional epidemiological study. Dietary patterns were evaluated using self-report questions regarding the weekly frequency of consumption of certain foods. Adiposity was determined using anthropometric measurements of weight, waist circumference, and height. SB was evaluated according to the time spent on screen devices. The usual physical activity level and socioeconomic status were considered confounding factors. Associations were determined using multivariate linear models with simultaneous adjustments for confounding variables. A statistical analysis indicated that fruit consumption was negatively related to the body mass index, regardless of the adjustment for SB domains. Red meat consumption was positively related to the body mass index, and fried food consumption was positively related to the waist-to-height ratio, regardless of the adjustment for SB domains. The consumption of fried food was positively associated with global and central adiposity after the adjustments for confounding factors and time spent on screen devices. We concluded that dietary habits are related to adiposity in adults. However, SB domains seem to influence the relationship between body adiposity and dietary habits, mainly regarding the consumption of fried foods.

Food Consumption during Binge Eating Episodes in Binge Eating Spectrum Conditions from a Representative Sample of a Brazilian Metropolitan City

The prevalence of binge eating spectrum conditions (BESC) are increasing globally. However, there is a lack of data from general population samples in low- and middle-income countries. Thus, this study described the food consumption during objective binge eating episodes (OBE) in people with BESC from a metropolitan city in Brazil. Participants comprised 136 adults (18 years old-60 years old) with Binge Eating Disorder (BED), Bulimia Nervosa (BN), or recurrent binge eating (RBE) from a two-phase epidemiological survey. They were interviewed in their homes by trained lay interviewers using the Questionnaire on Eating and Weight Patterns updated for the DSM-5 to assess BESC diagnosis and food consumption during a typical OBE. Overall, participants consumed a mean of 1067 kcal during the episodes. For the most part, these calories were derived from carbohydrates (58%) and lipids (30%), irrespective of the diagnosis. Regarding food item consumption, individuals with BED and RBE consumed staple foods (mainly rice and beans) more frequently than those with BN. Conversely, participants with BN ingested sugar-sweetened beverages more frequently than the BED group. In conclusion, there were differences in the eating patterns of individuals with BESC in Brazil. BED and RBE participants consumed more typical foods, whereas those with BN preferred foods with a high content of energy during their OBE.

Hyperpalatable Foods Consumption in a Representative Sample of the General Population in Brazil: Differences of Binge and Non-Binge Eating Meals

The availability of hyper-palatable foods (HPF) increased over the past three decades worldwide, a period when eating disorders (ED) and obesity have become global public health concerns. The present study aimed to assess HPF consumption during binge and non-binge meals in a representative sample of adults with and without ED from a metropolitan city in Brazil. A total of 2297 individuals were interviewed in their homes by trained lay interviewers to assess the presence of binge eating disorder (BED), bulimia nervosa (BN), and recurrent binge eating (RBE). Information on their food consumption in objective and subjective binge eating episodes (OBE and SBE, respectively), as well as in the 24 h food recall were obtained. Individuals from the general population consumed 56% of their total calories from HPF. In non-binge meals, people with BN consumed substantially fewer calories from HPF than BED (63% vs. 48%) and RBE (63% vs. 48%) groups. During OBE, participants consumed an average of 70% of the calories from HPF, with no between-group differences. During SBE, subjects with BN consumed substantially fewer calories from HPF than those with BED (76% vs. 50%). In conclusion, HPF were highly consumed by the Brazilian population. However, there was a greater impact on BED and RBE subjects and during binge eating episodes.

Dietary pattern changes, obesity and excess body fat in adults of a Brazilian birth cohort

BACKGROUND

Few studies have assessed dietary patterns (DPs) and the changes in these patterns over time in adults. The present study aimed to investigate whether possible changes in DPs in two assessments are associated with obesity and excess body fat.

METHODS

A prospective study was conducted in which data were collected from 1082 adults of a Brazilian birth cohort during two periods 15 years apart (T1: 2002-2004; T2: 2016-2017). Food consumption was assessed in both periods using validated food frequency questionnaires. Three similar DPs were found in the two assessments, and adherence to these patterns was classified as prudent, risk or mixed. Nine DPs changes were defined. At T2, subjects with a body mass index ≥ 30.0 kg m^- ² were classified as obese, and men and women with a body fat (BF) percentage ≥ 25.0 and ≥ 35.0, respectively, were classified as having excess BF. A directed acyclic graph was built to adjust the association for confounding variables.

RESULTS

At T2, 34.4% of the subjects were obese and 61.4% had excess BF. In the adjusted analysis, the changes associated with obesity and excess BF were prudent-mixed (prevalence ratio [PR] 1.55; 95% confidence interval [CI] = 1.04-2.29 and PR = 1.35; 95% CI = 1.10-1.65), risk-risk (PR = 1.49; 95% CI = 1.03-2.13 and PR = 1.27; 95% CI = 1.04-1.53), risk-mixed (PR = 1.56; 95% CI = 1.05-2.31 and PR = 1.33; 95% CI = 1.07-1.63) and mixed-risk (PR = 1.61; 95% CI = 1.10-2.35 and PR = 1.29; 95% CI = 1.04-1.58).

CONCLUSIONS

A decline in food quality over time or stagnation in an unhealthy DP can lead to obesity and excess BF.

Correlates of Physical Activity in Brazilian Older Adults: The National Health Survey 2019

Engagement in physical activity (PA) depends on intrapersonal, interpersonal/cultural, organizational, physical environment and political factors. Considering that it is important to understand this phenomenon in different populational contexts, this study aimed to investigate the factors related to engagement in PA according to sociodemographic aspects, eating habits, self-rated health, activities of daily living, noncommunicable diseases, mental health and public policies in Brazilian older people. This study had a cross-sectional design and used data from the Brazilian National Health Survey, 2019. Sample size was composed of 22,726 participants, aged 60 years or older, of both sexes, and all the data were collected by interview/questionnaire. According to the adjusted logistic regression, males were more active than females (OR = 1.59 (95% CI 1.40-1.80)), and those living in northern and northeastern Brazil were more likely to be inactive when compared to the southeastern region. Moreover, those with a higher educational level and income (OR = 1.36 (1.06-1.73) and OR = 1.60 (1.22-2.11)); with healthy eating habits (OR = 1.05 (1.03-1.06)); with positive self-rated health (OR = 2.67 (95% CI 1.51-4.71)); with better functional autonomy (OR = 1.22 (1.17-1.27)); and who reported that there was some public place (square, park, closed street, beach) to go for a walk, exercise or practice sport close to their home were more likely to be active (OR = 1.49 (1.34-1.67)). Sociodemographic factors, healthy eating habits, positive self-rated health, higher functioning in activities of daily living and living close to places where PA is practiced were associated with regular engagement in PA (i.e., ≥150 min/week).

Food Insecurity Reduces the Chance of Following a Nutrient-Dense Dietary Pattern by Brazilian Adults: Insights from a Nationwide Cross-Sectional Survey

Dietary patterns derived by data-driven techniques are still scarce in the food security context and may be a useful tool to inform policymakers to promote adequate and healthy diets for vulnerable populations. We investigated the association between food security status and dietary patterns among 28,127 Brazilian adults using data from the 2017–2018 Household Budget Survey. Food security status was measured by the Brazilian Food Insecurity Scale. Food items reported in two 24 h dietary recalls were combined into food groups. Dietary patterns were derived from exploratory factor analysis, and participants were grouped according to their factor scores by K-means cluster analysis. Multiple logistic regression models were fitted to investigate the association between food security status and clusters of adherence to dietary patterns. Four dietary patterns were derived: ‘Brazilian breakfast style’ (cluster 3), ‘Brazilian Traditional staple foods’ (cluster 2), ‘Beverages, ready-to-eat and convenience foods’ (cluster 4), and ‘Fruits, vegetables, and whole grains’ (cluster 1). After adjustments, food insecurity was inversely associated with adherence to the ‘Fruits vegetables, and whole grains’ pattern (OR = 0.75, 95% CI: 0.63–0.89). Findings suggest food insecurity negatively impact the adoption of a nutrient-dense dietary pattern and highlight the critical role of policy actions in a scenario of increasing food insecurity.