Ingestão inadequada de nutrientes na população de idosos do Brasil: Inquérito Nacional de Alimentação 2008-2009

Factors of food choice and nutritional intake of Brazilian older adults according sociodemographic and health characteristics

The rapid demographic transition in developing countries has always posed a challenge for the social and economic policies of these nations. The increase in longevity poses new challenges for understanding dietary consumption among different age groups at the old age population. The aim of this study was to evaluate the reasons for food choice and the composition of nutritional intake of older adults and its relationship to individual characteristics. Community-living older adults aged 60 and older were interviewed in their homes at the southeastern region of Brazil, between December 2021 and February 2022. The Food Choice Questionnaire and a Food Frequency Questionnaire were administered to obtain data on the reasons for food choice and nutritional intake. A structured interview was employed to gather information on individual characteristics. 168 older adults (mean age of 72.6 ± 8.9; 69.6% women) participated. The reasons for food choice differed significantly, with weight control being one of the least important and health being one of the most important. But older adults aged 80 and over valued the health criterion less than younger participants (60-69 years old). The intake of macronutrients and energy were below nutritional recommendations. Carbohydrate consumption was positively correlated with the mood motive. There was a relationship between the reasons for choosing food and/or the components of nutritional intake with: gender, age, living with a partner, self-report of depression/anxiety, self-perception of health and nutritional status anthropometric. The results are important to be considered in prevention policies and clinical-nutritional management, with special attention to the oldest-old.

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

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

Affordable Nutrient Density in Brazil: Nutrient Profiling in Relation to Food Cost and NOVA Category Assignments

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.

Association between vitamin D status and lifestyle factors in Brazilian women: Implications of Sun Exposure Levels, Diet, and Health

BACKGROUND

Vitamin D deficiency has been documented to be prevalent, even in low latitude regions; and this may be related to sun exposure behaviors. The aim of the current study was to assess the association between serum 25-hydroxyvitamin D [25(OH)D] concentrations and lifestyle-related factors in a sample of Brazilian women living at latitude 21º 8' S.

METHODS

A cross-sectional study was undertaken in 101 women aged 35 years or older in July 2019 to assess the association between 25(OH)D concentration and level of exposure to ultraviolet radiation (UVR), smoking habits, alcohol consumption, and physical activity levels. Age, body mass index (BMI), and postmenopausal status were investigated.

FINDINGS

According to the slope coefficient for individual daily UVR levels, the concentration of 25(OH)D increased by 5 nmol / L for each extra Standard Erythema Dose of UVR, regardless of age and BMI (p < 0·001). Postmenopausal women had a significantly higher mean concentration of 25(OH)D (p = 0·01), higher UVR exposure (p = 0·01) and lower BMI (p = 0·005) compared with younger women, independent of other confounders including smoking, alcohol, occupation and physical activity.

INTERPRETATION

Although postmenopausal women from Brazil had higher mean concentrations of 25(OH)D than younger women, more studies are necessary to understand how sun exposure and lifestyle variables interfere with these levels. These findings have important public health implications since they suggest that vitamin D deficiency in older age is not inevitable.

FUNDING

This study was funded by an award received by Universities Global Partnership Network - UGPN. KVSS and SLO receive scholarship from CAPES, Brazilian Ministry of Education. HR receives a productivity grant from CNPq.

Nursing outcomes and interventions associated with the nursing diagnoses: Risk for or actual frail elderly syndrome

PURPOSE

To clinically validate nursing outcomes and interventions associated with the nursing diagnoses of Risk for Frail elderly syndrome or Frail elderly syndrome.

METHODS

This cross-sectional study utilized an instrument containing assessment cues, nursing diagnoses, outcomes, and interventions in a sample of 28 older adults. The Generalized Estimation Equation model, complemented by the Bonferroni test, was used for statistical analysis.

RESULTS

Twenty-three (82%) older adults were diagnosed with Risk for Syndrome and five (18%) with Frail elderly syndrome. Ten outcomes and three interventions were validated with significant differences statistically.

CONCLUSIONS

The clinical validation made it possible to demonstrate the clinical evolution of these patients under follow-up.

IMPLICATIONS FOR NURSING PRACTICE

Those outcomes and interventions are a linkages proposal between them and the nursing diagnoses.

OBJETIVO

Validar clinicamente os resultados e intervenções de enfermagem associados ao diagnóstico de enfermagem Risco para Síndrome do Idoso Frágil ou Síndrome do Idoso Frágil. MÉTODOS: Estudo transversal que utilizou um instrumento contendo possibilidades de avaliação, diagnóstico de enfermagem, resultados e intervenções em uma amostra de 28 idosos. A análise estatística utilizou o modelo de Equações de Estimativas Generalizadas, complementado pelo teste de Bonferroni.

RESULTADOS

Vinte e três (82%) idosos foram diagnosticados com Risco de Síndrome e cinco (18%) idosos com Síndrome. Dez resultados e três intervenções foram validados com diferença estatisticamente significativa. CONCLUSÕES: A validação clínica permitiu demonstrar a evolução clínica desses pacientes em acompanhamento. Implicações para a prática de enfermagem. Esses resultados e intervenções são uma proposta de vínculo entre eles e os diagnósticos de enfermagem.

Effect of chocolate on older patients with cancer in palliative care: a randomised controlled study

Background

Older advanced stage cancer patients, with changes in nutritional status, represent an important demand for palliative care. The aim was to determine the effects of 4 weeks of chocolate consumption on the nutritional status of older cancer patients in palliative care.

Methods

Older cancer patients in palliative care with ambulatory (n = 46) monitoring were randomized to control (CG, n = 15), intervention with 55% cocoa chocolate (IG1, n = 16) and intervention with white chocolate (IG2, n = 15) groups and evaluated before and after 4 weeks for nutritional status (primary outcome), evaluated by the Mini Nutritional Assessment tool (MNA). Food consumption, anthropometry, body composition, laboratory parameters and quality of life (QL) with the European Organization for the Research and Treatment of Cancer instrument were also evaluated.

Results

IG1 progressed with increased screening (estimated difference [95% CI]: − 1.3 [− 2.2;-0.4], p < 0.01), and nutritional (estimated difference [95% CI]: − 1.3 [− 2.5;-0.1], p = 0.04) scores on the MNA, with no change in anthropometry and body composition. Regarding antioxidant capacity, reduced glutathione levels increased (estimated difference [95% CI]: − 0.8 [− 1.6;-0.02], p = 0.04) and malondealdehyde levels decreased in IG2 (estimated difference [95% CI]:+ 4.9 [+ 0.7;+ 9.1], p = 0.02). Regarding QL, functionality improved in IG1, with higher score in the functional domain (estimated difference [95% CI]:-7.0 [− 13.3;-0.7], p = 0.03).

Conclusions

The consumption of chocolate with a greater cocoa content may contribute to the improvement of the nutritional status and functionality among older cancer patients in palliative care. The consumption of white chocolate was associated with improved oxidative stress.

Trial registration

A randomized clinical trial (ClinicalTrials.gov NCT04367493).

Opportunities for diet quality improvement: the potential role of staple grain foods

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.

Feasibility in meeting nutrient amounts of the National School Feeding Program and its relationship with the menu cost

We evaluated the feasibility of the menu adequacy regarding the nutritional constraints established by the National School Feeding Program (PNAE) and its relation to the cost. Each menu accounted for a given food combination within each food group. A diet optimization model comprising each set of foods was designed to obtain food quantities in order to meet the exigences of the PNAE at the lowest cost (menus with 20% and 30% of dietary reference intake for energy, macronutrients, calcium, iron, magnesium, zinc, vitamins A and C, also restrictions for sodium, saturated and trans fats, and added sugar). There was no feasible solution that accommodated all nutrient targets. Limiting components were calcium, sodium, and carbohydrates; but the menus were adequate for the other nutrients. There was a positive correlation between the menu cost and the frequency of meat and fruits, and a negative correlation with the contents of sodium and carbohydrates, and with the frequencies of rice and beans. The probability of obtaining carbohydrate adequacy was close to zero when the meat frequency was higher than one serving per week. In conclusion, it is unlikely to obtain menus that meet all the requirements of the PNAE.

Current calcium fortification experiences: a review

Low dietary calcium is very common in many populations, contributing to nutritional rickets/osteomalacia in children/adults and increasing the risk of several health problems. Calcium is a nutrient of concern as the recommended nutrient requirements are difficult to meet in the absence of dairy products. The provision of culturally acceptable calcium-fortified foods may improve calcium intake when it is a feasible and cost-effective strategy in a particular setting. This landscape review was conducted in 2019 and describes current calcium fortification efforts and lessons learned from these experiences. Worldwide, the United Kingdom is the only country where calcium fortification of wheat flour is mandatory. It is estimated that this fortified staple ingredient contributes to 13-14% of calcium intake of the British population. Other items voluntary fortified with calcium include maize flour, rice, and water. Current calcium fortification programs may lack qualified personnel/training, clear guidelines on implementation, regulation, monitoring/evaluation, and functional indicators. Also, the cost of calcium premix is high and the target groups may be hard to reach. There is a lack of rigorous evaluation, particularly in settings with multiple micronutrient programs implemented simultaneously, with low quality of the evidence. Further research is needed to assess the impact of calcium fortification programs.

Changes in micronutrient intake and factors associated with this change among older Australian men: the Concord Health and Ageing in Men Project

OBJECTIVES

To examine changes in micronutrient intake over 3 years and identify any associations between socio-economic, health, lifestyle and meal-related factors and these changes in micronutrient intakes among older men.

DESIGN

Prospective study.

SETTING

Dietary adequacy of individual micronutrient was compared to the estimated average requirement of the nutrient reference values (NRV). Attainment of the NRV for twelve micronutrients was incorporated into a dichotomised variable 'not meeting' (meeting ≤ 6) or 'meeting' (meeting ≥ 7) and categorised into four categories to assess change in micronutrient intake over 3 years. The multinomial logistic regression analyses were conducted to model predictors of changes in micronutrient intake.

PARTICIPANTS

Seven hundred and ninety-four men participated in a detailed diet history interview at the third wave (baseline nutrition) and 718 men participated at the fourth wave (3-year follow-up).

RESULTS

The mean age was 81 years (range 75-99 years). Median intakes of the majority of micronutrients decreased significantly over a 3-year follow-up. Inadequacy of the NRV for thiamine, dietary folate, Zn, Mg, Ca and I were significantly increased at a 3-year follow-up than baseline nutrition. The incidence of inadequate micronutrient intake was 21 % and remained inadequate micronutrient intake was 16·4 % at 3-year follow-up. Changes in micronutrient intakes were significantly associated with participants born in the UK and Italy, low levels of physical activity, having ≥2 medical conditions and used meal services.

CONCLUSIONS

Micronutrient intake decreases with age in older men. Our results suggest that strategies to improve some of the suboptimal micronutrient intakes might need to be developed and implemented for older men.

Intake of saturated fat, trans fat, and added sugars by the Brazilian population: an indicator to evaluate diet quality

BACKGROUND/OBJECTIVE

In recent decades, changes in the diet of Brazilians have been characterized by increased consumption of high energy-dense foods, rich in fat and sugar. This study was aimed at assessing diet quality based on the intake of foods with high content of solid fat and added sugars (SoFAS).

SUBJECTS/METHODS

The first Brazilian National Dietary Survey (2008-2009) is a nationwide representative cross-sectional study that collected food records from 34,003 ≥ 10-year-old individuals. A receiver-operating characteristic curve was used to determine the limit that would identify diets with high SoFAS content.

RESULTS

The limit of 45% of total dietary energy provided by SoFAS was adopted to classify diets with excessive content. The SoFAS provided 53% of daily energy intake to adolescents, 49% to adults, and 48% to the elderly. A high intake of SoFAS was found in 64.7% of adolescents, 59.1% of adults, and 57.8% of the elderly. The contribution of SoFAS to daily energy intake increased with income in all age groups. Those with high consumption of SoFAS had higher intakes of sugar-sweetened beverages, cookies and cakes, processed meats, chips, candy and chocolate, and sandwiches and snacks, when compared with those that had moderate SoFAS intake (<45% of daily energy).

CONCLUSIONS

The 45% cutoff point for the contribution of SoFAS foods to total energy intake, utilized to classify low-quality diets, allowed to point out the high-risk profile of the Brazilian diet.

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

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

Planning dietary improvements without additional costs for low-income individuals in Brazil: linear programming optimization as a tool for public policy in nutrition and health

BACKGROUND

Meeting nutrient intake recommendations may demand substantial modifications in dietary patterns, and may increase diet cost. Incentives for modifying one's dietary intake that disregard prices are unlikely to be effective in the general population, especially among low-income strata, due to the high percentage of income committed to food purchases. The aim of this study is to evaluate how much the nutrient content can be increased through a modeled diet, without any cost increase, for low-income Brazilian households.

METHODS

Low-income households were selected from the Household Budget Survey (24,688 households) and National Dietary Survey (6,032 households, 16,962 individuals), from where we obtained food prices and consumption data. Food quantities were modeled using linear programming to find diets that meet nutritional recommendations in two sets of models: cost-constrained (the cost should not be higher than the observed diet cost) and cost-free. Minimum and maximum amounts of each food in the modelled diets were allowed at three levels of food acceptability: rigorous (least deviance from the current observed diets), moderate, and flexible (higher deviance from the current observed diets).

RESULTS

We found no feasible solution that would accommodate all the nutritional targets. The most frequent limiting nutrients were calcium; vitamins D, E, and A; zinc; fiber; sodium; and saturated and trans-fats. However, increases in nutrient contents were observed, especially for fiber, calcium, copper, magnesium, vitamin A, vitamin C, and vitamin E. In general, the best achievement was obtained with cost-free models. Fruits and beans increased in all models; large increase in whole cereals was observed only in the flexible models; large increase in vegetables was observed only in the cost-free models; and fish increased only in the cost-free models. Reductions were observed for rice, red and processed meats, sugar-sweetened beverages, and sweets. The mean observed cost was US$2.16 per person/day. The mean cost in the cost-free models was US$2.90 (moderate), US$2.70 (rigorous), and US$2.60 (flexible).

CONCLUSION

The complete nutritional adequacy is unattainable, although feasible changes would substantially improve diet quality by improving nutrient content without additional costs.

Comparison of nutritional status and dietary intake self-reported by elderly people of different birth cohorts (1936 to 1940 and 1946 to 1950): Health, Wellbeing and Aging (SABE) Study

INTRODUCTION

The aging process is characterized by several changes in individuals' life, including his or her nutritional status and food intake. To understand the trends of these changes, studies with elderly people who were born at different times are necessary.

OBJECTIVE

To compare the nutritional status and food intake of elderly people who participated in the Health, Well-being, and Aging study (SABE study), conducted in São Paulo, in 2000 and 2010.

METHODS

The nutritional status was identified by means of the body mass index (BMI) and was classified as underweight (BMI < 23 kg/m²), adequate weight (23 ≤ BMI < 28 kg/m²), or overweight (BMI ≥ 28 kg/m). Food intake was self-reported and was classified as the number of meals (≥ 3/day), frequency of intake of dairy products (≥ 1 serving/day), eggs and beans (≥ 1 serving/week), fruits and vegetables (≥ 2 servings/day), meat (≥ 3 servings/week), and liquids (≥ 5 glasses/day). The prevalence ratio was calculated to compare the variables of the cohorts, using Poisson regression.

RESULTS

A total of 755 individuals of both the genders aged 60 to 64 years and who were born between 1936 and 1940 and between 1946 and 1950 participated in this study. Elderly people who were born between 1946 and 1950 presented higher prevalence ratio of overweight (PR = 1.19), number of meals (PR = 1.34), and liquids intake (PR = 1.18), but presented lower prevalence of intake of dairy products (PR = 0.87), meats (PR = 0.93), and fruits and vegetables (PR = 0.83).

CONCLUSION

These results showed concerning scenarios of nutritional status and food intake for the most recent cohort (1946 - 1950).

Healthy Eating Index: Assessment of the Diet Quality of a Brazilian Elderly Population

Background

The food consumption assessment is necessary to monitor elderly's nutritional status because it allows detecting nutrition deficits and guiding the elaboration of effective conducts.

Objective

The objective of this study is to assess the global quality of the elderly's diet in Viçosa-MG, Brazil.

Methods

This is a population-based cross-sectional study, involving noninstitutionalized elderly. Diet quality was assessed through the Brazilian Healthy Eating Index-Revised (BHEI-R) validated to the Brazilian population.

Results

The study comprised 620 elderly individuals. The mean total BHEI-R score was 64.28. The worse consumption scores concerned the components Whole grains, Milk and derivatives, Sodium, Total fruit, and Whole fruit. Approximately 82% scored zero (0%) for Whole grains and 67% for Sodium. Men presented significantly lower scores than women, who have presented maximal score in the same items. Women's scores were not only significantly higher for Total fruit, Whole fruit, Milk and derivatives, but also significantly lower for Saturated fat.

Discussion

Most elderly need to improve their diet quality. Strategies heading toward the improvement of diet quality must be priority in policies to health promotion toward the healthy and active aging.

Anorexia of Aging Associated with Nutrients Intake in Brazilian Elderly

This study evaluated the association between anorexia of aging and nutrients intake. It was a cross-sectional study with 130 individuals aged 60 years or older, undergoing outpatient care in the city of Campinas, São Paulo. Anorexia of Aging (AA) was assessed using the Simplified Nutrition Appetite Questionnaire (SNAQ), and food consumption was evaluated using the 24-hour recall (24HR). The prevalence of AA was 27.7%, in which 66.7% were women and 38.9% were older than 80 years. Elderly with AA presented lower intake of calories (1172.6 kcal vs 1477.9 kcal; p = 0.003), carbohydrates (158.5 g vs 194.1 g; p = 0.015), proteins (49.9 g vs 68.5 g; p = 0.004) and lipids (34.6 g vs 46.1 g; p = 0.006). They also had lower intake of fibers (12.6 g vs 19.4 g; p < 0.001), iron (6.4 mg vs 8.9 mg; p < 0.001) and zinc (6.0 mg vs 8.5 mg; p = 0.004). Our results show that intake of most nutrients is significantly lower in AA elderly, except carbohydrates, which may point to worse-quality diets. The diagnosis of AA, as well as the evaluation of elderly food intake, are essential to prevent undernutrition, vulnerabilities, and increased morbidity and mortality.

Elevada prevalência de inadequação do consumo de fibras alimentares em idosos e fatores associados: um estudo de base populacional

RESUMO: Introdução: Vários fatores podem gerar mudanças nas práticas alimentares dos idosos, contribuindo para que as recomendações nutricionais não sejam atendidas. Objetivo: Estimar a prevalência de inadequação do consumo de fibras alimentares e seus fatores associados. Metodologia: Estudo transversal de base populacional que utilizou dados do Inquérito de Saúde no Município de Campinas, realizado em 2008/2009, no qual foram analisados 1.509 indivíduos ≥ 60 anos. O consumo alimentar foi estimado por meio do recordatório de 24 horas, e foi calculada a prevalência de inadequação de acordo com o ponto de corte para fibras totais do Institute of Medicine de 30 g/dia para homens e 21 g/dia para mulheres. Os fatores associados foram identificados utilizando modelo hierárquico de regressão de Poisson para estimativa das razões de prevalência, ajustados por variáveis de bloco distal (sociodemográficos) e bloco proximal (condições de saúde e indicadores de estilo de vida). Resultados: A inadequação do consumo de fibras alimentares foi observada em 90,1% da população, significantemente maior no sexo masculino (RP = 1,06), em idosos com parceiro (RP = 1,05), de menor renda (RP = 0,95), inativos fisicamente (RP = 1,05) e naqueles que não gostariam de mudar o peso corporal (RP = 1,05). Conclusão: Considerando que a inadequação de fibras alimentares foi muito elevada, toda a população de 60 anos ou mais deve ser alvo de intervenção nutricional para garantir o aporte adequado desse nutriente.

Eating patterns and nutrient intake for older people: analysis with different methodological approaches

This study aims to analyse the eating patterns and nutrient intake in different eating patterns of elderly persons. This is a cross-sectional study with elderly people from Botucatu, São Paulo state, Brazil. The mean daily nutrient intake of individuals with high adherence to the eating patterns identified by factor analysis was analysed, comparing the intake by analysis of variance. Individuals with high adherence to the Healthy eating pattern had the highest mean intake of retinol, vitamin A and vitamin E. Individuals with high adherence to the eating pattern Snacks and weekend meal presented lower means of vitamin B12, vitamin C, phosphorus, and retinol intake and the highest means of iron, manganese and magnesium intake. Individuals with high adherence to Fruits had the lowest mean fibre intake. Individuals with high adherence to Light and whole foods had the highest means of vitamin C intake. Individuals with high adherence to Soft diet showed lower protein intake and increased added sugar intake. Individuals with high adherence to the Traditional eating pattern presented high means of nutrient intake. In general, a better characterization of the eating behaviour of elderly people who adhere to each of these eating patterns was possible.

[Dietary patterns of the elderly in Brazil: National Heath Survey, 2013]

The study sought to identify dietary patterns and associated factors of elderly Brazilians. It involved a cross-sectional study based on data from the National Health Survey ("PNS/2013") of 11,177 elderly individuals, whose dietary patterns were identified by cluster analysis. Poisson regression with robust variance was used for the analysis of associated factors. The cluster analysis produced 2 clusters of dietary patterns, one healthy (55.4%), with greater consumption of raw and cooked vegetables and legumes, chicken, fruits, natural fruit juices and milk. And an unhealthy cluster (44.6%), with greater consumption of red meat and soft drinks or artificial juices. The prevalence of the healthy dietary pattern was greater for females (PR = 1.32, 95% CI 1.25- 1.40), Caucasian (PR = 1.09, 95% CI 1.02-1.15), elderly individuals with graduate or post-graduate degree (PR=1.56, 95% CI 1.41-1.72), living in the Southeast (PR = 1.54, 95% CI, 1.33-1.79) and South (PR = 1.51, 95% CI 1.30-1.76), non-smokers (PR = 1.19, 95% CI, 1.07-1.31) and physically active (PR = 1.24, 95% CI, 1.17-1.32). These results indicated an association between better social conditions and beneficial life habits with the consumption of healthy foods, reinforcing the hypothesis of social determination and the coexistence of health behaviors.

Food choices to meet nutrient recommendations for the adult Brazilian population based on the linear programming approach

OBJECTIVE

To identify optimal food choices that meet nutritional recommendations to reduce prevalence of inadequate nutrient intakes.

DESIGN

Linear programming was used to obtain an optimized diet with sixty-eight foods with the least difference from the observed population mean dietary intake while meeting a set of nutritional goals that included reduction in the prevalence of inadequate nutrient intakes to ≤20 %.

SETTING

Brazil.

SUBJECTS

Participants (men and women, n 25 324) aged 20 years or more from the first National Dietary Survey (NDS) 2008-2009.

RESULTS

Feasible solution to the model was not found when all constraints were imposed; infeasible nutrients were Ca, vitamins D and E, Mg, Zn, fibre, linolenic acid, monounsaturated fat and Na. Feasible solution was obtained after relaxing the nutritional constraints for these limiting nutrients by including a deviation variable in the model. Estimated prevalence of nutrient inadequacy was reduced by 60-70 % for most nutrients, and mean saturated and trans-fat decreased in the optimized diet meeting the model constraints. Optimized diet was characterized by increases especially in fruits (+92 g), beans (+64 g), vegetables (+43 g), milk (+12 g), fish and seafood (+15 g) and whole cereals (+14 g), and reductions of sugar-sweetened beverages (-90 g), rice (-63 g), snacks (-14 g), red meat (-13 g) and processed meat (-9·7 g).

CONCLUSION

Linear programming is a unique tool to identify which changes in the current diet can increase nutrient intake and place the population at lower risk of nutrient inadequacy. Reaching nutritional adequacy for all nutrients would require major dietary changes in the Brazilian diet.

[Factors associated with being underweight among elderly community-dwellers from seven Brazilian cities: the FIBRA Study]

The aim of this study was to assess the prevalence of being underweight among the elderly according to demographic and socioeconomic characteristics, health-related behaviors, diseases and health status. This was a cross-sectional multi-center study with 3,478 community-dwelling elders (≥ 65 years). The dependent variable was the prevalence of being underweight, classified by Body Mass Index < 22kg/m2. Adjusted prevalence rate ratios were estimated using multivariable Poisson regression. The mean age was 72.9 years and 12.0% of the elderly were underweight (CI95%:10.9-13.1). Aged elderly ≥ 80 years, former and current smokers, those who reported appetite loss and those classified as pre-frail or frail (PR=1.41; CI95%:1.09-1.82) presented a higher prevalence of being underweight. Individuals who received medical diagnosis of hypertension, diabetes and rheumatism had the lowest underweight prevalence observed. The results highlight the importance of nutritional status assessment and monitoring among the elderly, with emphasis on the most vulnerable subgroups, particularly the frail elderly, taking into account the health consequences of low weight.

Trends and association of BMI between sociodemographic and living conditions variables in the Brazilian elderly: 2002/03-2008/09

This study aimed to describe BMI's short-term trends and analyze the association between the Body Mass Index (BMI) and the sociodemographic variables and variables of family perception of the sufficiency and type of food consumed by Brazilian elderly of both sexes. The authors used data from the Household Budget Surveys (HBS) collected by the Brazilian Institute of Geography and Statistics (IBGE) in 2002/03 and 2008/09. The prevalence of overweight and obesity increased, whereas normal and low weight decreased. Multinomial regression models were used for 2008/09 to analyze the association between BMI and sociodemographic variables and variables of family perception of the sufficiency and type of food intake. Income and age were more associated with BMI. We suggest that health and nutrition prevention and monitoring measures be implemented through public policies, considering multifactorial overweight in the Brazilian elderly.

Low diet quality in older adults: a population-based study in southern Brazil

The aim of this study was to identify the factors associated with low diet quality in older adults from the city of Pelotas, Southern Brazil. Information on food consumption was collected using a reduced food frequency questionnaire, and diet quality was assessed by the Elderly Diet Quality Index DQI-E ("Índice de Qualidade da Dieta de Idosos - IQD-I"), devised by the authors. Points were attributed to each food evaluated according to frequency of consumption. Higher consumption frequency of healthy foods received higher scores whilst unhealthy foods received lower scores. Scores were divided into tertiles classified as: low quality, intermediate quality, and good quality. Multinomial logistic regression was used to assess the association between diet quality and the independent variables. The factors associated with low diet quality were: male gender, age < 80 years, low education, problems affording food, underweight, mouth or teeth problems, and having less than four meals a day. Important barriers to the consumption of a good quality diet were observed, highlighting the importance of considering these aspects in the promotion of healthy eating among older adults.

ADIPOQ + 45T≥G Polymorphism, Food Ingestion, and Metabolic Syndrome in Elderly Persons

INTRODUCTION

The current nutritional transition process contributes further to accelerate the onset of metabolic disorders, as do a number of environmental factors that lead to the diagnosis of chronic diseases, as a diet of low nutritional value, is possibly related to the incidence of metabolic syndrome. In addition to these factors, metabolic syndrome may also be related to genetic factors, the ADIPOQ + 45T> G polymorphism has been associated with serum adiponectin levels, insulin sensitivity, and obesity, which affects adiponectin levels act as protective factor for cardiovascular disease. In this way, the present study aimed to analyze the possible association between the ADIPOQ + 45T> G gene polymorphism, usual diet and metabolic syndrome in the elderly.

METHODS

We evaluated inflammatory and biochemical markers compared with older age groups (age 60 years) with and without metabolic syndrome. In addition to the anthropometric measurements of weight, height and waist circumference, the ADIPOQ + 45T> G gene polymorphism was determined by PCR- RFLP, and food consumption was investigated using a food frequency questionnaire.

RESULTS

The study included 111 elderly individuals. Our main results show that there was a significant relationship between the habitual consumption of milk for the group that had metabolic syndrome (p < 0.05). HDL-c levels, glucose, triglycerides, diastolic blood pressure and weight, height and waist circumference had to be altered in patients with metabolic syndrome. There was an association between habitual dietary intake of white meat with haplotypes TG and GG.

CONCLUSION

We conclude that the relationship between the habitual consumption of certain food groups and ADIPOQ indicates the need for further studies to develop a better understanding of this relationship; however, there was no association between the ADIPOQ + 45T> G gene polymorphism and metabolic syndrome in the group of elderly studied.

Tooth loss and its relationship with protein intake by elderly Brazilians-A structural equation modelling approach

OBJECTIVE

This study aimed at assessing the relationship between self-perceived tooth loss and wearing dentures, on the one hand, and the consumption of protein, on the other hand, among the elderly population of Botucatu, SP. Food consumption tends to decrease with ageing, especially protein intake, and one of the causes could be the precariousness of oral health. Several risk factors associated with deficient dietary protein intake have been identified, namely greater physical dependence, reduced caloric intake and food insecurity, but no studies have analysed whether tooth loss and prostheses interfere with protein intake.

METHODS

An interview was conducted among 365 elderly individuals, in which we examined oral health-related quality of life (OHRQoL) as the only latent variable, in a 24-hour nutritional assessment dietary recall repeated 3 times, conducted in person by a trained nutritionist and also performed an analysis of nutritional needs using the Nutrition Data System Research (NDSR) Program.

RESULTS

The structural equation model, performed using Stata v.14, showed that lack of teeth (standardised coefficient [SC] = 0.21, P < .001), and prosthesis use (SC = -0.21, P < .001) was associated with OHRQoL. Lack of teeth had a direct effect on the consumption of animal protein (SC = 0.08, P = .02), a strong total effect on animal protein intake (SC = 0.51, P = .04) and a medium effect on total protein intake (SC = 0.20, P = .03), adjusted for confounders (depression and medical problems).

CONCLUSION

Tooth loss had a strong and significant total effect on animal protein intake and a medium effect on total protein intake among elderly Brazilians.

Latent Class Analysis: a new vision of the phenomenon of depression in elderly men in the Brazilian Northeast

Abstract Objective: to identify the prevalence of depression in elderly men and associated factors using Latent Class Analysis. Method: a cross-sectional, epidemiological study evaluating 162 Primary Care users resident in the community in Recife, Brazil, was carried out. The Yesavage Geriatric Depression Scale was used as a screening instrument. The study was based on descriptive analysis and Latent Class Analysis, which allows the indirect measurement of the phenomenon of Depression by measuring the latent phenomenon of depression through 15 directly observed questions/answers from the scale used followed by ordinal logistic regression. Results: Elderly men with up to four years of schooling had a 2.43 times greater chance of developing depression. Those with normal levels of cortisol were less likely to become depressed while elderly men with low levels of Vitamin D and testosterone and high levels of thyroid stimulating hormones (TSH) were more likely to be depressed. The prevalence of the highest level of depression in the study population was 29% and was associated with low levels of education and alterations in the clinical data investigated. Conclusion: The study concluded that Latent Class Analysis allowed an innovative perspective of the phenomenon of depression and its relationship with associated factors, allowing a better and broader approach to this phenomenon in clinical practice.

The share of ultra-processed foods determines the overall nutritional quality of diets in Brazil

Objective

To estimate the dietary share of ultra-processed foods and to determine its association with the overall nutritional quality of diets in Brazil.

Design

Cross-sectional.

Setting

Brazil.

Subjects

A representative sample of 32 898 Brazilians aged ≥10 years was studied. Food intake data were collected. We calculated the average dietary content of individual nutrients and compared them across quintiles of energy share of ultra-processed foods. Then we identified nutrient-based dietary patterns, and evaluated the association between quintiles of dietary share of ultra-processed foods and the patterns’ scores.

Results

The mean per capita daily dietary energy intake was 7933 kJ (1896 kcal), with 58·1 % from unprocessed or minimally processed foods, 10·9 % from processed culinary ingredients, 10·6 % from processed foods and 20·4 % from ultra-processed foods. Consumption of ultra-processed foods was directly associated with high consumption of free sugars and total, saturated and trans fats, and with low consumption of protein, dietary fibre, and most of the assessed vitamins and minerals. Four nutrient-based dietary patterns were identified. ‘Healthy pattern 1’ carried more protein and micronutrients, and less free sugars. ‘Healthy pattern 2’ carried more vitamins. ‘Healthy pattern 3’ carried more dietary fibre and minerals and less free sugars. ‘Unhealthy pattern’ carried more total, saturated and trans fats, and less dietary fibre. The dietary share of ultra-processed foods was inversely associated with ‘healthy pattern 1’ (−0·16; 95 % CI −0·17, −0·15) and ‘healthy pattern 3’ (−0·18; 95 % CI −0·19, −0·17), and directly associated with ‘unhealthy pattern’ (0·17; 95 % CI 0·15, 0·18).

Conclusions

Dietary share of ultra-processed foods determines the overall nutritional quality of diets in Brazil.

Factors associated with diet quality of older adults

ABSTRACT Objective Evaluate the factors associated with diet quality of older adults from the city of São Caetano do Sul, São Paulo, Brazil. Methods A cross-sectional study was carried out on a sample of 295 older adults receiving care in health care units in São Caetano do Sul. Diet quality was assessed using the Brazilian Healthy Eating Index. The associations between the diet quality mean score and the socio-demographic, economic, and anthropometric characteristics and lifestyle and health conditions were verified using multiple linear regression. Results Lower diet quality mean score were associated with the variables: marital status (widowed or separated) (β=-2.02; p=0.047), retired (β=-4.24; p=0.034), and smoking (β=-8.06; p=0.001); whereas higher diet quality mean score were associated with higher education level (9 years or more) (β=3.49; p=0.013). Conclusion Individuals with higher education level had better diet quality, and those who were widowed or separated, retired, and smokers had worse diet quality indicating that socio-demographic, economic, and lifestyle are factors that can influence food choice of older adults.

Balanço de macronutrientes na dieta de idosos brasileiros: análises da Pesquisa Nacional de Alimentação 2008-2009

RESUMO: Objetivo: Analisar a contribuição de proteína, lipídio e carboidrato no total de energia da dieta de idosos das diferentes regiões brasileiras. Métodos: Foram analisados dados de 4.286 idosos (60 a 104 anos) provenientes da Pesquisa de Orçamentos Familiares 2008/2009. Baseado no consumo obtido por dois registros alimentares, o programa Multiple Source Method estimou o consumo habitual de macronutrientes e gordura saturada. As recomendações do Institute of Medicine (IOM), segundo os Acceptable Macronutrient Distribution Ranges (AMDR), foram utilizadas para avaliar a participação relativa dos macronutrientes de acordo com percentual energético (PE). Modelos de regressão linear identificaram diferenças entre PE dos macronutrientes, situação do domicílio, macrorregiões e gênero. Resultados: A proteína foi o macronutriente que apresentou maior concordância com o AMDR (99,8%). Com relação ao PE lipídico, observou-se que 9,2% da população ficaram acima da recomendação, sendo o dobro do encontrado para carboidrato (4,9%) e nove vezes o percentual de idosos, cujo PE-proteico (1,0%) foi acima do recomendado. Em 14,5% dos idosos a ingestão de carboidratos foi abaixo da AMDR, sendo que essas dietas apresentaram maior PE lipídico (β = 8,19; p < 0,001), revelando que 50% dos idosos que consumiam carboidratos abaixo do PE recomendado apresentou um consumo excessivo de lipídio. Segundo macrorregiões, o Centro-Oeste foi o único a apresentar diferença para carboidrato, sendo esta de menor percentual (51,6%; p < 0,05). A região Sul (17,9%; p < 0,01) apresentou o menor PE proteico e o maior de lipídios (28,7%; p < 0,01). Conclusões: A elevada frequência de inadequação da ingestão de lipídio pode significar uma pior qualidade da dieta, contribuindo com o aumento no risco de desenvolvimento de doenças crônicas.

Malnutrition risk and hospitalization in elderly assisted in Primary Care

Abstract The aim of this study was to investigate the association of malnutrition risk and single items of the Mini Nutritional Assessment (MNA®) with hospitalization in the last 12 months in the elderly assisted in primary care. A cross-sectional study was conducted with the evaluation of 1229 elderly persons assisted in Family Health Strategies in seven cities of South Brazil. Malnutrition risk was evaluated using the MNA®, and hospitalization was determined by one question of the Probability of Repeated Admission (PRA) instrument. Most of the elderly were women (61.7%), with a mean age of 71.7 ± 7.7 years. The malnutrition risk rate was 23.3% and hospitalization was 32.9%. The frequency of malnutrition and risk of malnutrition was two times greater among the elderly who were hospitalized (36.8 versus 18.6% - P < 0.001). There was a significant association between hospitalization and 11 (64.7%) of the 17 items on the MNA® evaluated (P < 0.05). Of these, seven items were independently associated with hospitalization by multivariate analysis. We observed an association of malnutrition risk and most of the single MNA® items as well, with hospitalization in the elderly assisted in primary care.

Dairy products consumption in Brazil is associated with socioeconomic and demographic factors: Results from the National Dietary Survey 2008-2009

ABSTRACT Objective: To estimate the consumption of dairy products in the Brazilian population. Methods: Data from two non-consecutive food records from 34,003 individuals (aged ³10 years) in the first Brazilian nationally representative dietary survey (2008-2009) were used to estimate the dairy products intake. Dairy products were divided into four major subgroups: cow's milk, cheese, yogurt and other dairy products. Absolute and relative frequencies of individuals in the population who reported consumption of dairy products in at least one of the two-day food record according to sex, age, geographic region and levels of per capita monthly family income were calculated. Moreover, the mean consumption of dairy products, as well as their nutritional contribution in total energy, protein, calcium, phosphorus and magnesium intake was estimated. Results: It was observed that only 43.0% of the population reported consuming dairy products, being the milk subgroup the most frequently consumed (21.1%). The prevalence of consumption was higher among females, elderly, residents of the South region, and among individuals from higher per capita monthly family income. The nutritional contribution of dairy products was less than 10.0% of total energy intake and for most nutrients and the mean daily consumption are justified was 101.8g. Conclusion: Therefore, in view of the low intake of dairy products by Brazilian population and the nutritional benefits associated with this food group, public health strategies to increase dairy consumption are justified.

Inadequate dietary intake of minerals: prevalence and association with socio-demographic and lifestyle factors

This cross-sectional, population-based study aimed to estimate the prevalence of dietary mineral inadequacies among residents in urban areas of Sao Paulo, to identify foods contributing to mineral intake and to verify possible associations between socio-demographic and lifestyle factors and mineral intake. Data were obtained from the 2008 Health Survey of Sao Paulo (n 1511; mean age 43·6 (sd 23·2), range 14–97 years). Dietary intake of minerals was measured using two 24-h dietary recalls. Socio-demographic and lifestyle data were collected. The prevalence of inadequate intake was estimated according to Dietary Reference Intakes methods. Associations between mineral intake and baseline factors were determined using multiple linear regression. Na, Ca and Mg showed the highest dietary inadequacies. Some age/sex groups had lower intakes of P, Zn, Cu and Se. Rice, beans and bread were the main foods contributing towards mineral intake. Female sex was negatively associated with K, Na, P, Mg, Zn and Mn intakes. All age groups were positively associated with the intakes of K, P, Mg and Mn. Family income above one minimum wage was positively associated with Se intake. Living in a household whose head completed ≥10 years of education was positively associated with Ca and negatively associated with Na intake. Former smoker status was negatively associated with Ca intake. Current smoker status was inversely associated with K, Ca, P and Cu intakes. Sufficient physical activity was positively associated with K, Ca and Mg intakes. Overall, the intakes of all major minerals were inadequate and were influenced by socio-demographic and lifestyle factors.

Proposal for a breakfast quality index for brazilian population: Rationale and application in the Brazilian National Dietary Survey

Breakfast has been related to positive nutrition and health outcomes, but criteria for an optimal composition of this meal are not well established. The aim of this study was to propose a breakfast quality index (BQI) for the Brazilian population, and to describe the relationship between breakfast quality, socio-demographic factors, dietary intake at breakfast and for the total day. BQI was constructed based on individual dietary data of 22,279 breakfast consumers, aged 20+ years from the Brazilian National Dietary Survey, a population-based cross-sectional study. The BQI was comprised of food components (cereals, fruit/vegetables, dairy products), and nutrient criteria (energy, fiber, free sugar, saturated fat, calcium and sodium). Mean, percentage and 95% CIs were estimated for variables according to BQI categories. The mean BQI was 4.2, with 71% of individuals falling into medium BQI category and 6% in high category. Individuals in urban areas, in higher categories of income and education and women had higher BQI means. Consumers with high BQI had higher intake of fruits/vegetables and higher breakfast and total daily intake of energy, carbohydrates, fiber, total sugar, sodium, potassium, phosphorus, thiamin, riboflavin, niacin, folate and vitamins B6, A, C, and D, and lower trans fatty acids compared to those in low and medium BQI groups. Promoting a high-quality breakfast may contribute to a better nutrient intake and achievement of daily requirements.

Dietary patterns of the elderly: characteristics and association with socioeconomic aspects

Abstract Objective: To investigate the association between dietary patterns and the socioeconomic aspects of elderly patients registered with the Family Health Strategy in Viçosa, Minas Gerais. Method: A cross-sectional study with a probabilistic sample was employed. To identify dietary patterns, dietary intake was assessed through a Food Frequency Questionnaire (FFQ) adapted for an elderly population. From the FFQ dietary patterns were identified by factor analysis. After the identification of the dietary patterns, logistic regression was performed considering each different dietary pattern and the related socioeconomic variables. Results: The consumption of a Fat and sugar pattern was greater among women and lower in elderly persons who considered themselves as mixed race. The consumption of the Balanced pattern was also lower among mixed race, married individuals, with one to four years of schooling and from the CDE economic classes. The Fruit and fish pattern was less consumed by elderly persons with 1-4 years of schooling, while the opposite was observed among those with five years or more of study. But the consumption of a Leafy vegetables pattern was lower among those with five or more years of schooling. Conclusion: The evaluation of the consumption of dietary patterns and the establishment of a relationship with the socioeconomic aspects of the elderly helps to achieve a better understanding of risk and protective factors for health.

Usual Vitamin Intakes by Mexican Populations

BACKGROUND

In the past several years, the consumption of high-energy, nutrient-poor foods has increased globally. Dietary intake data collected by the National Health and Nutrition Survey (ENSANUT) 2012 provide information to assess the quality of the Mexican diet and to guide food and nutrition policy.

OBJECTIVE

The aim was to describe the usual intake and the prevalence of inadequate intakes of vitamins for the overall Mexican population and by subgroups defined by sex, age, region, urban or rural areas, and socioeconomic status (SES).

METHODS

ENSANUT 2012 is a cross-sectional probabilistic survey representative of the Mexican population. Dietary information was collected by using the 24-h recall automated multiple-pass method (n = 10,096) with a repeated measurement on a subsample (n = 889) to permit adjustment for intraindividual variability with the use of the Iowa State University method. Mean usual intakes and the prevalence of inadequate intakes of thiamin, riboflavin, niacin, folate, and vitamins A, D, E, C, B-6, and B-12 were calculated for children aged 1-4 y (CH1-4y), children aged 5-11 y (CH5-11y), adolescents aged 12-19 y, and adults aged ≥20 y.

RESULTS

In all of the age groups, prevalences of inadequate intakes of vitamins D and E were the highest (77-99% of adults and adolescents and 53-95% of CH5-11y and CH1-4y) and those of folate and vitamin A were intermediate (47-70% of adults and adolescents, 15-23% of CH5-11y and 8-13% of CH1-4y), whereas those of thiamin, riboflavin, niacin, and vitamins B-6, B-12, and C were the lowest (0-37% of adults, 1-27% of adolescents, and 0-2.4% of CH5-11y and CH1-4y). With few exceptions, the highest prevalences of inadequate intakes for vitamins were observed in the poorest populations (rural South region and the lowest tertile of SES).

CONCLUSIONS

The intake of vitamins among Mexicans is inadequate overall. Information collected by ENSANUT can help target food assistance programs and develop strategies to prevent vitamin deficiencies.

Excessive red and processed meat intake: relations with health and environment in Brazil

The aims of the present study were to verify the proportion of population that consumed more red and processed meat than the World Cancer Research Fund (WCRF) dietary recommendation, to estimate the environmental impact of beef intake and the possible reduction of greenhouse gas emissions if the dietary recommendation was followed. We used the largest, cross-sectional, population-based survey entitled the National Dietary Survey (34 003 participants aged 10–104 years). The usual meat intake was obtained by two food records completed on 2 non-consecutive days. The usual intake was estimated by the multiple source method. The environmental impact was analysed according to estimates of CO2 equivalent emissions from beef intake as a proxy for beef production in Brazil. The red and processed meat intake mean was 88 g/d. More than 80 % of the population consumed more red and processed meat than the WCRF recommendation. Beef was the type of meat most consumed, accounting to almost 50 %. Each person contributed 1005 kg of CO2 equivalents from beef intake in 2008, the same quantity of CO2 produced if a car travelled a distance between the extreme north and south of Brazil (5370 km). The entire Brazilian population contributed more than 191 million tons of CO2 equivalents, which could have been reduced to more than 131 million tons if the dietary recommendation was followed. The present study shows that the magnitude of the excessive red and processed meat intake in Brazil can impact on health and the environment, pointing to the urgency of promoting a sustainable diet.

Social and demographic inequalities in diet quality in a population-based study

Objective : To evaluate sociodemographic inequalities in the diet quality of the urban population of the city of Campinas, São Paulo, Brazil. Methods: A population-based, cross-sectional study was performed using data from a health survey conducted in the city of Campinas in 2008-2009. Diet quality was evaluated using the Brazilian Healthy Eating Index Revised. A total of 3,382 individuals aged 10 years old and older were analyzed. Results : Brazilian Healthy Eating Index Revised scores increased with age and education level. Women consumed more vegetables, fruits, and milk, and less sodium, meat and eggs, oils, saturated and solid fats, alcohol, and added sugars than men. Scores for whole grains, vegetables, and fruits also increased with age and education level. Conclusion: These findings point to sociodemographic segments that are more vulnerable to an inappropriate diet and identify the need of strategies to increase the consumption of whole grains, dark green vegetables, fruits, and milk, and decrease the consumption of sodium, solid fats, alcohol, and added sugar.

Consumo de nutrientes em idosos residentes em Porto Alegre (RS), Brasil: um estudo de base populacional

Resumo Para descrever o perfil de consumo de nutrientes e verificar a sua associação com as variáveis sociodemográficas e de saúde, desenvolveu-se um estudo transversal, de base populacional em uma amostra aleatória de 427 idosos residentes em Porto Alegre, Brasil. O consumo alimentar foi avaliado através do Inquérito Recordatório de 24 Horas e Investigação da História Dietética. Dos idosos entrevistados, 70% eram mulheres; 48,5% possuíam entre 60 e 69 anos; 68,8% possuíam menos de 8 anos de escolaridade; 39,0%, renda familiar entre 2 e 5 salários mínimos; e 58,4% não praticava exercício físico. A hipertensão foi a doença mais prevalente, e 54,9% dos idosos estavam abaixo do peso. Os homens consumiam mais calorias, proteínas, fibras, minerais e vitaminas do que as mulheres. O consumo de carboidrato e cálcio aumentou conforme o avanço da idade, assim como diminuiu a ingestão de zinco. A prática de exercício físico elevou o consumo de calorias, magnésio, potássio e fósforo. Quanto maior a escolaridade, maior é o consumo de vitaminas B6 e B12; quanto maior a renda familiar, maior o consumo de vitamina B6 e ácido fólico. Os resultados demonstram que há deficiências nutricionais na alimentação diária da nossa população de idosos, principalmente entre as mulheres e os indivíduos acima de 80 anos.

Daily intake of dairy products in Brazil and contributions to nutrient intakes: a cross-sectional study

Objective

Dairy products are sources of protein and micronutrients important in a healthy diet. The purpose of the present analysis was to estimate consumption of dairy products by Brazilians and identify contributions of dairy products to nutrient intakes.

Design

Dairy consumption data were obtained from 24 h dietary records. Dairy products were defined as milk (including flavoured), cheese and yoghurt. Estimates of dairy product intakes were generated for all individuals, individuals in urban and rural households and for age groups 10–18 years, 19–59 years and ≥60 years. Contributions to nutrient intakes were estimated for the total sample and sub-populations.

Setting

Nationwide cross-sectional survey, 2008–2009.

Subjects

Nationally representative sample of individuals aged ≥10 years in the Individual Food Intake survey, a component of the Brazilian Household Budget Survey (n 34 003).

Results

Among individuals aged ≥10 years, per capita intake of dairy products was 142 (se 2·1) g/d. Dairy product intake was higher among individuals in urban compared with rural areas and among groups 10–18 years and ≥60 years compared with adults aged 19–59 years. Dairy products accounted for 6·1 % of daily energy intake, 7·3 % of protein, 16·9 % of saturated fat, 11·1 % and 4·3 % of total and added sugars, respectively, and 10·2–37·9 % of daily Ca, vitamin D, P, vitamin A and K.

Conclusions

Dairy products were substantial contributors to daily intakes of selected nutrients of concern in Brazil, although mean daily dairy product consumption was less than a typical portion. Education efforts in Brazil to raise awareness about the nutritional role of dairy foods may serve to improve overall diet quality.

[Diet quality and associated factors among the elderly: a population-based study in Campinas, São Paulo State, Brazil]

The aim of this study was to assess the quality of diet among the elderly and associations with socio-demographic variables, health-related behaviors, and diseases. A population-based cross-sectional study was conducted in a representative sample of 1,509 elderly participants in a health survey in Campinas, São Paulo State, Brazil. Food quality was assessed using the Revised Diet Quality Index (DQI-R). Mean index scores were estimated and a multiple regression model was employed for the adjusted analyses. The highest diet quality scores were associated with age 80 years or older, Evangelical religion, diabetes mellitus, and physical activity, while the lowest scores were associated with home environments shared with three or more people, smoking, and consumption of soft drinks and alcoholic beverages. The findings emphasize a general need for diet quality improvements in the elderly, specifically in subgroups with unhealthy behaviors, who should be targeted with comprehensive strategies.

An evaluation of the effectiveness of the flour iron fortification programme in Brazil

OBJECTIVE

The present communication reports a strategy to calculate the intake of Fe based on data available for folic acid and evaluate the programme of flour fortification in Brazil.

DESIGN

Cross-sectional study conducted in Brazil during 2008 and 2009. A 2d dietary record of individuals was used. The usual intake of folic acid by sex and age group was estimated using the National Cancer Institute method. The quantity of folic acid and Fe established by mandatory food fortification in Brazil was used, and based on that quantity we calculated the amount of flour consumed and the intake of Fe from fortification and Fe from food. Then, the absorption of each nutrient was calculated.

SETTING

Brazilian households (n 16,764).

SUBJECTS

Individuals (men and women, n 34,003, aged 10 to 60+ years) from a Brazilian nationwide survey.

RESULTS

Mean intake and absorption of Fe from fortification (electrolytic Fe) was low in men and women.

CONCLUSIONS

The impact from the consumption of fortified products is small in relation to Fe intake in Brazil. The strategy proposed to estimate Fe intake from the fortification programme indicates that the amount of flour intake observed in Brazil does not justify the current ranges of mandatory flour fortification and the form of Fe that is mainly used (electrolytic Fe).

Beverage consumption in Brazil: results from the first National Dietary Survey

OBJECTIVE

To provide an overview of beverage consumption patterns using the first nationally representative survey of dietary intake in Brazil.

DESIGN

Beverage consumption data were obtained by 1 d food records in an individual dietary survey.

SETTING

Nationwide cross-sectional survey, 2008-2009.

SUBJECTS

Nationally representative sample of individuals aged ≥10 years (n 34 003).

RESULTS

Beverages contributed 17.1 % of total energy consumption. Caloric coffee beverages provided the greatest level of energy overall (464 kJ (111 kcal)/d). Individuals aged 10-18 years (243 kJ (58 kcal)/d) and 19-39 years (230 kJ (55 kcal)/d) consumed a higher proportion of energy from sugar-sweetened soft drinks than individuals over this age (142 kJ (34 kcal)/d for those aged 40-59 years and 79 kJ (19 kcal)/d for those aged ≥60 years).

CONCLUSIONS

Overall, the contribution of beverages, particularly sugary beverages, to total energy consumption in Brazil represents an important public health challenge and is comparable with those from other countries.