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Zulkifli MF, Masimen MAA, Ridzuan PM, Wan Ismail WI. Exploring honey's potential as a functional food for natural sleep aid. Food Funct 2024; 15:9678-9689. [PMID: 39248637 DOI: 10.1039/d4fo02013h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
Sleep disorders present significant challenges to public health, necessitating effective and sustainable solutions beyond conventional pharmacological interventions. This study aims to investigate the potential of honey and its compositions as a functional food for addressing sleep disorders. A comprehensive review of existing literature explores honey's intrinsic properties and impact on sleep quality. The findings suggest that honey, with its unique composition and soothing effects, offers a promising avenue for enhancing sleep patterns without relying on pharmaceutical drugs. This study also discusses the possible mechanism of action and the challenges of using honey in this field. While further research is needed to elucidate specific mechanisms and optimal utilisation, integrating honey into holistic sleep management strategies holds promise for improving overall well-being and quality of life.
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Affiliation(s)
- Muhammad Faiz Zulkifli
- Department of Research and Development, BioInnovSphere Labs, 21030 Kuala Nerus, Terengganu, Malaysia.
- Cell Signalling and Biotechnology Research Group (CeSBTech), Faculty of Science and Marine Environment, Universiti Malaysia Terengganu, 21030 Kuala Nerus, Terengganu, Malaysia
| | - Mohammad Asyraf Adhwa Masimen
- Department of Research and Development, BioInnovSphere Labs, 21030 Kuala Nerus, Terengganu, Malaysia.
- Cell Signalling and Biotechnology Research Group (CeSBTech), Faculty of Science and Marine Environment, Universiti Malaysia Terengganu, 21030 Kuala Nerus, Terengganu, Malaysia
| | - P M Ridzuan
- Department of Research and Development, Dr. Ridz Research Centre, 21030, Kuala Nerus, Terengganu, Malaysia
| | - Wan Iryani Wan Ismail
- Department of Research and Development, BioInnovSphere Labs, 21030 Kuala Nerus, Terengganu, Malaysia.
- Biological Security and Sustainability Research Group (BIOSES), Faculty of Science and Marine Environment, Universiti Malaysia Terengganu, 21030 Kuala Nerus, Terengganu, Malaysia
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Schiza S, Bouloukaki I, Kaditis A, Lombardi C, Bonsignore MR. Vitamin D deficiency: A forgotten aspect in sleep disorders? A critical update. Sleep Med 2024; 121:77-84. [PMID: 38941960 DOI: 10.1016/j.sleep.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/28/2024] [Accepted: 06/23/2024] [Indexed: 06/30/2024]
Abstract
Over the past few years, there has been a surge in interest regarding the connection between sleep duration and quality, sleep disorders, mainly Obstructive sleep apnoea (OSA) and Vitamin D. There is growing evidence to support a new role of Vitamin D in the maintenance and regulation of optimal sleep. Furthermore, a notable link has been identified between OSA and a decrease in serum Vitamin D levels, which appears to intensify as the severity of sleep apnea worsens. Vitamin D status could also potentially serve as a mediator or provide an explanation for the association between OSA and cardiometabolic morbidity, but the current state of research in this area is inadequate. Studies have indicated that the supplementation of Vitamin D can optimize sleep quality, presenting more proof of the connection between insufficient vitamin D levels and sleep disorders. However, it is unclear whether low serum Vitamin D levels are a contributing factor to OSA development or if OSA predisposes individuals to Vitamin D deficiency. As a result, various studies have endeavored to examine the complex relationship between OSA and Vitamin D deficiency. In children and adolescents, while data is limited, there seems also to be a link between sleep disorders and Vitamin D levels. Therefore, the objective of this review is to provide a comprehensive overview of the current evidence on the association between Vitamin D and sleep disorders in both adults and children.
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Affiliation(s)
- Sophia Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece.
| | - Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Athanasios Kaditis
- Division of Pediatric Pulmonology and Cystic Fibrosis Center, Department of Child Health, University of Missouri School of Medicine, MUHC Children's Hospital, Columbia, MO, USA; Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, St. Luke Hospital, Milan, Italy
| | - Maria R Bonsignore
- Division of Respiratory Medicine, PROMISE Dept, University of Palermo, Palermo, Italy; IBIM CNR, Palermo, Italy
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Maniaci A, Lavalle S, Parisi FM, Barbanti M, Cocuzza S, Iannella G, Magliulo G, Pace A, Lentini M, Masiello E, La Via L. Impact of Obstructive Sleep Apnea and Sympathetic Nervous System on Cardiac Health: A Comprehensive Review. J Cardiovasc Dev Dis 2024; 11:204. [PMID: 39057624 PMCID: PMC11277108 DOI: 10.3390/jcdd11070204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/22/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024] Open
Abstract
A prevalent condition linked to an elevated risk of cardiovascular disease is sleep apnea. This review examines the connections between cardiac risk, the sympathetic nervous system, and sleep apnea. The increased risk of hypertension, arrhythmias, myocardial infarction, and heart failure was highlighted in the pathophysiology of sleep apnea and its effect on sympathetic activation. It is also important to consider potential processes such as oxidative stress, inflammation, endothelial dysfunction, and autonomic imbalance that may relate sleep apnea-induced sympathetic activation to cardiac risk. With implications for creating innovative diagnostic and treatment approaches to lessen the cardiovascular effects of sleep apnea, the goal of this investigation is to improve the understanding of the intricate link between sympathetic activity, cardiac risk, and sleep apnea. This study aimed to clarify the complex relationship between cardiovascular health and sleep apnea by synthesizing the available research and highlighting the crucial role played by the sympathetic nervous system in moderating this relationship. Our thorough investigation may have important therapeutic ramifications that will direct the creation of focused therapies to enhance cardiovascular outcomes in sleep apnea sufferers.
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Affiliation(s)
- Antonino Maniaci
- Department of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy; (A.M.); (M.B.)
| | - Salvatore Lavalle
- Department of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy; (A.M.); (M.B.)
| | - Federica Maria Parisi
- Department of Medical, Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy; (F.M.P.); (S.C.)
| | - Marco Barbanti
- Department of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy; (A.M.); (M.B.)
| | - Salvatore Cocuzza
- Department of Medical, Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95123 Catania, Italy; (F.M.P.); (S.C.)
| | - Giannicola Iannella
- Otorhinolaryngology Department, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 00161 Rome, Italy; (G.I.); (G.M.); (A.P.)
| | - Giuseppe Magliulo
- Otorhinolaryngology Department, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 00161 Rome, Italy; (G.I.); (G.M.); (A.P.)
| | - Annalisa Pace
- Otorhinolaryngology Department, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 00161 Rome, Italy; (G.I.); (G.M.); (A.P.)
| | - Mario Lentini
- ASP Ragusa-Hospital Giovanni Paolo II, 97100 Ragusa, Italy;
| | - Edoardo Masiello
- Radiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Luigi La Via
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Policlinico “G. Rodolico–San Marco”, 95123 Catania, Italy
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Menezes-Júnior LAAD, Sabião TDS, Moura SSD, Batista AP, Menezes MCD, Carraro JCC, Machado-Coelho GLL, Meireles AL. The role of interaction between vitamin D and VDR FokI gene polymorphism (rs2228570) in sleep quality of adults. Sci Rep 2024; 14:8141. [PMID: 38584183 PMCID: PMC10999418 DOI: 10.1038/s41598-024-58561-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 04/01/2024] [Indexed: 04/09/2024] Open
Abstract
To evaluate association of vitamin D with sleep quality in adults and the influence of VDR-gene polymorphism FokI (rs2228570;A > G). Cross-sectional population-based study in adults, conducted in Brazil. The outcome was sleep-quality, evaluated by the Pittsburgh Sleep Quality Index. Vitamin D was determined by indirect electrochemiluminescence and classified as deficiency (VDD), 25(OH)D < 20 ng/mL in a healthy population or 25(OH)D < 30 ng/mL for groups at risk for VDD. FokI polymorphism in the VDR-gene was genotyped by qPCR and classified as homozygous wild (FF or AA), heterozygous (Ff or AG), or homozygous mutant (ff or GG). Multivariate logistic analysis was used to estimate the association between vitamin D and FokI polymorphism with sleep-quality. In a total of 1674 individuals evaluated, 53.6% had poor-sleep-quality, 31.5% had VDD, and the genotype frequency of the FokI polymorphism was 9.9% FF, 44.6% Ff, and 45.5% ff. In multivariate analysis, individuals with VDD had 1.51 times the chance of poor-sleep-quality, and individuals with the ff genotype had 1.49 times the chance of poor-sleep-quality (OR:1.49;95%CI:1.05-2.12) when compared to individuals with the FF or Ff genotype. In the combined analysis, individuals with VDD and ff genotype had more chance of poor-sleep-quality than individuals with sufficient vitamin D and genotype Ff or FF (OR:2.19;95%CI:1.27-3.76). Our data suggest that VDD and VDR FokI gene polymorphism are associated with poor-sleep-quality, and combining the two factors increases the chance of poor-sleep-quality compared to separate groups.
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Affiliation(s)
- Luiz Antônio Alves de Menezes-Júnior
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, R. Diogo de Vasconcelos, 122, Ouro Preto, MG, Brazil.
- Research and Study Group On Nutrition and Public Health (GPENSC), Federal University of Ouro Preto, Ouro Preto, Brazil.
- Department of Clinical and Social Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, MG, Brazil.
| | - Thais da Silva Sabião
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, R. Diogo de Vasconcelos, 122, Ouro Preto, MG, Brazil
- Research and Study Group On Nutrition and Public Health (GPENSC), Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Samara Silva de Moura
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, R. Diogo de Vasconcelos, 122, Ouro Preto, MG, Brazil
- Research and Study Group On Nutrition and Public Health (GPENSC), Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Aline Priscila Batista
- Postgraduate Programs in Biological Sciences, Institute of Biological Sciences, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
- School of Medicine, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
| | - Mariana Carvalho de Menezes
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, R. Diogo de Vasconcelos, 122, Ouro Preto, MG, Brazil
- Research and Study Group On Nutrition and Public Health (GPENSC), Federal University of Ouro Preto, Ouro Preto, Brazil
- Department of Clinical and Social Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
| | - Júlia Cristina Cardoso Carraro
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, R. Diogo de Vasconcelos, 122, Ouro Preto, MG, Brazil
- Research and Study Group On Nutrition and Public Health (GPENSC), Federal University of Ouro Preto, Ouro Preto, Brazil
- Department of Clinical and Social Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
| | - George Luiz Lins Machado-Coelho
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, R. Diogo de Vasconcelos, 122, Ouro Preto, MG, Brazil
- Postgraduate Programs in Biological Sciences, Institute of Biological Sciences, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
- School of Medicine, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
| | - Adriana Lúcia Meireles
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, R. Diogo de Vasconcelos, 122, Ouro Preto, MG, Brazil
- Research and Study Group On Nutrition and Public Health (GPENSC), Federal University of Ouro Preto, Ouro Preto, Brazil
- Department of Clinical and Social Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
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Minoretti P, Santiago Sáez A, García Martín Á, Liaño Riera M, Gómez Serrano M, Emanuele E. Serum Calcium and Magnesium Levels, Not 25-Hydroxyvitamin D, Are Associated With Sleep Quality in Airline Pilots. Cureus 2023; 15:e50940. [PMID: 38259397 PMCID: PMC10801269 DOI: 10.7759/cureus.50940] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Despite the vulnerability of airline pilots (APs) to sleep disturbances, the biological underpinnings responsible for this phenomenon are still not entirely elucidated. However, there is an increasing amount of evidence indicating an association between 25-hydroxyvitamin D, Ca2+, and Mg2+ levels and sleep health. In this cross-sectional study, we sought to examine the potential associations between serum levels of these biomarkers and the occurrence of poor sleep among APs. METHODS We examined a convenience sample of 100 male APs who underwent the Pittsburgh Sleep Quality Index (PSQI) to assess their sleep quality. Those who scored 5 or higher on the PSQI were labeled as poor sleepers. Serum levels of 25-hydroxyvitamin D, Ca2+, and Mg2+ were quantified in all participants. RESULTS Out of the 100 APs, 58 (58%) and 42 (42%) were classified as good and poor sleepers, respectively, based on the PSQI scores. We defined vitamin D deficiency as serum 25-hydroxyvitamin D levels below 10 ng/mL and insufficiency as levels ranging from 10 to 30 ng/mL. The results revealed no significant differences in serum levels of 25-hydroxyvitamin D between the two groups, and there was no evidence of vitamin D deficiency or insufficiency. However, poor sleepers exhibited significantly lower levels of both Mg2+ (1.8 ± 0.1 mg/dL versus2.0 ± 0.1 mg/dL, respectively) and Ca2+ (8.5 ± 0.4 mg/dL versus9.1 ± 0.5 mg/dL, respectively) compared to good sleepers (P < 0.001 for both). Logistic regression analysis identified both Mg2+ and Ca2+ as independent biomarkers associated with poor sleep quality in APs (P < 0.001 for both). CONCLUSION Lower serum concentrations of Mg2+ and Ca2+, not 25-hydroxyvitamin D, may be associated with poor sleep in APs.
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Affiliation(s)
| | - Andrés Santiago Sáez
- Legal Medicine, Hospital Clinico San Carlos, Madrid, ESP
- Legal Medicine, Psychiatry, and Pathology, Complutense University of Madrid, Madrid, ESP
| | - Ángel García Martín
- Legal Medicine, Psychiatry, and Pathology, Complutense University of Madrid, Madrid, ESP
| | - Miryam Liaño Riera
- Legal Medicine, Psychiatry, and Pathology, Complutense University of Madrid, Madrid, ESP
| | - Manuel Gómez Serrano
- Legal Medicine, Psychiatry, and Pathology, Complutense University of Madrid, Madrid, ESP
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Xie Y, Bai C, Feng Q, Gu D. Serum Vitamin D 3 Concentration, Sleep, and Cognitive Impairment among Older Adults in China. Nutrients 2023; 15:4192. [PMID: 37836477 PMCID: PMC10574235 DOI: 10.3390/nu15194192] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Cognitive decline in older adults has become one of the critical challenges to global health. This study aims to examine both cross-sectional and longitudinal associations of levels of serum 25-hydroxyvitamin D3 (25(OH)D3) (briefed as VD3) concentration and sleep quality/duration, especially their interactions, with risk of cognitive impairment among older adults in China. METHODS We utilized a special subsample of adults aged 65-105 years (individuals = 3412, observations = 4816) from eight provinces in China derived from the 2011/2012 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey. Cognitive impairment was measured by the Mini-Mental State Examination scale. Sleep quality was classified as good versus fair/poor, and sleep duration was classified into short (<7 h), normal (≥7 but <9 h), and long (≥9 h). The VD3 concentration was divided into three levels: deficiency (VD3 < 25 nmol/L), insufficiency (25 nmol/L ≤ VD3 < 50 nmol/L), and sufficiency (VD3 ≥ 50 nmol/L). A wide set of covariates that include demographics, socioeconomic status, family support, health practice, and health conditions was adjusted for robust findings. Multilevel random intercept logit regression models were used to examine the cross-sectional associations between VD3, sleep, and cognitive impairment, whereas logit regression models were applied to investigate the longitudinal associations. RESULTS In the cross-sectional analyses, when all covariates were adjusted, VD3 sufficiency was significantly associated with a 33% lower risk of cognitive impairment compared with VD3 deficiency; good sleep quality was associated with 34% lower odds of cognitive impairment compared with fair/poor sleep quality; sleep hours were not associated with cognitive impairment, although a long sleep duration (≥9 h) was associated with 30% higher odds of being cognitively impaired when baseline health was not controlled. Interaction analyses reveal that VD3 sufficiency could help to additionally reduce the risk of cognitive impairment for good sleep quality and normal sleep hours. In the longitudinal analyses, the association of VD3 sufficiency remains significant, whereas sleep quality and sleep duration were not significant associates. CONCLUSIONS Good sleep quality, normal sleep hours, and VD3 sufficiency are positively associated with good cognitive function. VD3 sufficiency could enhance the associations between sleep and cognitive impairment.
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Affiliation(s)
- Yuning Xie
- School of Labor and Human Resources, Renmin University of China, Beijing 100872, China; (Y.X.); (C.B.)
| | - Chen Bai
- School of Labor and Human Resources, Renmin University of China, Beijing 100872, China; (Y.X.); (C.B.)
| | - Qiushi Feng
- Centre for Family and Population Research, Department of Sociology and Anthropology, National University of Singapore, Singapore 119077, Singapore
| | - Danan Gu
- Independent Researcher, Nanjing 210042, China
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de Menezes-Júnior LAA, Sabião TDS, de Moura SS, Batista AP, de Menezes MC, Carraro JCC, Andrade ACDS, Machado-Coelho GLL, Meireles AL. Influence of sunlight on the association between 25-hydroxyvitamin D levels and sleep quality in Brazilian adults: A population-based study. Nutrition 2023; 110:112008. [PMID: 36940625 PMCID: PMC9941068 DOI: 10.1016/j.nut.2023.112008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES This study aimed to evaluate the association of vitamin D with sleep quality during the COVID-19 pandemic and the influence of daily sunlight on this association. METHODS This cross-sectional, population-based study among adults stratified by multistage probability cluster sampling was conducted from October to December 2020 in the Iron Quadrangle region of Brazil. The outcome was sleep quality, evaluated by the Pittsburgh Sleep Quality Index. Vitamin D (25-hydroxyvitamin D) concentrations were determined by indirect electrochemiluminescence and a deficiency was classified as 25(OH)D < 20 ng/mL. To assess sunlight, the average daily sunlight exposure was calculated and was classified as insufficient when less than 30 min/d. Multivariate logistic analysis was used to estimate the association between vitamin D and sleep quality. A directed acyclic graph was used to select minimal and sufficient sets of adjustment variables for confounding from the backdoor criterion. RESULTS In a total of 1709 individuals evaluated, the prevalence of vitamin D deficiency was 19.8% (95% CI, 15.5-24.9%), and the prevalence of poor sleep quality was 52.5% (95% CI, 48.6-56.4%). In multivariate analysis, vitamin D was not associated with poor sleep quality in individuals with sufficient sunlight. Moreover, in individuals with insufficient sunlight, vitamin D deficiency was associated with poor sleep quality (odds ratio [OR], 2.02; 95% CI, 1.10-3.71). Furthermore, each 1-ng/mL increase in vitamin D levels reduced the chance of poor sleep quality by 4.2% (OR, 0.96; 95% CI, 0.92-0.99). CONCLUSIONS Vitamin D deficiency was associated with poor sleep quality in individuals with insufficient exposure to sunlight.
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Affiliation(s)
- Luiz Antônio Alves de Menezes-Júnior
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil; Research and Study Group on Nutrition and Public Health (GPENSC), Federal University of Ouro Preto, Brazil.
| | - Thais da Silva Sabião
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil; Research and Study Group on Nutrition and Public Health (GPENSC), Federal University of Ouro Preto, Brazil.
| | - Samara Silva de Moura
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil; Research and Study Group on Nutrition and Public Health (GPENSC), Federal University of Ouro Preto, Brazil.
| | | | - Mariana Carvalho de Menezes
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil; Research and Study Group on Nutrition and Public Health (GPENSC), Federal University of Ouro Preto, Brazil; Department of Clinical and Social Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil.
| | - Júlia Cristina Cardoso Carraro
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil; Research and Study Group on Nutrition and Public Health (GPENSC), Federal University of Ouro Preto, Brazil; Department of Clinical and Social Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil.
| | | | - George Luiz Lins Machado-Coelho
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil; School of Medicine, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil.
| | - Adriana Lúcia Meireles
- Postgraduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil; Research and Study Group on Nutrition and Public Health (GPENSC), Federal University of Ouro Preto, Brazil; Department of Clinical and Social Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil.
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