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da Silva ADS, Brito FDSB, dos Santos DM, Adegboye ARA. Use of Digital Tools for the Assessment of Food Consumption in Brazil: A Scoping Review. Nutrients 2024; 16:1399. [PMID: 38732645 PMCID: PMC11085537 DOI: 10.3390/nu16091399] [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: 03/25/2024] [Revised: 04/26/2024] [Accepted: 05/01/2024] [Indexed: 05/13/2024] Open
Abstract
This is a scoping review on mapping the use of digital tools to assess food consumption in Brazil. Searches were carried out in nine electronic databases (Medline, Lilacs, Scopus, Embase, Web of Science, Science Direct, Ovid, Free Medical Journal and Crossref) to select studies published from October 2020 to December 2023. This review identified forty-eight digital tools in the 94 publications analyzed, the most frequent being web-based technologies (60%) and mobile devices (40%). Among these studies, 55% (n = 52) adopted a population-based approach, while 45% (n = 42) focused on specific regions. The predominant study design observed was cross-sectional (n = 63). A notable trend observed was the increasing frequency of validation studies in recent years. Although the use of digital tools in the assessment of food consumption in Brazil has grown in recent years, studies did not describe the process of creating and validating the tools, which would contribute to the improvement of data quality. Investments that allow the expansion of the use of the internet and mobile devices; the improvement of digital literacy; and the development of open-access tools, especially in the North and Northeast regions, are challenges that require a concerted effort towards providing equal opportunities, fostering encouragement, and delving deeper into the potential of digital tools within studies pertaining to food consumption in Brazil.
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Affiliation(s)
- Adriane dos Santos da Silva
- Nutrition Institute, Rio de Janeiro State University, São Francisco Xavier Street, 524, Rio de Janeiro 20550-900, Brazil; (A.d.S.d.S.); (D.M.d.S.)
| | - Flávia dos Santos Barbosa Brito
- Nutrition Institute, Rio de Janeiro State University, São Francisco Xavier Street, 524, Rio de Janeiro 20550-900, Brazil; (A.d.S.d.S.); (D.M.d.S.)
| | - Debora Martins dos Santos
- Nutrition Institute, Rio de Janeiro State University, São Francisco Xavier Street, 524, Rio de Janeiro 20550-900, Brazil; (A.d.S.d.S.); (D.M.d.S.)
| | - Amanda Rodrigues Amorim Adegboye
- Centre for Agroecology, Water and Resilience (CAWR), Coventry University, Coventry CV8 3LG, UK
- Centre for Healthcare Research, Coventry University, Coventry CV1 5FB, UK
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de O Alencar L, Silva SA, Borges LPSL, da Costa THM, de Carvalho KMB. Lifestyle Patterns in the Late Postoperative Period of Bariatric Surgery: a Descriptive Analysis of the CINTO Study. Obes Surg 2023; 33:3938-3943. [PMID: 37880463 DOI: 10.1007/s11695-023-06897-5] [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: 03/14/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND The behavior of patients undergoing metabolic bariatric surgery (MBS) has been widely investigated to better understand their attitudes and to formulate effective advisory strategies. Although these elements have been studied separately, the magnitude of these behaviors still needs to be determined from a combined factors approach. This study aimed to identify the lifestyle patterns of patients who underwent MBS 5 or more years ago. METHODS In this observational study, 123 patients who underwent MBS at least 5 years ago were included. Anthropometric data, sociodemographic profile, dietary intake, physical activity level, sleeping, smoking, and alcohol consumption were collected for all participants. Lifestyle pattern was evaluated using principal component analysis (PCA) and the Kaiser-Meyer-Olkin (KMO) index was applied to evaluate data factorability. RESULTS PCA identified two patterns of behavior adopted by the participants in the late postoperative (PO) period (more than 5 years PO) of MBS. In the first pattern, a positive correlation was found between consumption of ultra-processed foods (r = 0.459), risky consumption of alcoholic beverages (r = 0.630), and tobacco use (r = 0.584). In the second, a positive correlation was observed between the consumption of unprocessed or minimally processed foods (r = 0.692) and more sleep time per day (r = 0.654). CONCLUSION After 5 years of PO, combined behavior analysis revealed healthy and unhealthy lifestyle patterns, which points to the relevance of permanent clinical follow-up of these patients to ensure the best health status.
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Affiliation(s)
| | - Sara A Silva
- Graduate Program of Human Nutrition, Faculty of Health Sciences, University of Brasília, Campus Universitario Darcy Ribeiro, Brasília, Federal District, 70910-900, Brazil
| | - Lara P S L Borges
- Graduate Program of Human Nutrition, Faculty of Health Sciences, University of Brasília, Campus Universitario Darcy Ribeiro, Brasília, Federal District, 70910-900, Brazil
| | - Teresa Helena M da Costa
- Graduate Program of Human Nutrition, Faculty of Health Sciences, University of Brasília, Campus Universitario Darcy Ribeiro, Brasília, Federal District, 70910-900, Brazil
| | - Kênia M B de Carvalho
- Graduate Program of Human Nutrition, Faculty of Health Sciences, University of Brasília, Campus Universitario Darcy Ribeiro, Brasília, Federal District, 70910-900, Brazil.
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Pepe RB, Lottenberg AM, Fujiwara CTH, Beyruti M, Cintra DE, Machado RM, Rodrigues A, Jensen NSO, Caldas APS, Fernandes AE, Rossoni C, Mattos F, Motarelli JHF, Bressan J, Saldanha J, Beda LMM, Lavrador MSF, Del Bosco M, Cruz P, Correia PE, Maximino P, Pereira S, Faria SL, Piovacari SMF. Position statement on nutrition therapy for overweight and obesity: nutrition department of the Brazilian association for the study of obesity and metabolic syndrome (ABESO-2022). Diabetol Metab Syndr 2023; 15:124. [PMID: 37296485 PMCID: PMC10251611 DOI: 10.1186/s13098-023-01037-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 03/23/2023] [Indexed: 06/12/2023] Open
Abstract
Obesity is a chronic disease resulting from multifactorial causes mainly related to lifestyle (sedentary lifestyle, inadequate eating habits) and to other conditions such as genetic, hereditary, psychological, cultural, and ethnic factors. The weight loss process is slow and complex, and involves lifestyle changes with an emphasis on nutritional therapy, physical activity practice, psychological interventions, and pharmacological or surgical treatment. Because the management of obesity is a long-term process, it is essential that the nutritional treatment contributes to the maintenance of the individual's global health. The main diet-related causes associated with excess weight are the high consumption of ultraprocessed foods, which are high in fats, sugars, and have high energy density; increased portion sizes; and low intake of fruits, vegetables, and grains. In addition, some situations negatively interfere with the weight loss process, such as fad diets that involve the belief in superfoods, the use of teas and phytotherapics, or even the avoidance of certain food groups, as has currently been the case for foods that are sources of carbohydrates. Individuals with obesity are often exposed to fad diets and, on a recurring basis, adhere to proposals with promises of quick solutions, which are not supported by the scientific literature. The adoption of a dietary pattern combining foods such as grains, lean meats, low-fat dairy, fruits, and vegetables, associated with an energy deficit, is the nutritional treatment recommended by the main international guidelines. Moreover, an emphasis on behavioral aspects including motivational interviewing and the encouragement for the individual to develop skills will contribute to achieve and maintain a healthy weight. Therefore, this Position Statement was prepared based on the analysis of the main randomized controlled studies and meta-analyses that tested different nutrition interventions for weight loss. Topics in the frontier of knowledge such as gut microbiota, inflammation, and nutritional genomics, as well as the processes involved in weight regain, were included in this document. This Position Statement was prepared by the Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), with the collaboration of dietitians from research and clinical fields with an emphasis on strategies for weight loss.
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Affiliation(s)
- Renata Bressan Pepe
- Grupo de Obesidade e Sindrome Metabolica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP Brazil
| | - Ana Maria Lottenberg
- Laboratório de Lipides (LIM10), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP Brazil
- Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), Rua Mato Grosso 306 – cj 1711, Sao Paulo, SP 01239-040 Brazil
| | - Clarissa Tamie Hiwatashi Fujiwara
- Grupo de Obesidade e Sindrome Metabolica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP Brazil
| | - Mônica Beyruti
- Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), São Paulo, SP Brazil
| | - Dennys Esper Cintra
- Centro de Estudos em Lipídios e Nutrigenômica – CELN – University of Campinas, Campinas, SP Brazil
| | - Roberta Marcondes Machado
- Liga Acadêmica de Controle de Diabetes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP Brazil
| | - Alessandra Rodrigues
- Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), São Paulo, SP Brazil
| | - Natália Sanchez Oliveira Jensen
- Liga Acadêmica de Controle de Diabetes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP Brazil
| | | | - Ariana Ester Fernandes
- Grupo de Obesidade e Sindrome Metabolica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP Brazil
| | - Carina Rossoni
- Instituto de Saúde Ambiental, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Fernanda Mattos
- Programa de Obesidade e Cirurgia Bariátrica do Hospital Universitário Clementino Fraga Filho da UFRJ, Rio de Janeiro, RJ Brazil
| | - João Henrique Fabiano Motarelli
- Núcleo de Estudos e Extensão em Comportamento Alimentar e Obesidade (NEPOCA) da Universidade de São Paulo - FMRP/USP, Ribeirão Preto, Brazil
| | - Josefina Bressan
- Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, MG Brazil
| | | | - Lis Mie Masuzawa Beda
- Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), São Paulo, SP Brazil
| | - Maria Sílvia Ferrari Lavrador
- Liga Acadêmica de Controle de Diabetes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP Brazil
| | - Mariana Del Bosco
- Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), São Paulo, SP Brazil
| | - Patrícia Cruz
- Grupo de Obesidade e Sindrome Metabolica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP Brazil
| | | | - Priscila Maximino
- Instituto PENSI - Fundação José Luiz Egydio Setúbal, Instituto Pensi, Fundação José Luiz Egydio Setúbal, Hospital Infantil Sabará, São Paulo, SP Brazil
| | - Silvia Pereira
- Núcleo de Saúde Alimentar da Sociedade Brasileira de Cirurgia Bariátrica e Metabólica, São Paulo, Brazil
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Gonçalves HVB, Batista LS, de Amorim ALB, Bandoni DH. Association between Consumption of Ultra-Processed Foods and Sociodemographic Characteristics in Brazilian Adolescents. Nutrients 2023; 15:2027. [PMID: 37432151 DOI: 10.3390/nu15092027] [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: 02/13/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND The consumption of ultra-processed foods is associated with several negative health outcomes. Studies on adolescents have shown that this population has a high consumption of these foods, especially in high-income countries. However, there are no studies on the types of ultra-processed foods consumed. The present study evaluated secondary data from a representative sample of the National School Health Survey, the consumption of ultra-processed foods by 159,245 Brazilian adolescents. METHODS Data were collected via a self-administered questionnaire using a mobile device. A Poisson regression model was used to assess the prevalence of ultra-processed food consumption and its correlation with sociodemographic characteristics. RESULTS The consumption of ultra-processed foods was significant among Brazilian adolescents, and almost half of the participants reported consumption the day before. We observed that sociodemographic characteristics such as school type, race/skin color, region, municipality type, age, living with mother, living with father, and maternal education level were associated with greater or lesser consumption of ultra-processed foods. Adolescents who study in private schools, are female, white, and live in non-capital cities consume more ultra-processed foods. CONCLUSIONS Access to in natura and minimally processed foods must be on the agenda of governments and encouraged by food and nutrition education to guarantee the right to adequate and healthy food.
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Affiliation(s)
- Hélida Ventura Barbosa Gonçalves
- Instituto de Saúde e Sociedade, Universidade Federal de São Paulo, Santos 11015-020, SP, Brazil
- Serviço Nacional de Aprendizagem Comercial, Senac Santos, Santos 11015-003, SP, Brazil
| | | | - Ana Laura Benevenuto de Amorim
- Instituto de Saúde e Sociedade, Universidade Federal de São Paulo, Santos 11015-020, SP, Brazil
- Campus Rosinha Viegas, Universidade Metropolitana de Santos, Santos 11045-002, SP, Brazil
| | - Daniel Henrique Bandoni
- Instituto de Saúde e Sociedade, Universidade Federal de São Paulo, Santos 11015-020, SP, Brazil
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Fonseca AA, Spósito GI, Freitas RF, Reis VMCP. Autopercepção Negativa de Saúde em Adolescentes durante a Pandemia de Covid-19 e Fatores Associados. REVISTA PSICOLOGIA E SAÚDE 2023. [DOI: 10.20435/pssa.v14i4.2095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
O objetivo deste estudo foi analisar a prevalência da autopercepção negativa de saúde de adolescentes durante a pandemia de covid-19 e fatores associados. Trata-se de um estudo descritivo de corte transversal, realizado com 287 adolescentes. Foram avaliadas questões referentes à autopercepção de saúde, ao perfil sociodemográfico e aos fatores comportamentais. As razões de prevalência (RP) e os intervalos com 95% de confiança (IC95%) foram estimados por meio de modelos múltiplos de regressão de Poisson. A prevalência de autopercepção negativa de saúde foi observada em 31,0% dos adolescentes. Observou-se que a imagem corporal (RP = 1,14; IC95%:1,05-1,23), a prática de atividade física (RP = 1,12; IC95%:1,03-1,21), a qualidade do sono (RP = 1,17; IC95%:1,08-1,28) e o consumo de frutas (RP = 1,18; IC95%:1,07-1,30) mostraram-se associados à autopercepção negativa de saúde dos adolescentes. Conclui-se que, durante a pandemia de covid-19, foi observada alta prevalência de autopercepção negativa da saúde. Ademais, a insatisfação com a imagem corporal, a prática de atividade física insuficiente, a qualidade do sono ruim e o consumo de frutas afetaram a autopercepção de saúde dos adolescentes.
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Vale D, Lyra CDO, Dantas NM, Andrade MEDC, Oliveira AGRDC. Dietary and Nutritional Profiles among Brazilian Adolescents. Nutrients 2022; 14:nu14204233. [PMID: 36296917 PMCID: PMC9608776 DOI: 10.3390/nu14204233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The present study analyzed the prevalence of dietary and nutritional profiles among Brazilian adolescents and their associations with social determinants of health. (2) Methods: A population-based survey was administered to 16,409 adolescents assessed by the 2015 National School Health Survey. A multivariate model of dietary and nutritional profiles was estimated from correspondence analysis. (3) Results: The dietary and nutritional profiles more prevalent among Brazilian adolescents were “lower nutritional risk dietary pattern and eutrophic” (42.6%), “lower nutritional risk dietary pattern and overweight” (6.8%), and “higher nutritional risk dietary pattern and overweight” (6.0%). Healthier profiles were associated with less urbanized territories, health-promoting behaviors, and families with worse material circumstances. The less healthy profiles were associated with more urbanized environments, health risk behaviors, and families with better material circumstances. (4) Brazilian adolescents have different dietary and nutritional profiles that are characterized by sociopolitical and economic contexts, family material and school circumstances, and the behavioral and psychosocial health factors of the individuals. All of this points to the social determination of these health problems among adolescents in Brazil.
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Affiliation(s)
- Diôgo Vale
- Postgraduate Program in Collective Health, Federal University of Rio Grande do Norte, Natal 59056-000, RN, Brazil
- Federal Institute of Education, Science and Technology of Rio Grande do Norte, Natal 59015-300, RN, Brazil
- Correspondence: ; Tel.: +55-84-998625453
| | - Clélia de Oliveira Lyra
- Postgraduate Program in Collective Health, Federal University of Rio Grande do Norte, Natal 59056-000, RN, Brazil
| | - Natalie Marinho Dantas
- Postgraduate Program in Nutrition in Public Health, School of Public Health, University of São Paulo, São Paulo 05508-000, SP, Brazil
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Neves FS, Fontes VS, Nogueira MC, Pereira PMDL, de Faria ER, Netto MP, Oliveira RMS, Cândido APC. Eating contexts and their associations with socio-demographic factors in Brazilian adolescents (EVA-JF Study). Public Health Nutr 2022; 26:1-13. [PMID: 35993174 PMCID: PMC10131148 DOI: 10.1017/s136898002200180x] [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: 12/23/2021] [Revised: 05/18/2022] [Accepted: 08/11/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe the eating contexts and estimate their associations with socio-demographic factors in a sample of Brazilian adolescents. DESIGN Cross-sectional study. We used an exploratory questionnaire about eating contexts (encompassing regularity of meals, places where they occur and if they take place with attention and in company), which was submitted to cluster analysis. Subsequently, three clusters were identified: cluster 1, 'appropriate eating contexts at breakfast, lunch and dinner'; cluster 2, 'inappropriate eating context at breakfast' and cluster 3, 'inappropriate eating context at dinner'. Multinomial logistic regression models were performed, without and with adjustments, using cluster 1 as reference. SETTING Twenty-nine public schools of Juiz de Fora, MG, Southeast Brazil. PARTICIPANTS Adolescents, 14-19-year-olds (n 835). RESULTS We observed relevant prevalence of adolescents omitting breakfast (52·9 %) and dinner (39·3 %), and who had the habit of eating sitting/lying on the couch/bed or standing/walking, and in front of screens. Breakfast usually occurred unaccompanied (70·8 %); around half (47·5 %) and little over a third (36·1 %) of the sample also would usually have lunch and dinner unaccompanied, respectively. Furthermore, through multivariate analysis, we found associations of eating contexts clusters with female sex (more likely in clusters 2 and 3), age range 14-15-year-olds (less likely in cluster 2) and higher mother's schooling (more likely in cluster 3). CONCLUSIONS We verified an alarming prevalence of adolescents with eating contexts unaligned with healthy eating recommendations. Additionally, inappropriate eating contexts at breakfast and/or at dinner were associated with socio-demographic factors (sex, age range and mother's schooling).
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Affiliation(s)
- Felipe Silva Neves
- Department of Nutrition, Institute of Biological Sciences, Federal University of Juiz de Fora – UFJF, José Lourenço Kelmer St., Campus Universitário, São Pedro, Juiz de Fora, MG36036-900, Brazil
- Graduate Program in Public Health, Department of Public Health, School of Medicine, Federal University of Juiz de Fora – UFJF, Juiz de Fora, MG, Brazil
| | - Vanessa Sequeira Fontes
- Department of Nutrition, Institute of Biological Sciences, Federal University of Juiz de Fora – UFJF, José Lourenço Kelmer St., Campus Universitário, São Pedro, Juiz de Fora, MG36036-900, Brazil
- Graduate Program in Public Health, Department of Public Health, School of Medicine, Federal University of Juiz de Fora – UFJF, Juiz de Fora, MG, Brazil
| | - Mário Círio Nogueira
- Department of Public Health, School of Medicine, Federal University of Juiz de Fora – UFJF, Juiz de Fora, MG, Brazil
| | - Priscila Moreira de Lima Pereira
- Department of Nutrition, Institute of Biological Sciences, Federal University of Juiz de Fora – UFJF, José Lourenço Kelmer St., Campus Universitário, São Pedro, Juiz de Fora, MG36036-900, Brazil
- Graduate Program in Public Health, Department of Public Health, School of Medicine, Federal University of Juiz de Fora – UFJF, Juiz de Fora, MG, Brazil
| | - Eliane Rodrigues de Faria
- Department of Nutrition, Institute of Biological Sciences, Federal University of Juiz de Fora – UFJF, José Lourenço Kelmer St., Campus Universitário, São Pedro, Juiz de Fora, MG36036-900, Brazil
| | - Michele Pereira Netto
- Department of Nutrition, Institute of Biological Sciences, Federal University of Juiz de Fora – UFJF, José Lourenço Kelmer St., Campus Universitário, São Pedro, Juiz de Fora, MG36036-900, Brazil
- Graduate Program in Public Health, Department of Public Health, School of Medicine, Federal University of Juiz de Fora – UFJF, Juiz de Fora, MG, Brazil
| | - Renata Maria Souza Oliveira
- Department of Nutrition, Institute of Biological Sciences, Federal University of Juiz de Fora – UFJF, José Lourenço Kelmer St., Campus Universitário, São Pedro, Juiz de Fora, MG36036-900, Brazil
- Graduate Program in Public Health, Department of Public Health, School of Medicine, Federal University of Juiz de Fora – UFJF, Juiz de Fora, MG, Brazil
| | - Ana Paula Carlos Cândido
- Department of Nutrition, Institute of Biological Sciences, Federal University of Juiz de Fora – UFJF, José Lourenço Kelmer St., Campus Universitário, São Pedro, Juiz de Fora, MG36036-900, Brazil
- Graduate Program in Public Health, Department of Public Health, School of Medicine, Federal University of Juiz de Fora – UFJF, Juiz de Fora, MG, Brazil
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Social Determinants of Obesity and Stunting among Brazilian Adolescents: A Multilevel Analysis. Nutrients 2022; 14:nu14112334. [PMID: 35684134 PMCID: PMC9183094 DOI: 10.3390/nu14112334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/20/2022] [Accepted: 05/26/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Background: The purpose of this study was to identify the prevalence of obesity and stunting among Brazilian adolescents and its associations with social determinants of health (individual, family, and school), grounded on the necessity of investigating the determinants of nutritional problems within this population. (2) Methods: A population-based survey was administered to 16,556 adolescents assessed by the 2015 National School Health Survey. Multivariate models of obesity and stunting were estimated from Multilevel Poisson Regressions. (3) Results: The prevalence of obesity among Brazilian adolescents (10.0%; 95% CI: 9.4–10.6) was associated directly with indifference or dissatisfaction with body image, with eating breakfast four or fewer days a week, living with up to four people in the household, studying in private schools, and being from the South region, and was inversely associated with being female, 15 years old or older, with having the highest nutritional risk eating pattern, dining at fast-food restaurants, and eating while watching television or studying. The prevalence of stunting (2.3%; 95% CI: 2.0–2.8) was directly associated with the age of 15 years or older, and inversely associated with the lower number of residents living in the household, maternal education—decreasing gradient from literate to college level education, studying in urban schools, and being from the South and Central-West regions. (4) Conclusions: Obesity in adolescence presented behavioral determinants. Stunting and obesity have structural social determinants related, respectively, to worse and better socioeconomic position among Brazilian adolescents.
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da Silva SU, Alves MDA, de Vasconcelos FDAG, Gonçalves VSS, Barufaldi LA, de Carvalho KMB. Association between body weight misperception and dietary patterns in Brazilian adolescents: Cross-sectional study using ERICA data. PLoS One 2021; 16:e0257603. [PMID: 34555063 PMCID: PMC8460023 DOI: 10.1371/journal.pone.0257603] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/04/2021] [Indexed: 01/13/2023] Open
Abstract
The association between body image and eating behaviors or weight control strategies has been demonstrated in the scientific literature, but there is a lack of evidence on the association between weight misperception and food consumption indicators in adolescents. This study aimed to evaluate the association between weight misperception and dietary patterns (DPs) in the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA). It was a national school-based cross-sectional study conducted among students aged 12-17 years. Data were collected in the form of anthropometric measurements, responses in self-answered questionnaires, and 24-h dietary recall. The following variables were assessed: weight underestimation and overestimation (independent variables), which were defined as the presence of a disagreement between nutritional status and self-perceived weight; dietary patterns (dependent variables), defined by a posteriori method using principal component factor analysis; and individual and demographic variables (covariates). Data analysis was performed using the Poisson regression models method, stratified by sex. A total of 52,038 adolescents with normal weights were evaluated. The weight misperception prevalence was 34.0% (95% confidence interval [CI]: 33.0, 35.0). Three DPs were identified: "Traditional Brazilian," "Processed meat sandwiches and coffee," and "Ultra-processed and sweet foods." In girls, weight underestimation was directly associated with the "Traditional Brazilian" (1.24; 95% CI: 1.08, 1.43) and "Ultra-processed and sweet foods" DPs (1.29; 95% CI: 1.09, 1.54), and overestimation was inversely associated with all the DPs. In boys, a direct association between underestimation and the "Ultra-processed and sweet foods" DP (1.29; 95% CI: 1.10, 1.51) was found. Overestimation was inversely associated with the "Traditional Brazilian" DP (0.79; 95% CI: 0.63, 0.99). The inverse association between overestimation and the "Traditional Brazilian" DP, and the direct association between underestimation and the "Ultra-processed and sweet foods" DP indicated that weight misperception was related to unhealthy eating habits in Brazilian adolescents.
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Affiliation(s)
- Simoni Urbano da Silva
- Faculty of Health Sciences, Graduate Program of Public Health, University of Brasilia, Brasilia, Federal District, Brazil
| | - Mariane de Almeida Alves
- Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, São Paulo, Brazil
| | | | | | - Laura Augusta Barufaldi
- Population Research Division, Brazilian National Cancer Institute José Alencar Gomes da Silva, Rio de Janeiro, Rio de Janeiro, Brazil
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Ushula TW, Lahmann PH, Mamun A, Wang WYS, Williams GM, Najman JM. Lifestyle correlates of dietary patterns among young adults: evidence from an Australian birth cohort. Public Health Nutr 2021; 25:1-12. [PMID: 34486516 PMCID: PMC9991692 DOI: 10.1017/s1368980021003864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 08/25/2021] [Accepted: 09/02/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Previous studies of sociodemographic and lifestyle correlates of dietary patterns among young adults have primarily focused on physical activity and smoking, with inconclusive results. This study aims to examine the associations between a broader range of lifestyles of young adults and their patterns of food consumption. DESIGN Cross-sectional. SETTING Brisbane, Australia. PARTICIPANTS The data set are from a long running birth cohort study which commenced in 1981. Details of dietary intake and sociodemographic and lifestyle factors were from the 21-year follow-up of the Mater-University of Queensland Study of Pregnancy (MUSP) birth cohort. The effective cohort (n 2665, 57 % women) is of young adult offspring. Usual dietary intake was assessed using a Food Frequency Questionnaire (FFQ). Data on sociodemographic and lifestyle variables were obtained from self-reports. RESULTS Western and prudent dietary patterns were identified for the combined cohort of women and men using principal components analysis. Multivariable linear regression models were used to examine the associations between lifestyle variables and dietary patterns adjusting for potential confounders. Results from multivariable adjusted models showed that physical activity, watching TV and smoking were strongly associated with each dietary pattern; alcohol consumption and BMI showed weaker associations (P < 0·05 for all). CONCLUSIONS Our study describes a clustering of unhealthy lifestyles in young adults. Young adults with unhealthy lifestyles less often adhere to a healthy prudent dietary pattern and more often an unhealthy Western pattern. Dietary preferences are enmeshed in a lifestyle matrix which includes physical activity, sedentary activity, smoking and alcohol consumption of young adults.
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Affiliation(s)
- Tolassa W Ushula
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Nutrition and Dietetics Department, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Petra H Lahmann
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Abdullah Mamun
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
- The Australian Research Council (ARC) Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Australia
- The Queensland Alliance for Environmental Health Sciences, The University of Queensland, Brisbane, Australia
| | - William YS Wang
- Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - Gail M Williams
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jake M Najman
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Percentage of energy contribution according to the degree of industrial food processing and associated factors in adolescents (EVA-JF study, Brazil). Public Health Nutr 2021; 24:4220-4229. [PMID: 33436138 DOI: 10.1017/s1368980021000100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate energetic contribution according to the degree of industrial food processing and its association with sociodemographic, anthropometric, biochemical, clinical and behavioural characteristics in adolescents. DESIGN Cross-sectional study (Adolescent Lifestyle Study). Food consumption was assessed using 24-h dietary recalls, with foods classified by degree of industrial progressing. The usual diet was estimated using the Multiple Source Method. In a linear regression model, the energy percentage (E %) was associated with sociodemographic, anthropometric, biochemical, clinical and behavioural characteristics, after adjustment for sex and age. SETTING Juiz de Fora, Brazil. PARTICIPANTS Eight hundred and four adolescents, of both sexes, 14-19 years of age, enrolled in public schools. RESULTS The E % of unprocessed or minimally processed foods corresponded to 43·1 %, processed foods to 11·0 % and the ultraprocessed foods to 45·9 %. E % of unprocessed foods was associated with socio-economic stratum (adjusted β = -0·093; P = 0·032), neck circumference (adjusted β = 0·017; P = 0·049), screen time (adjusted β = -0·247; P = 0·036) and HDL-cholesterol (adjusted β = -0·156; P = 0·003). E % of ultraprocessed foods was associated with socio-economic stratum (adjusted β = 0·118; P = 0·011), screen time (adjusted β = 0·375; P = 0·003), BMI (adjusted β = -0·029; P = 0·025), neck circumference (adjusted β = -0·017; P = 0·028) and HDL-cholesterol (adjusted β = 0·150; P = 0·002). CONCLUSIONS There was a high E % of ultraprocessed foods in the diet of the adolescents. Actions are needed to raise the awareness of adopting healthy eating habits.
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Barros NERP, Moreno LA, Arruda SPM, de Assis RC, Celedonio RF, Silva FRA, Pinto FJM, Maia CSC. Association between Eating Patterns and Excess Body Weight in Adolescents. Child Obes 2021; 17:400-407. [PMID: 33902325 DOI: 10.1089/chi.2020.0265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Excess body weight is a risk factor for the development of diseases. Adolescence is a nutritionally vulnerable age group that suffers due to influences on food intake. We aimed to identify the main dietary patterns of adolescents to investigate their association with excess body weight. Methods: This was a cross-sectional study. Anthropometric measurements (weight and height) were collected to calculate the BMI. Nutritional statuses were classified according to World Health Organization classification. Food consumption data were obtained through a 24-hour recall and food patterns were identified through factor analyses of the main components. The patterns were categorized into quintiles and dichotomized into greater (fourth and fifth quintile) and lower (first to third quintile) adherences. Binomial regression was used to assess the association between food patterns and excess body weight. The study was conducted in a capital city in Northeast Brazil from adolescents aged between 10 and 19 years in 826 public schools. Results: Three main food patterns were identified in women and men: coffee with bread (white bread, coffee, fat, and eggs), common Brazilian (white rice, beans, meat, pasta, with negative factor load for regional foods), and mixed pattern (sweets, fruits, biscuits and cakes, vegetables, and dairy products). Adolescents with a greater adherence to the coffee and bread pattern [odds ratio (OR) = 0.68; 95% confidence interval (95% CI): 0.50-0.93] and the common Brazilian pattern (OR = 0.72; 95% CI: 0.53-0.99) had a lower chance of being excess body weight than those with lower adherence. Conclusions: Three main eating patterns were identified among adolescents, and greater adherence to the coffee with bread and common Brazilian patterns implied a lower chance of excess body weight.
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Affiliation(s)
| | - Luis Alberto Moreno
- Department of Physiatry and Nursing, Universidad de Zaragoza, Zaragoza, Spain
| | | | - Renata Carmo de Assis
- Post-Graduate Program in Nutrition and Health, State University of Ceará, Fortaleza, Brazil
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Said L, Gubbels JS, Kremers SPJ. Dietary Knowledge, Dietary Adherence, and BMI of Lebanese Adolescents and Their Parents. Nutrients 2020; 12:nu12082398. [PMID: 32796513 PMCID: PMC7468749 DOI: 10.3390/nu12082398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 12/28/2022] Open
Abstract
Paediatric obesity is a severe public health problem accompanied by several physical and mental complications, mainly due to an imbalance between energy input and output. Dietary behaviours are influenced by many demographic factors and determinants, such as the place of residence and the level of dietary knowledge of the children and their parents. The aim of the current paper is to assess the levels of dietary knowledge, dietary adherence (in relation to recommendations), and the body mass index (BMI) of Lebanese adolescents in association with demographic variables, their parents’ dietary knowledge and adherence levels, and with other lifestyle behaviours. This cross-sectional study included 1535 Lebanese adolescents aged 15 to 18 years, from 16 public and private high schools located in urban and rural regions, and 317 of their parents. Our results showed that 30.2% of the adolescents were overweight or obese. Participants enrolled in private schools and those living in urban regions had a significantly higher BMI z-score compared to those enrolled in public schools and living in rural regions, respectively. In addition, Lebanese adolescents generally had low levels of dietary knowledge and 32.4% had low levels of dietary adherence. Their dietary adherence was significantly associated with their parents’ dietary adherence. The findings underline the significant role of the parents in shaping their children’s eating behaviours, in addition to the other determinants and factors affecting the diet of Lebanese adolescents. As the prevalence of paediatric overweight and obesity has reached alarming rates, the results of the current study have important implications for both public health policies and obesity prevention interventions in the Middle East and worldwide.
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Affiliation(s)
- Liliane Said
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine, and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands; (J.S.G.); (S.P.J.K.)
- Department of Nutrition and Food Sciences, Faculty of Arts and Sciences, Lebanese International University, Bekaa, Lebanon
- Correspondence:
| | - Jessica S. Gubbels
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine, and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands; (J.S.G.); (S.P.J.K.)
| | - Stef P. J. Kremers
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine, and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands; (J.S.G.); (S.P.J.K.)
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Pinho-Pompeu M, Paulino DSM, Surita FG. Influence of breakfast and meal frequency in calcium intake among pregnant adolescents. MATERNAL AND CHILD NUTRITION 2020; 16:e13034. [PMID: 32510806 PMCID: PMC7507371 DOI: 10.1111/mcn.13034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 12/14/2022]
Abstract
Calcium is an essential micronutrient that plays a role in growing and pregnancy, and its necessity is increased during pregnancy in adolescence. Thus, the aim of the study is to describe the daily calcium intake and its associations with dietetic habits, sociodemographic data and perinatal outcomes among pregnant adolescents. A prospective cohort study was conducted among primiparous adolescents who started prenatal care before 20 weeks of gestation. Sociodemographic data, weight and height, 24‐h dietary recall (24hRec) and perinatal outcomes were collected over four meetings (three during pregnancy and one in puerperium). All 24hRecs were analysed by the Nutrition Data System for Research (NDSR)® programme, and descriptive analysis and univariate and multivariate logistic regression were done. A total of 150 pregnant adolescents were included, with a mean of daily calcium intake of 659.9 mg (50% of recommended intake). Adolescents who ate more than three meals per day (89.3%), and ate breakfast every day (69.3%), were shown to have higher daily calcium intake, odds ratio (OR CI 95%) of 3.4 (1.0, 11.0) and 16.8 (1.0, 302.1), respectively. No correlation was observed between calcium daily intake and sociodemographic data or perinatal outcomes. Dairy products were the foods that mostly contributed to achieving recommended daily calcium intake. In our cohort, pregnant adolescents had a low daily calcium intake. They should be advised to eat more than three meals per day, eat breakfast in particular, increase the consumption of calcium rich‐foods, such as dairy products and green leafy vegetables, and consider calcium supplementation.
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Affiliation(s)
- Maira Pinho-Pompeu
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
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Fernandes Gomes AP, da Costa ACC, Massae Yokoo E, de Matos Fonseca V. Impact of Bean Consumption on Nutritional Outcomes amongst Adolescents. Nutrients 2020; 12:nu12041083. [PMID: 32295142 PMCID: PMC7230442 DOI: 10.3390/nu12041083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 12/31/2022] Open
Abstract
Brazilian adolescents have undergone a noteworthy nutritional epidemiological transition. There is an increase in the prevalence of overweight and high consumption of ultra-processed foods in parallel with patterns of traditional meals that include beans. This study analyzed associations between bean consumption in the diet of adolescents and nutrition outcomes. Multiple regression analysis showed a significant reduction in body mass index (BMI), body fat percentage (%BF) and LDL-cholesterol (LDL-c) values among those with bean consumption equal to or greater than five times a week. Adolescents who had lunch outside the home and those who did not have the habit of having lunch showed a significantly higher BMI. There was an increase in the %BF among married adolescents and those who did not have lunch. There was a reduction of LDL-c among those with intermediate per capita income and those who consumed processed juice less than 5 times a week, and an increase among those who did not have breakfast. There were significant interactions between sexual maturation, energy consumption, physical activity and energy consumption. Thus, in the context of this study, the presence of beans in the diet, at frequencies equal to or greater than five times a week, can be considered a proxy for healthy eating.
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Affiliation(s)
- Ana Paula Fernandes Gomes
- Postgraduate Program in Child and Women’s Health, National Institute of Women’s, Child and Adolescent Health Fernandes Figueira, Oswaldo Cruz Foundation, 20021-140 Rio de Janeiro, Brazil
- Department of Fundamental Nutrition, Federal University of the State of Rio de Janeiro, 22290-240 Rio de Janeiro, Brazil
- Correspondence:
| | - Ana Carolina Carioca da Costa
- National Institute of Women’s, Child and Adolescent Health Fernandes Figueira, Oswaldo Cruz Foundation, 20021-140 Rio de Janeiro, Brazil; (A.C.C.d.C.); (V.d.M.F.)
| | - Edna Massae Yokoo
- Department of Epidemiology and Biostatistics, Fluminense Federal University, 24220-000 Niterói, Brazil;
| | - Vania de Matos Fonseca
- National Institute of Women’s, Child and Adolescent Health Fernandes Figueira, Oswaldo Cruz Foundation, 20021-140 Rio de Janeiro, Brazil; (A.C.C.d.C.); (V.d.M.F.)
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Dietary Patterns of Breakfast Consumption Among Chilean University Students. Nutrients 2020; 12:nu12020552. [PMID: 32093261 PMCID: PMC7071493 DOI: 10.3390/nu12020552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/10/2020] [Accepted: 02/17/2020] [Indexed: 12/26/2022] Open
Abstract
Breakfast is one of the most important meals of the day. A good quality breakfast must include dairy products, cereals, and fruits. The aim of this study is to determine breakfast dietary patterns and their nutritional quality among Chilean university students. A cross-sectional non-probabilistic study was conducted in 200 university students between 18 and 27 years in Santiago, Chile. To identify dietary patterns and breakfast quality, a breakfast food survey was conducted. Patterns were identified by factor analysis. Most of the subjects (53%) ate breakfast daily, with a higher prevalence among females (60.2% vs. 43.7%, p < 0.05); 68% did not consume fruits and 17.5% had good breakfast quality, with no differences by sex. Four breakfast dietary patterns were identified: “dairy & cereals”, “healthy”, “traditional salty” and “traditional sweet” that together explained 35.6% of the total variance. There was no sex difference in predominant dietary patterns. The “dairy & cereals” and “traditional sweet” patterns were associated with regularly eating breakfast (β: −0.47, p = 0.001; β: −0.32, p = 0.020) and the “healthy” pattern with BMI ≥25 kg/m2 (β: 0.35, p = 0.024). In conclusion, breakfast quality was inadequate due to low fruit consumption and energy intake. The four identified patterns included cereals, bread, dairy, fats and sugars. Results may be usual in the planning of future interventions aimed at improving breakfast consumption and quality in university students.
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Falcão RCTMDA, Lyra CDO, de Morais CMM, Pinheiro LGB, Pedrosa LFC, Lima SCVC, Sena-Evangelista KCM. Processed and ultra-processed foods are associated with high prevalence of inadequate selenium intake and low prevalence of vitamin B1 and zinc inadequacy in adolescents from public schools in an urban area of northeastern Brazil. PLoS One 2019; 14:e0224984. [PMID: 31800573 PMCID: PMC6892533 DOI: 10.1371/journal.pone.0224984] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/26/2019] [Indexed: 12/12/2022] Open
Abstract
Changes in eating behavior of adolescents are associated with high consumption of processed and ultra-processed foods. This study evaluated the association between these foods and the prevalence of inadequate micronutrient intake in adolescents. A cross-sectional study was conducted with 444 adolescents from public schools in the city of Natal, northeastern Brazil. The adolescents' habitual food consumption was evaluated using two 24-hour dietary recalls. Foods were categorized according to the degree of processing (processed and ultra-processed) and distributed into energy quartiles, using the NOVA classification system. Inadequacies in micronutrient intake were assessed using the estimated average requirement (EAR) as the cutoff point. Multivariate logistic regression models were used to estimate the relationship between energy percentage from processed and ultra-processed foods and prevalence of inadequate micronutrient intake. The mean (Standard Deviation (SD)) consumption of total energy from processed foods ranged from 5.8% (1.7%) in Q1 to 20.6% (2.9%) in Q4, while the mean consumption of total energy from ultra-processed foods ranged from 21.4% (4.9%) in Q1 to 61.5% (11.7%) in Q4. The rates of inadequate intake of vitamin D, vitamin E, folate, calcium, and selenium were above 80% for both sexes across all age groups. Energy consumption from processed foods was associated with higher prevalence of inadequate selenium intake (p < 0.01) and lower prevalence of inadequate vitamin B1 intake (p = 0.04). Energy consumption from ultra-processed foods was associated with lower prevalence of inadequate zinc and vitamin B1 intake (p < 0.01 and p = 0.03, respectively). An increase in the proportion of energy obtained from processed and ultra-processed foods may reflect higher prevalence of inadequate selenium intake and lower prevalence of vitamin B1 and zinc inadequacy.
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Affiliation(s)
| | - Clélia de Oliveira Lyra
- Postgraduate Nutrition Program, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | | | - Lucia Fátima Campos Pedrosa
- Postgraduate Nutrition Program, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Severina Carla Vieira Cunha Lima
- Postgraduate Nutrition Program, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Karine Cavalcanti Maurício Sena-Evangelista
- Postgraduate Nutrition Program, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
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