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Verly E, Jolliet O. Moderate low-cost modifications in diet prevent a substantial number of deaths and mitigate environmental impacts in Brazil. Eur J Nutr 2024; 63:1783-1796. [PMID: 38622295 DOI: 10.1007/s00394-024-03375-1] [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: 03/29/2023] [Accepted: 03/16/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE This study aimed to estimate the health, economic, and environmental impacts of moderate simulated interventions on dietary intake in Brazil. METHODS Data on food price and consumption were obtained from three nationwide surveys. Baseline dietary intake was estimated for 33,859 individuals aged 25 years and older. Counterfactual intakes were based on six hypothetical intervention scenarios, by changing the weekly frequency and serving size in low or high consumers of fruit and vegetables (FV), milk, whole grains, red and processed meats, and sugar-sweetened beverages. For each scenario, we estimated the attributable number of deaths and disability-adjusted life years (DALY), monetary cost, environmental impacts (14 midpoint indicators), and environmentally-mediated health impacts. RESULTS Compared with the baseline intake and cost, the most expensive intervention (+ 8.3%) was to increase FV intake (+ 125 g), resulting in a 1.2% reduction in all-cause mortality (16,307 deaths/year). The cheapest (- 9.9%) was to reduce red and processed meat intake (- 40 g), resulting in a 1.1% reduction in all-cause mortality (14,272 deaths/year). The combined intervention was, on average, 3.7% cheaper than the baseline cost, resulting in an increase in diet cost for 30% of the population (45-22% in the lower- and higher-income groups); all-cause mortality would be reduced by 3.8% (49,488 deaths/year). Interventions targeting red and processed meats would reduce emissions and resource use by 35-55%, in addition to reducing 2300 DALYs/year. CONCLUSION A meaningful number of deaths can be avoided and environmental impacts reduced through moderate and potentially affordable diet modifications.
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Affiliation(s)
- Eliseu Verly
- Institute of Social Medicine, Rio de Janeiro State University, Rua São Francisco Xavier, 524, Rio de Janeiro, RJ, 20550-013, Brazil.
| | - Olivier Jolliet
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Department of Sustain, Technical University of Denmark, Anker Engelunds Vej 1 Bygning 101A, 2800, Kgs. Lyngby, Hovedstaden, Denmark
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Viroli G, Kalmpourtzidou A, Cena H. Exploring Benefits and Barriers of Plant-Based Diets: Health, Environmental Impact, Food Accessibility and Acceptability. Nutrients 2023; 15:4723. [PMID: 38004117 PMCID: PMC10675717 DOI: 10.3390/nu15224723] [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: 10/11/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Unhealthy dietary patterns are directly linked to the current Global Syndemic consisting of non-communicable diseases, undernutrition and climate change. The dietary shift towards healthier and more sustainable plant-based diets is essential. However, plant-based diets have wide intra differences; varying from vegan diets that totally exclude meat and animal products to traditional ones such as the Mediterranean diet and the new Nordic diet. It is acknowledged that plant-based diets may contribute simultaneously to improving population health as well as to decreasing the environmental impact of food systems. Evidence from cohort and randomized-controlled trials suggests that plant-based dietary patterns have beneficial effects on bodyweight control, cardiovascular health and diabetes prevention and treatment. On the other hand, micronutrient requirements may not be met, if some plant-based diets are not well-planned. Additionally, studies showed that lower consumption of meat and animal products results in lower environmental impacts. Consequently, plant-based diets could be a key factor to increase diet sustainability. This narrative review addresses the advantages of adherence to plant-based diets on human and planetary health considering strains and barriers to achieve this dietary transition, including cultural acceptability and affordability factors. Finally, potential intervention and policy recommendations are proposed, focusing on the update of current national food-based dietary guidelines.
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Affiliation(s)
- Giulia Viroli
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (A.K.); (H.C.)
| | - Aliki Kalmpourtzidou
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (A.K.); (H.C.)
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (A.K.); (H.C.)
- Clinical Nutrition Unit, General Medicine, ICS Maugeri IRCCS, 27100 Pavia, Italy
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Canaan JCDR, Canaan MM, Costa PD, Pereira MDA, Castelo PM, Pardi V, Murata RM, Pereira LJ. Food preferences and periodontal status of adults assisted by a public health care system. PLoS One 2023; 18:e0291878. [PMID: 37851692 PMCID: PMC10584113 DOI: 10.1371/journal.pone.0291878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/07/2023] [Indexed: 10/20/2023] Open
Abstract
This study aimed to investigate the relationship between food choices and periodontal health status (PHS) in adults who receive care through a public health system. We evaluated food preferences and periodontal status in a sample of 442 individuals with at least eight natural teeth. We employed the Food Frequency Questionnaire (FFQ) to assess food choices and the Periodontal Screening and Recording (PSR) instrument to evaluate periodontal health status during clinical appointments. Fisher's discriminant analysis was used to differentiate the participants according to PHS severity within three age-ranges (18-39; 40-59 and > 60 years-old). The results showed that the prevalence of overweight/obesity was high in all age groups (above 65%), and BMI increased with age, accompanied by an increase in the prevalence of chronic diseases. A lower preference for natural foods and a higher intake of processed and ultra-processed foods, along with a high waist circumference and diabetes, were associated with a poorer periodontal health status. In the 18-39 age group, a lower waist circumference was associated with healthier periodontal status. In the 40-59 age group, a worse periodontal status resulted from a higher frequency of diabetes, lower intake of green leafy vegetables, olive oil, and fruit, and higher intake of industrialized juice. Conversely, a healthier periodontal status was associated with a lower frequency of diabetes and higher intake of fruit and vegetables. In the > 60age group, the worst periodontal status was associated with male sex. Overall, the study highlights the possible beneficial role of a healthy diet in maintaining periodontal health, particularly for those who receive care through a public health system.
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Affiliation(s)
| | - Marcelo Martins Canaan
- Department of Medicine, Universidade Federal de Lavras (UFLA), Lavras, Minas Gerais, Brazil
| | - Patrícia Daniela Costa
- Department of Medicine, Universidade Federal de Lavras (UFLA), Lavras, Minas Gerais, Brazil
| | | | - Paula Midori Castelo
- Department of Pharmaceutical Sciences, Universidade Federal de São Paulo (UNIFESP), Diadema, São Paulo, Brazil
| | - Vanessa Pardi
- Department of Foundational Sciences, School of Dental Medicine, East Carolina University (ECU), Greenville, NC, United States of America
| | - Ramiro Mendonça Murata
- Department of Foundational Sciences, School of Dental Medicine, East Carolina University (ECU), Greenville, NC, United States of America
| | - Luciano José Pereira
- Department of Medicine, Universidade Federal de Lavras (UFLA), Lavras, Minas Gerais, Brazil
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Verly E, Machado ÍE, Meireles AL, Nilson EAF. Avoidable diet-related deaths and cost-of-illness with culturally optimized modifications in diet: The case of Brazil. PLoS One 2023; 18:e0288471. [PMID: 37432939 DOI: 10.1371/journal.pone.0288471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 06/27/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Dietary risk factors have an important impact on premature deaths and disabilities due to non-communicable diseases. In this study, we perform diet optimization to design different dietary scenarios taking into account food prices and preferences and evaluate the number of deaths that would be prevented as well as the economic burden and costs from the health system that would be saved in Brazil. METHODS We used dietary intake and food prices data from the nationwide Household Budget Survey (HBS) and the National Dietary Survey (NDS) 2017-2018. Linear programming models were performed to design five scenarios which different sets of key diet modifications at the least deviation from the baseline consumption. Comparative risk assessment models were used to estimate the health impacts of optimized dietary changes on mortality and the economic impacts on morbidity (hospitalizations) and premature deaths. RESULTS The optimized diets were, on average, more expensive than the baseline diets, varying from Int$ (international dollar) 0.02/day to 0.52/day/adult. The number of deaths prevented or postponed varied from 12,750 (10,178-15,225) to 57,341 (48,573-66,298) according to the different scenarios. The diet modifications would save from 50 to 219 million in hospitalizations and from 239 to 804 million yearly in productivity losses with the reduction of premature deaths. CONCLUSION A substantial number of deaths and costs due to hospitalization and productivity losses would be avoidable even with small changes in diets. However, even the cheapest intervention might be prohibitive for deprived families, yet subsidies and social policies could contribute to improving diets.
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Affiliation(s)
- Eliseu Verly
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Ísis Eloah Machado
- Medicine School, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
| | | | - Eduardo A F Nilson
- Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo, SP, Brazil
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Heerschop SN, Kanellopoulos A, Biesbroek S, van 't Veer P. Shifting towards optimized healthy and sustainable Dutch diets: impact on protein quality. Eur J Nutr 2023:10.1007/s00394-023-03135-7. [PMID: 36949232 DOI: 10.1007/s00394-023-03135-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 03/10/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE To reduce the environmental impact of Western diets, a reduction of meat consumption and a substitution by plant-based protein sources is needed. This protein transition will affect the quantity and quality of dietary protein. Therefore, the aim of this study was to evaluate the protein adequacy of diets optimized for nutritional health and diet-related greenhouse gas emission (GHGE). METHODS Data from 2150 adult participants of the Dutch National Food Consumption Survey were used, with diet assessed using two non-consecutive 24 h dietary recalls. Utilizable protein of current diets per day was based on meal composition and the Protein Digestibility-Corrected Amino Acid Score and was compared to protein requirements. Optimized diets were derived as linear combinations of current diets that minimized GHGE and maximized the Dutch Healthy Diet 2015 score, with/without constraints to keep dietary change within 33% of current consumption. Protein adequacy was evaluated in both current and optimized diets. RESULTS In all age and gender strata, the healthiest diets had higher GHGE, the most sustainable diets had the lowest dietary quality, though higher than current diets, and protein adequacy remained sufficient. When limiting dietary change to 33% of current consumption, in the most promising trade-off diet GHGE was reduced by 12-16%. The current diet provided 1.4-2.2 times the required amount of utilizable protein. CONCLUSION These results suggest that a realistic aim for the next decade might be to reduce diet-related GHGE to 12-16% of the current levels without compromising protein adequacy and diet quality. To achieve global targets, upstream food system transformations are needed with subsequent dietary changes.
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Affiliation(s)
- Samantha N Heerschop
- Division of Human Nutrition and Health, Wageningen University and Research, Postbox 17, 6700 AA, Wageningen, Gelderland, The Netherlands.
| | - Argyris Kanellopoulos
- Operations Research and Logistics Group, Wageningen University and Research, Wageningen, Gelderland, The Netherlands
| | - Sander Biesbroek
- Division of Human Nutrition and Health, Wageningen University and Research, Postbox 17, 6700 AA, Wageningen, Gelderland, The Netherlands
| | - Pieter van 't Veer
- Division of Human Nutrition and Health, Wageningen University and Research, Postbox 17, 6700 AA, Wageningen, Gelderland, The Netherlands
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Usual dietary intake, physical activity, weight loss, and body composition after five years of Roux-en-Y gastric bypass. Int J Obes (Lond) 2023; 47:263-272. [PMID: 36690843 DOI: 10.1038/s41366-023-01256-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To estimate usual dietary intake (UDI), physical activity (PA), and their association with weight loss and body composition in patients who underwent Roux-en-Y gastric bypass (RYGB) after five years in the Federal District, Brazil. METHODS We assessed anthropometry and body composition using bioimpedance, and dietary intake and PA with three nonconsecutive 24-h recalls. PC-Side was used to estimate UDI. Dietary patterns (DPs) were identified through principal component analysis, and association between UDI and PA with percentage of total weight loss (%TWL) and fat-free mass (FFM) through multinomial logistic regression. RESULTS Sample (n = 124) presented mean (SD) age of 48.9 (9.4) years, median (IQR) of 9 years (7-10) post RYGB, current BMI = 32.3 kg/m² (28.8-35.7), %TWL = 24.7% (10.9), and FFM = 45.1 kg (41.1-51.9). Mean usual energy intake of 1556 kcal/d, with adequate protein intake, poor fiber intake, and excessive carbohydrate, total fat, and added sugar intake, compared to dietary guidelines. Calcium, vitamins C, D, and E presented the greatest inadequacy (15%, 24%, 32%, and 49% of individuals, respectively, reported usual intake below EAR); 83 participants were considered active/very active, according PA. DP with high energy, protein, total fat, saturated fat, and sodium intake, was negatively associated with %TWL (OR = 0.545, p = 0.037). Protein intake was positively associated with FFM (OR = 1.091, p = 0.004). PA was not associated with %TWL or FFM. CONCLUSION Participants demonstrated intake of carbohydrate, fat, fiber, added sugar not in accordance with guidelines. A DP rich in energy, protein, total fat, saturated fat, and sodium appears to decrease TWL. However, protein intake appears to increase FFM.
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de Mello AV, Sarti FM, Barros MBDA, Goldbaum M, Cesar CLG, Fisberg RM. Differences in Cost-Effectiveness of Adherence to Nutritional Recommendations: Why, Where, and What? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:772. [PMID: 36613092 PMCID: PMC9819702 DOI: 10.3390/ijerph20010772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/16/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
Cost-effectiveness analysis of diets may comprise an important tool to promote food security; however, studies show divergent evidence regarding the relationship between diet quality and cost in diverse populations. Thus, this study assesses differences in cost-effectiveness ratios regarding adherence to nutritional recommendations using data representative of the population level in Sao Paulo municipality, Brazil. Information from adolescents and adult individuals (n = 1742) was used to estimate diet quality and cost in 2015. Differences in cost-effectiveness ratios were investigated through application of two diet quality indexes and exploration of individuals' personal and contextual characteristics. Results indicated that higher diet cost was associated with higher adherence to nutritional recommendations at the national level and inversely associated with adherence to international recommendations. Purchasing foods in street markets was linked to healthier diets at lower costs, and protein consumption was associated with higher diet cost regardless of diet quality; however, diet quality was linked to type of protein consumed by individuals. Differences in cost-effectiveness ratios were attributable to methodological choices in measuring dietary quality (why); individuals' personal and contextual characteristics, in particular, access to retail equipment (where); and certain food choices (what). Therefore, cost-effectiveness analyses should be tailored to policy goals and local environments to ensure proper assessment of nutrition programs and to foster improvements in nutritional diet quality at lower cost.
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Affiliation(s)
| | - Flavia Mori Sarti
- School of Public Health, University of Sao Paulo, Sao Paulo 01246-904, Brazil
| | | | - Moises Goldbaum
- School of Medicine, University of Sao Paulo, Sao Paulo 01246-903, Brazil
| | | | - Regina Mara Fisberg
- School of Public Health, University of Sao Paulo, Sao Paulo 01246-904, Brazil
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Mendoza-Velázquez A, Lara-Arévalo J, Siqueira KB, Guzmán-Rodríguez M, Drewnowski A. Affordable Nutrient Density in Brazil: Nutrient Profiling in Relation to Food Cost and NOVA Category Assignments. Nutrients 2022; 14:nu14204256. [PMID: 36296940 PMCID: PMC9611234 DOI: 10.3390/nu14204256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/10/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022] Open
Abstract
Affordable nutrient density is provided by low-cost and nutrient-rich foods. We explored nutrient density, cost, and NOVA category assignments within and across food groups in Brazil. The nutrient density of the foods (n = 591) was assessed using the Nutrient Rich Food Index (NRF9.3) based on protein, fiber, vitamin A (RAE), vitamin C, vitamin E (mg), Ca, Fe, K and Mg; and NRF6.3 score for priority nutrients: Ca, Fe, Zn, vitamin A, vitamin B12, and folate. Nutrients to limit (LIM) were saturated fat, added sugar, and sodium. Affordability was defined as the ratio of energy and/or nutrient density of foods and retail price per 100 kcal. Foods were classified as minimally processed (n = 106), processed (n = 188), ultra-processed (n = 286), and culinary ingredients (n = 11). Nutrient density was positively linked to per 100 kcal food cost. Ultra-processed foods (UPF) contained more energy, fat, sugar, and salt and had lower NRF scores compared to minimally processed (MPF) foods. UPF was also less expensive than MPF foods. Nutrient-rich foods below the median per 100 kcal costs included MPF foods, but also processed foods (PF) and UPF. Affordable nutrient-rich foods can be found in the different categories of the NOVA classification.
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Affiliation(s)
- Alfonso Mendoza-Velázquez
- Center for Public Health Nutrition, University of Washington, Seattle, WA 98195, USA
- Centro de Investigación e Inteligencia Económica, Universidad Popular Autónoma del Estado de Puebla (UPAEP), Puebla 72410, Mexico
| | - Jonathan Lara-Arévalo
- Center for Public Health Nutrition, University of Washington, Seattle, WA 98195, USA
- Correspondence:
| | | | - Mariano Guzmán-Rodríguez
- Centro de Investigación e Inteligencia Económica, Universidad Popular Autónoma del Estado de Puebla (UPAEP), Puebla 72410, Mexico
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA 98195, USA
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Mello AVD, Sarti FM, Fisberg RM. Associations among diet costs, food prices and income: Elasticities of risk and protection food groups for cardiometabolic diseases in Sao Paulo, Brazil (2003-2015). Nutr Health 2022:2601060221104579. [PMID: 35673763 DOI: 10.1177/02601060221104579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Economic dimension comprises important determinants of food choices, particularly income and prices. Aim: Identification of the influence of food prices and diet costs on the consumption of food groups considered protection and risk factors for cardiometabolic diseases. Methods: Food groups classification follows the proposal of "What we eat in America?" from the National Health and Nutrition Examination Survey (NHANES), adapted to Latin America. Data on food consumption from the Health Survey of Sao Paulo (2003, 2008, and 2015), representative at population level, was used. Log-linear regressions were estimated for food groups, controlling for endogeneity through augmented regression-test Results: Results showed increase in prices per calorie of whole grains and red meat from 2003-2015 and a decrease in prices per calorie of fruits, vegetables, beans, legumes, oilseeds and fish/seafood. Food groups had price elasticities between -0.01 and -1.6, i.e., decrease in consumption associated with increase in prices. Results showed statistically significant effects of substitution and complementarity, particularly substitution between sweetened beverages and fruits (2003, β = 0.606; 2008: β = 0.683; 2015, β = 0.848), complementarity between nuts and seeds and whole grains (2003, β = -0.646; 2008, β = -0.647; 2015,β = -0.901), and vegetables and processed meat (2003, β = -1.379; 2015, β = -1.685). Conclusion: Findings of the study represent relevant evidence for design strategies towards the adoption of healthier diets, particularly through subsidies to protection food groups, promoting lower prices and higher diet quality. The evidence may be useful for policymakers and researchers in fields of nutrition and health in diverse countries worldwide, especially due to absence of robust evidence in literature.
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Affiliation(s)
- Aline Veroneze de Mello
- Nutrition Department, School of Public Health, 28133University of São Paulo, São Paulo, Brazil
| | - Flávia Mori Sarti
- Nutrition Department, School of Public Health, 28133University of São Paulo, São Paulo, Brazil
| | - Regina Mara Fisberg
- Nutrition Department, School of Public Health, 28133University of São Paulo, São Paulo, Brazil
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Carvalho Ramos Salles de Oliveira D, Nunes Oliveira Jardim A, Perignon M, Drogue S, Darmon N, Dutra Caldas E, Verly-Jr E. Meeting nutritional adequacy in the Brazilian population increases pesticide intake without exceeding chronic safe levels. Int J Food Sci Nutr 2021; 73:538-551. [PMID: 34957904 DOI: 10.1080/09637486.2021.2017408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Achieving nutritional adequacy requires an increase in fresh foods consumption, which may increase pesticide intakes. This study aimed to identify required dietary modifications to achieve nutritional adequacy without exceeding the acceptable daily intake (ADI) for pesticides. Data from the National Dietary Survey 2017-2018 were linked to the pesticide database from the Program on Pesticide Residue Analysis in Food. We performed linear programming models to design nutritionally adequate diets constrained by food preferences for different constraints on pesticide intake at the least cost increment. Nutritional adequacy led to an increase in pesticide intakes without exceeding their ADI. Modifications in diets varied according to the model, but, in general, consisted in an increase in fruits and vegetables, dairy, and seafood, and a reduction in rice, red meat, and sugar-sweetened beverages quantities. In conclusion, meeting nutritional adequacy increases pesticide intake compared to the observed diets, without representing a health concern to consumers.
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Affiliation(s)
| | | | - Marlène Perignon
- MoISA, Univ Montpellier, CIHEAM-IAMM, CIRAD, INRAE, Institut Agro, IRD, Montpellier, France
| | - Sophie Drogue
- MoISA, Univ Montpellier, CIHEAM-IAMM, CIRAD, INRAE, Institut Agro, IRD, Montpellier, France
| | - Nicole Darmon
- MoISA, Univ Montpellier, CIHEAM-IAMM, CIRAD, INRAE, Institut Agro, IRD, Montpellier, France
| | - Eloisa Dutra Caldas
- Laboratory of Toxicology, Department of Pharmacy, University of Brasilia, Brasilia, Brazil
| | - Eliseu Verly-Jr
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Fontanelli MDM, Martinez Arroyo A, Sales CH, Seal CJ, Fisberg RM. Opportunities for diet quality improvement: the potential role of staple grain foods. Public Health Nutr 2021; 24:6145-6156. [PMID: 33843545 PMCID: PMC11374563 DOI: 10.1017/s1368980021001531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Given the high disease burden associated with the low intake of whole grains, modelling studies that estimate the impact of dietary strategies to increase more healthful grain foods consumption are essential to inform evidence-based and culturally specific policies. The current study investigated the potential nutritional impact of replacing staple grain foods with more healthful options. DESIGN Based on the 2015 Health Survey of São Paulo, a cross-sectional, population-based study, we modelled the substitution of white rice and white bread with brown rice and whole-wheat bread. Outcomes included changes in more healthful grain foods, energy and nutrient intakes. SETTING Urban area of São Paulo, Brazil. PARTICIPANTS Participants aged over 12 years who completed a semi-structured questionnaire and one 24-h recall (n 1741). RESULTS The substitution of all white rice and white bread with brown rice and whole-wheat bread, respectively, would result in more than 5 % increases in Zn (+9·1 %), Ca (+9·3 %), vitamin E (+18·8 %), dietary fibre (+27·0 %) and Mg (+52·9 %) intake, while more than a 5 % decrease would be seen for total carbohydrate (-6·1 %), folate (-6·6 %), available carbohydrate (-8·5 %), Fe (-8·6 %), vitamin B6 (-12·5 %), vitamin B2 (-17·4 %), and vitamin B1 (-20·7 %). A substantial increase in the amount of more healthful grain foods consumed would be seen (10 g/d to 220 g/d, or from 4 % to 69 % of total grain intake). CONCLUSIONS Replacing white rice and white bread with their whole-grain versions has the potential to improve diet quality, suggesting they are prime targets for policy actions aiming at increasing intake of more healthful grain foods.
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Affiliation(s)
- Mariane de Mello Fontanelli
- Department of Nutrition, School of Public Health, University of São Paulo, Avenida Dr. Arnaldo, 715, Cerqueira Cesar 01246-904, São Paulo, SP, Brazil
| | - Angela Martinez Arroyo
- Department of Nutrition, School of Public Health, University of São Paulo, Avenida Dr. Arnaldo, 715, Cerqueira Cesar 01246-904, São Paulo, SP, Brazil
- School Nutrition and Dietetics, Faculty of Pharmacy, University of Valparaíso, Valparaíso, Chile
| | - Cristiane Hermes Sales
- Department of Nutrition, School of Public Health, University of São Paulo, Avenida Dr. Arnaldo, 715, Cerqueira Cesar 01246-904, São Paulo, SP, Brazil
| | - Chris J Seal
- Human Nutrition Research Centre, Public Health Sciences Institute, Newcastle upon TyneNE2 4HH, UK
| | - Regina Mara Fisberg
- Department of Nutrition, School of Public Health, University of São Paulo, Avenida Dr. Arnaldo, 715, Cerqueira Cesar 01246-904, São Paulo, SP, Brazil
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Verly E, de Oliveira DCRS, Sichieri R. Cost of healthy and culturally acceptable diets in Brazil in 2009 and 2018. Rev Saude Publica 2021; 55:7s. [PMID: 34852164 PMCID: PMC8627151 DOI: 10.11606/s1518-8787.2021055003329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/08/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To estimate the lowest cost of a healthy and culturally acceptable diet and to assess the evolution of its cost in the periods 2008-2009 and 2017-2018. METHODS We used data on the individual food consumption and food prices from the Pesquisas de Orçamentos Familiares (Household Budget Surveys), in the 2008-2009 and 2017-2018. The sample strata of each period were aggregated, forming 108 new strata with geographic and economic homogeneity. Linear programming models generated diets for each new stratum, considering the constraints in two models: model 1 (≥ 400g of fruits and vegetables); and model 2 (≥ 400g of fruits and vegetables, < 2300mg of sodium, sodium/potassium ratio < 1, ≥ 500mg of calcium). Each food could progressively deviate 5g from the observed consumption averages until the models found a solution in each of the strata. The objective function was to minimize the total cost of the diet. RESULTS The average observed and optimized costs were R$4.96, R$4.62 (model 1) and R$5.08 (model 2) in 2008-2009, and R$9.18, R$8.69 and R$9.87 in 2017-2018. Models 1 and 2 resulted in an increase of up to 6% and 11% in 2008-2009, and of up to 25% and 34% in 2017-2018 in the lowest income strata. The main changes observed in the two models include the reduction in the amounts of sweetened beverages, sweets, sauces, ready-to-eat foods, and an increase in fruits and vegetables, flour, and tubers. CONCLUSION The adequate amount of fruits and vegetables resulted in an increase in costs to some population strata. When the adequacy of calcium, sodium, and potassium was considered, we observed a more significant increase in cost, especially in 2017-2018.
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Affiliation(s)
- Eliseu Verly
- Universidade do Estado do Rio de JaneiroInstituto de Medicina SocialDepartamento de EpidemiologiaRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil
| | - Dayan Carvalho Ramos Salles de Oliveira
- Universidade do Estado do Rio de JaneiroInstituto de Medicina SocialDepartamento de EpidemiologiaRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil
| | - Rosely Sichieri
- Universidade do Estado do Rio de JaneiroInstituto de Medicina SocialDepartamento de EpidemiologiaRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil
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Abstract
AbstractFood systems that deliver healthy diets without exceeding the planet’s resources are essential to achieve the worlds’ ambitious development goals. Healthy diets need to be safe, accessible, and affordable for all, including for disadvantaged and nutritionally vulnerable groups such as of smallholder producers, traders, and consumers in low- and middle-income countries. Globally, food systems are experiencing rapid and drastic changes and are failing to fulfil these multiple duties simultaneously. The international community therefore calls for rigorous food systems transformations and policy solutions to support the achievement of healthy diets for all. Most strategies, however, are essentially supply- and market-oriented. Incorporation of a healthy diet perspective in food system transformation is essential to enable food systems to deliver not only on supplying nutritious foods but also on ensuring that consumers have access can afford and desire healthy, sustainable, and culturally acceptable diets. This paper argues that this should be guided by information on diets, dietary trends, consumer motives, and food environment characteristics. Transformational approaches and policies should also take into account the stage of food system development requiring different strategies to ensure healthier diets for consumers. We review current knowledge on drivers of consumer choices at the individual and food environment level with special emphasis on low- and middle income countries, discuss the converging and conflicting objectives that exist among multiple food-system actors, and argue that failure to strengthen synergies and resolve trade-offs may lead to missed opportunities and benefits, or negative unintended consequences in food system outcomes. The paper proposes a menu of promising consumer- and food-environment- oriented policy options to include in the food systems transformation agenda in order to shift LMIC consumer demand towards healthier diets in low- and middle income countries.
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Sousa AG, Costa THMD. Diet and supplement assessment in a Brazilian urban population. Rev Saude Publica 2021; 55:26. [PMID: 34037138 PMCID: PMC8139845 DOI: 10.11606/s1518-8787.2021055002356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 09/02/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE: To assess total usual nutrient intakes from foods and dietary supplements by age, sex, physical activity, and nutritional status, and to compare usual nutrient intakes to the Dietary Reference Intakes among non-users and users of dietary supplements in an urban population. METHODS: Cross-sectional population-based survey with 506 adults conducted in the city of Brasília, Brazil, using 24h food recalls. The 24-HR was collected on two nonconsecutive days, for which individuals reported all food, supplements, and beverages consumed in the previous 24 hours. The estimates of mean and the distribution percentiles were adjusted to reflect usual nutrient intake using the Iowa State University method. The prevalence of inadequate micronutrient intake was estimated according to sex using the Estimated Average Requirement (EAR), and values above the Tolerable Upper Intake Level (UL) were also considered. Also, a comparison was made of the total mean usual intake between supplement users and non-users according to BMI and physical activity. RESULTS: The total mean usual dietary intake was significantly higher among users than non-users of dietary supplements (p ≤ 0.02). Dietary supplement use increased intakes of nutrients and decreased prevalence of inadequacy according to sex, with only small (typically < 13%) increases in the population exceeding the Tolerable Upper Intake Level. There was a significant interaction between physical activity and BMI categories with supplement use. CONCLUSIONS: The population that consumes food supplements comprises individuals with more advanced age, female, normal BMI, and physically active. Our findings show that the use of supplements appears beneficial to attain nutrient adequacy. Careful monitoring of intake from food and supplements is recommended, and the statistical methods must be powerful enough to achieve relevant information.
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Affiliation(s)
- Alessandra Gaspar Sousa
- Universidade de Brasília. Faculdade de Ciências da Saúde. Programa de Pós-Graduação em Nutrição Humana. Brasília, Distrito Federal (DF), Brasil.,Centro Universitário Unieuro. Departamento de Nutrição. Brasília, Distrito Federal (DF), Brasil
| | - Teresa Helena Macedo da Costa
- Universidade de Brasília. Faculdade de Ciências da Saúde. Departamento de Nutrição. Brasília, Distrito Federal (DF), Brasil
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15
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Costa PD, Canaan JCR, Midori Castelo P, Campideli Fonseca D, Márcia Pereira-Dourado S, Mendonça Murata R, Pardi V, José Pereira L. Influence of Micronutrient Intake, Sociodemographic, and Behavioral Factors on Periodontal Status of Adults Assisted by a Public Health Care System in Brazil: A Cross-Sectional Multivariate Analysis. Nutrients 2021; 13:973. [PMID: 33802889 PMCID: PMC8002608 DOI: 10.3390/nu13030973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023] Open
Abstract
The lack of access to a balanced diet, rich in vitamins and minerals, can predispose people to inflammatory diseases such as obesity, diabetes mellitus, and periodontitis. We aimed to evaluate the relationship between micronutrient intake, sociodemographic behavioral characteristics, and periodontal health in adults assisted by a public health care system. Participants (n = 450) answered a food frequency questionnaire and were submitted to anthropometric and oral clinical examinations. Principal component analysis was used to summarize the number of components emerging from 17-micronutrient intake. Subsequently, cluster analysis was employed. The prevalence of at least one periodontal pocket ≥ 4 mm was 67.4%. Three clusters were identified according to periodontal status. Cluster 1 "poor periodontal status" was characterized by older individuals (n = 202; 85% females) with poor periodontal status, lower education level, mainly smokers with non-transmissible chronic diseases (NTCD), with lower energy, omega-3, fiber, Zn, K, Cu, and vitamin C intake. Cluster 3 "healthy periodontal status" included younger individuals (n = 54) with the healthiest periodontal status, a higher education level, without NTCD, and with higher energy, omega-3, fiber, Zn, calcium, retinol, and riboflavin intake. Cluster 2 was labeled as "intermediate periodontal status". Micronutrient ingestion was associated with periodontal status and may be considered in health promotion actions for low-income populations.
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Affiliation(s)
- Patrícia Daniela Costa
- Health Sciences Faculty, Universidade Federal de Lavras (UFLA), 37200-900 Lavras, Minas Gerais, Brazil; (P.D.C.); (J.C.R.C.); (S.M.P.-D.)
| | - Juliana Cristina Reis Canaan
- Health Sciences Faculty, Universidade Federal de Lavras (UFLA), 37200-900 Lavras, Minas Gerais, Brazil; (P.D.C.); (J.C.R.C.); (S.M.P.-D.)
| | - Paula Midori Castelo
- Department of Pharmaceutical Sciences, Universidade Federal de São Paulo (UNIFESP), 09913-030 Diadema, São Paulo, Brazil;
| | | | - Stela Márcia Pereira-Dourado
- Health Sciences Faculty, Universidade Federal de Lavras (UFLA), 37200-900 Lavras, Minas Gerais, Brazil; (P.D.C.); (J.C.R.C.); (S.M.P.-D.)
| | - Ramiro Mendonça Murata
- Department of Foundational Sciences, School of Dental Medicine, East Carolina University (ECU), Greenville, NC 27834, USA;
| | - Vanessa Pardi
- Department of Foundational Sciences, School of Dental Medicine, East Carolina University (ECU), Greenville, NC 27834, USA;
| | - Luciano José Pereira
- Health Sciences Faculty, Universidade Federal de Lavras (UFLA), 37200-900 Lavras, Minas Gerais, Brazil; (P.D.C.); (J.C.R.C.); (S.M.P.-D.)
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Verly-Jr E, de Carvalho AM, Marchioni DML, Darmon N. The cost of eating more sustainable diets: A nutritional and environmental diet optimisation study. Glob Public Health 2021; 17:1073-1086. [PMID: 33720802 DOI: 10.1080/17441692.2021.1900315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We aim to identify the dietary changes to improve nutrition and reduce diet-related greenhouse gas emission (GHGE) simultaneously in Brazil, taking into account the heterogeneity in food habits and prices across the country. Food consumption and prices were obtained from two nationwide surveys (n = 55,970 households and 34,003 individuals). Linear programming models were performed to design optimised diets most resembling the observed diets, and meeting different sets of constraints: (i) nutritional, for preventing chronic diseases and meeting nutrient adequacy; (ii) socio-cultural: by respecting food preferences; and (iii) environmental: by reducing GHGE by steps of 10%. Moving toward a diet that meets nutritional recommendations led to a 14% to 24% cost increase and 10% to 27% GHGE reduction, depending on the stringency of the acceptability constraints. Stronger GHGE reductions were achievable (up to about 70%), with greater departure from the current diet, but not achieving calcium and potassium goals. Diet cost increment tended to be mitigated with GHGE reduction in most models, along with reductions in red meat, chicken, eggs, rice, and high-fat sugar sodium foods.
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Affiliation(s)
- Eliseu Verly-Jr
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | | | - Nicole Darmon
- MOISA, INRAE, CIHEAM-IAMM, CIRAD, Montpellier SupAgro, Université de Montpellier, Montpellier, France
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Nutrient density and affordability of foods in Brazil by food group and degree of processing. Public Health Nutr 2020; 24:4564-4571. [PMID: 33109278 DOI: 10.1017/s1368980020004358] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Affordable nutrition refers to the relation between nutrient density of foods and their monetary cost. There are limited data on affordable nutrition in low- and middle-income countries. The present study aimed to develop a nutrient density score and nutrient affordability metrics for 377 most consumed foods in Brazil. DESIGN The foods were aggregated into seven major food groups and four NOVA food categories. Nutrient composition data were obtained from the Brazilian Institute of Geography and Statistics. Food prices were obtained from retailer websites and were converted to prices per 100 g and 418 kJ. The Nutrient Rich Food (NRF8.2) score was based on protein, fiber, vitamins A, C and E, Ca, Fe and K. Nutrients to limit were sugar and Na. Affordability was measured as kcal/R$ and nutrients/R$. RESULTS Grains, fats and sweets were more energy dense and had lower NRF8.2 scores than dairy, vegetables and fruits. Grains, fats and sweets were the lowest cost sources of energy. Vegetables and fruits, beans, nuts and seeds and eggs and dairy were the lowest cost sources of multiple nutrients. Ultra-processed foods (48 % of total) had higher energy density and lower NRF8.2 scores than did unprocessed foods. In Brazil, fruits, vegetables and dairy products offered the most nutrients per real. CONCLUSIONS Analysis of the relationship between nutrient density of foods and their cost can help identify locally available foods that are nutrient rich, affordable and culturally acceptable. Achieving high nutrient density at an affordable cost should be the goal of Brazil's food systems.
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Micronutrient deficiency in the diets of para-athletes participating in a sports scholarship program. Nutrition 2020; 81:110992. [PMID: 33049574 DOI: 10.1016/j.nut.2020.110992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/09/2020] [Accepted: 08/09/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The aim of this study was to determine the usual energy and micronutrient intake distributions and compare the prevalence of insufficient/excessive micronutrient intake in Brazilian para-athletes with and without scholarship support. METHODS The study was conducted between September 2018 and August 2019 and included 101 athletes with a disability from 13 Paralympic disciplines living in Brasília, the Federal District. Food intake was estimated from two or four non-consecutive 24-h food recalls in which para-athletes reported all food, beverages, and supplements consumed in the previous 24-h. Dietary intake analysis was performed by implementing the National Cancer Institute method. Comparisons between scholarship and non-scholarship athletes were performed using Student's t tests for parametric variables and Wilcoxon signed-rank tests for nonparametric variables. RESULTS Mean usual energy intake was significantly lower in scholarship para-athletes (2128 ± 125 kcal/d) than in non-scholarship para-athletes (2239 ± 116 kcal/d; P < 0.001). The prevalence of inadequacy for vitamin D, calcium, vitamin A, thiamine, riboflavin, and zinc was significantly higher in scholarship than in non-scholarship para-athletes (P < 0.001). The prevalence of risk for iron deficiency was 29.5% in female para-athletes. The prevalence of micronutrient inadequacy was >10% for eight (60%) and seven (54%) micronutrients among scholarship and non-scholarship para-athletes, respectively. CONCLUSIONS The Brazilian Federal sport scholarship assistance program in its current format is insufficient to protect athletes from micronutrient inadequacies.
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