Validação da terceira versão do Questionário Alimentar do Dia Anterior (QUADA-3) para escolares de 6 a 11 anos

Validation of the illustrated questionnaire on food consumption for Brazilian schoolchildren (QUACEB) for 6- to 10-year-old children

Introduction

Evaluating the food consumption of school-aged children is crucial to monitor their dietary habits, promote targeted interventions, and contribute public policies that aimed healthy eating. In this context, our objective was to develop and validate the Illustrated Questionnaire on Food Consumption for Brazilian Schoolchildren (QUACEB) of 6 to 10 years old, which is a self-reported illustrated recall.

Methods

Validity was obtained in four stages as follows: selection of foods, validation of items, validation of illustrations, and pretest. Foods were selected by considering the data from the main surveys that have been conducted with the Brazilian population and schoolchildren in recent years, the degree of food processing, and the main foods from each of the country's five macroregions. The content of the items was validated by comparing the children's and their parent's responses. For this, the questionnaire was published in an online format, and 6- to 10-year-old elementary schoolchildren were recruited using the snowball technique. The first part of the questionnaire was answered by the parent after the child's lunch, and the second was completed by the child the following day. Thirty-two parent and child dyads participated. Sensitivity, specificity, area under the curve (AUC), and kappa (k) tests were performed.

Results

Of the 30 foods presented on the questionnaire, 15 were reported as consumed. High sensitivity (mean of 88.5%), high specificity (average of 92.0%), substantial agreement (k = 0.78), low disagreement (6.2%), and AUC of 0.90 were found. The illustrations were validated in a focus group with fourth-grade children from a school chosen for convenience. The food illustrations were designed for children, who were asked to name the food. Eighteen children participated and verified that the images were representative of the foods. In the pretest, three schools were chosen for convenience that announced the link to the online questionnaire in WhatsApp groups of parents with students from first to fifth grade. Fifteen children answered the questionnaire and 86.7% (n = 13) judged it excellent or good.

Conclusion

Thus, the food consumption questionnaire is valid for elementary schoolchildren of 6 to 10 years old and can be applied in research to assess the dietary patterns of children in Brazil.

Consumption of ultra-processed foods and associated factors in children from Barbacena (MG), Brazil

OBJECTIVE

To evaluate the prevalence of ultra-processed food consumption and associated factors among children enrolled in the public school system of the city of Barbacena, Minas Gerais, Brazil.

METHODS

This is a cross-sectional study conducted with schoolchildren aged 7-9 years, of both sexes, enrolled in state public schools. Food intake was assessed using the Previous Day Food Questionnaire and the level of physical activity by the Previous Day Physical Activity Questionnaire. The listed foods were classified according to the extent and purpose of industrial processing, using the NOVA classification. Pearson's χ2 test, Fisher's exact test, χ2 with Yates correction, and Poisson regression were used in the statistical analysis, estimating the crude and adjusted prevalence ratio, with 95% confidence intervals.

RESULTS

The prevalence of daily ultra-processed food consumption was 69.6%. After adjusted analyses, the consumption of ultra-processed food was associated with the omission of breakfast, mid-afternoon snack, supper, low physical activity, and consumption of risk foods. On the other hand, consumption of in natura or minimally processed foods was associated with older age, the consumption of lunch, mid-afternoon snack, dinner, and protective foods.

CONCLUSIONS

There is a high prevalence of ultra-processed foods consumption, associated with unhealthy dietary habits among schoolchildren. This highlights the need for nutritional counseling and educational actions, favoring healthy eating in childhood.

How Brazilian Schoolchildren Identify, Classify, and Label Foods and Beverages-A Card Sorting Methodology

This study examined how Brazilian schoolchildren identified, classified, and labeled foods and beverages. Semi-structured interviews were conducted with 133 schoolchildren aged 7 to 10 years old from a public school located in southern Brazil in 2015. A set of cards with pictures of 32 food and beverage items from the web-based Food Intake and Physical Activity of Schoolchildren tool (Web-CAAFE) were used. Participants identified each item, formed groups for them based on similarity, and assigned labels for those groups. Student's t-tests and analysis of variance (ANOVA) tests were used to verify the mean difference between the groups of items. K-means cluster analysis was applied to identify similar clusters. Schoolchildren made an average of 9.1 piles of foods and beverages that they thought were similar (±2.4) with 3.0 cards (±1.8) each. Five groups were identified: meats, snacks and pasta, sweets, milk and dairy products, and fruits and vegetables. The most frequently used nomenclature for labeling groups was taxonomic-professional (47.4%), followed by the specific food item name (16.4%), do not know/not sure (13.3%), and evaluative (health perception) (8.8%). The taxonomic-professional category could be applied to promote improvements in the identification process of food and beverage items by children in self-reported computerized dietary questionnaires.

Validation of the illustrated questionnaire on eating and sedentary behaviors (QUICAS) for seven to ten-year-old children

The Illustrated Questionnaire on Eating and Sedentary Behaviors (QUICAS) was developed and validated for schoolchildren seven to ten years old. It used previous day recall and was illustrated with ten eating behaviors (referring to the act of eating without distractions, with company, on a regular basis, the type of food eaten, and participation in tasks involved in meal preparation) and five sedentary behaviors (related to the use of television, computer, tablet, cell phone, and video game). The instrument was validated in four stages: (1) Its content was developed based on literature review and expert evaluation; (2) Items were validated by comparing the responses of children and their parents, through a questionnaire on Google Forms. At this stage, a convenience sample was adopted, consisting of 145 parent-child dyads. High sensitivity (average of 90.7%); high specificity (mean of 87.9%); low number of false positives (mean of 12.1%); low number of false negatives (mean of 9.3%); almost perfect agreement between the child's and the parent's reports (k = 0.81); and low disagreement (≤22%) were found. In addition, the child's gender and age did not significantly influence the child's report. (3) The illustrations were validated in a focus group with 18 children, who satisfactorily described all the eating and sedentary behaviors of the illustrations. (4) In the pretest of the questionnaire on Google Forms, with the participation of 15 children, the majority (86.7%) judged the questionnaire as excellent or good. Therefore, the QUICAS is valid to assess eating and sedentary behaviors in schoolchildren seven to ten years old.

Body image and association with BMI, and purgative behaviours for weight control in adolescents aged 11-14 years

We aimed to evaluate the association of overweight/obesity based in BMI and purgative behaviours with body image (BI). Methods: Cross-sectional study, with probabilistic sample of 976 adolescents, aged 11-14 years, from the city of Florianópolis, Brazil. Multivariate analyses were performed. Overweight (including obesity) and four variables related to purgative methods for body weight control or eating behaviour were evaluated as outcomes, while BI satisfaction was the primary independent variable in each model. Models were controlled for age, sex, type of school (public or private), intake of fruit and vegetables, number of daily meals, and physical activity scores levels. A total of 31·4 % of adolescents wanted to enlarge their silhouette and 45·6 % wanted to reduce it. Among overweight/obese adolescents, 9·6 % were satisfied with their bodies, while 89·8 % wanted to reduce it, while among the not overweight/obese adolescents, 45·4 % wanted to enlarge their silhouette (P < 0·001). Multivariate analysis showed that the odds for overweight/obesity is higher among adolescents who wanted to reduce their silhouette (OR = 11·20; 95 % CI = 5·55, 22·58). Adolescents who want to reduce their silhouette are more likely to use diuretics (OR = 3·08; CI = 1·78, 5·32) and to use laxatives (OR = 2·10; CI = 1·20, 3·68). A significant association was also found between dissatisfaction with BI and overeating (among those who want to enlarge their silhouette: OR = 1·78; CI = 1·12, 2·85 and among those who want to reduce their silhouette: OR = 1·81; CI = 1·03, 3·19). Conclusion: BI dissatisfaction was associated with overweight/obesity, as well with overeating, and the use of purgative methods.

Food Availability, Motivational-Related Factors, and Food Consumption: A Path Model Study with Children

The promotion of children’s healthy eating is a key public health priority. However, children’s food consumption is a complex phenomenon with several contributing factors, and there is a call to continue developing comprehensive models with several variables acting simultaneously. The present study aimed to examine the role different motivational-related variables (e.g., self-regulation, self-efficacy) may play in children’s consumption of healthy and unhealthy foods. To address this goal, data were collected in a sample of 242 fifth and sixth graders with access to both healthy and unhealthy foods at home. A path model was conducted to analyze networks of relationships between motivational-related variables and children’s healthy and unhealthy eating. The gender variable was included as a covariate to control its effect. The data showed that self-regulation for healthy eating mediates the relationship between the predictor variables (i.e., knowledge, attitude, and self-efficacy) and the type of food consumption (healthy and unhealthy). Current data contribute to understanding the complexity behind food consumption by providing a comprehensive model with motivational-related factors associated with both healthy and unhealthy eating. The present findings are likely to help inform the development of early preventive interventions focused on the promotion of healthy eating.

Abdominal obesity-related risk factors in children from public schools of Barbacena, Minas Gerais, Brazil

OBJECTIVE

To evaluate the sociodemographic and lifestyle factors associated with abdominal obesity in children from public schools in Barbacena, state of Minas Gerais, Brazil.

METHODS

This is a cross-sectional study conducted on 326 students aged 7 to 9 years from public schools in the urban area of the city. Anthropometric data included body weight, height, body mass index according to age, waist circumference, and waist-to-height ratio. Food consumption was evaluated using the Previous Day Food Questionnaire. Abdominal obesity was assessed based on waist circumference and waist-to-height ratio. The bivariate and multivariate analyses were performed by logistic regression, estimating the crude and adjusted odds ratio (OR), with 95% confidence interval.

RESULTS

The prevalence of overweight was 30.7%; whereas the prevalence of abdominal obesity was 9.2 and 12.6% according to waist circumference and waist-to-height ratio, respectively. Boys (OR 2.76; 95%CI 1.22-6.25) and children from central schools (OR 2.73; 95%CI 1.08-6.80) presented an increased chance of abdominal obesity according to waist circumference. Abdominal obesity according to waist-to-height ratio was associated with the central location of the schools (OR 2.18; 95%CI 1.02-4.63) and the habit of skipping supper (OR 2.01; 95%CI 1.00-4.09).

CONCLUSIONS

The findings showed that being a boy, studying in a central school, and skipping supper were the main risk factors associated with abdominal obesity.

"More Than Buying Extra Fruits and Veggies, Please Hide the Fats and Sugars": Children's Diet Latent Profiles and Family-Related Factors

Promoting children’s healthy diets is a key public health priority. Family can play a relevant role in children’s eating patterns. The goals of the current research were to identify different latent diet profiles in children based on their food consumption and to assess the relationship between profiles and family-related factors. A total of 678 school-aged children from the fifth and sixth grades participated. The study design was cross-sectional and questionnaire based. Research assessed healthy (fruit and vegetables) and unhealthy (fast food, sugar-sweetened beverages, and candies) food consumption and family-related factors. A latent profile analysis and multivariate data analysis were developed. Four diet profiles were identified: Combined Diet, Mainly Healthy Diet, Mainly Unhealthy Diet, and Very Unhealthy Diet. Nearly half of the children (45.22%) showed a Combined Diet profile, meaning that they reported eating nearly the same amount of healthy and unhealthy types of foods. Associations between the diet profiles, family income, and food availability were found. For example, the Mainly Healthy Diet profile was statistically associated with a higher family income and less access to unhealthy foods. The present study reinforces the idea that profiling diets can allow for a tailored healthy eating intervention model according to the specific needs of each diet profile.

Ultraprocessed food consumption and factors associated with a sample of public school bases in the South of Brazil

This study aims to evaluate the consumption of ultraprocessed foods and its association with sociodemographic, behavioral and nutritional factors in schoolchildren from public schools in Caxias do Sul-RS. A cross-sectional study was conducted with 1,309 students aged 6-16 years. The consumption of ultraprocessed foods was obtained by means of a questionnaire according to the self-report of the student. A pre-tested questionnaire was used to evaluate the characteristics of the students. A Poisson regression analysis was performed following a statistical hierarchical modeling to determine factors associated with outcome. Results with p value ≤ 0.05 were considered statistically significant. A high prevalence of ultraprocessed food consumption was identified (69.7%) among schoolchildren. After adjusted analysis, higher prevalence of ultraprocessed food consumption was associated with buying/taking snacks to school and snacking. Nutritional counseling was also associated with protection against the consumption of these foods. Nutrition education actions are necessary for schoolchildren and caregivers in order to reduce the consumption of ultraprocessed foods by schoolchildren, especially in snacks.

Multilevel analysis of factors that influence overweight in children: research in schools enrolled in northern Brazil School Health Program

BACKGROUND

The study evaluates children in schools that participate in the School Health Program in the Northern region of Brazil with the objective of assessing whether their schools interfered in the development of overweight/obesity and how individual and school environment variables behave according to contextual analysis.

METHODS

The analyses were carried out with 1036 children from 25 municipal public schools in Northern Brazil that participated in the School Health Program. We evaluated both individual characteristics and scholar environment through univariate and multivariate logistic regressions to identify which of these factors were related to overweight/obesity as well as the effect of varying such associations.

RESULTS

The considered individuals had an median age of 8 years, being 54.9% female and 27.8% presenting overweight/obesity. In multivariate logistic regression, the overweight/obesity variance in schools was 0.386 (individual variables) and 0.102 (individual and school variables), explaining 23.7% of the variation, reduction of ICC and MOR. The Akaike Information Criterion between the models was reduced and the likelihood ratio indicated better adequacy of the latter model. The investigated children had a greater chance of developing overweight/obesity when they performed 2+ sedentary activities/day, depending on school location as well as whether or not candies were sold in the school surroundings. On the other hand, a lower chance of developing overweight/obesity was identified in children that ate 5+ meals/day and practiced dance at school.

CONCLUSION

We observed that the variables inherent to both individuals and schools favored the development of overweight/obesity in children. It is relevant that scholar curriculums incorporate healthy eating interventions and encourage body practices associated with policies that restrain the sale of ultra-processed food in schools as well as the development of intersectoral actions between education and health to control childhood obesity.

Association between pubertal development stages and body adiposity in children and adolescents

Background

The study aimed to analyze the association between pubertal development stages and adiposity in children and adolescents.

Methods

Cross-sectional study conducted in 2007 in Florianópolis, Brazil, with 2339 schoolchildren 32 aged 8 to 14 years old (1107 males). The outcome (adiposity) was evaluated using Z score and 33 percentilee values > = 85 of four skinfolds (triceps, subscapular, suprailiac and calf) and waist 34 circumference. Total body adiposity (Z score of the sum of skinfolds), central adiposity (Z score 35 of waist circumference) and peripheral adiposity (Z scores of triceps and calf skinfolds) were 36 estimated. Pubertal development stages was self-assessed according to Tanner stages of development. Thirty-seven Children and adolescents were classified according to tertiles of age for each pubertal development stages 38 stage - early, normal and late. Statistical analysis was performed using univariate and 39 multivariate Poisson regression models.

Results

Children and adolescent from both sexes with early pubertal development stages presented higher prevalence of central adiposity (waist circumference), with adjusted prevalence ratio (CI 95%) of 2.21 (1.12; 4.35) for males and 2.18 (1.04; 4.57) for females (reference group: normal pubertal development stages). Among females, there was a reduction in the prevalence of excess adiposity with decreased occurrence of early pubertal development stages. There was a strong relationship between adiposity and pubertal development stages.

Conclusions

Excess adiposity was higher in both sexes for those with early pubertal development stages.

Efeito do dia e do número de dias de aplicação na reprodutibilidade de um questionário de avaliação do consumo alimentar de escolares

RESUMO: Introdução: O questionário de Consumo Alimentar e Atividade Física de Escolares (Web-CAAFE) foi desenvolvido para o monitoramento da dieta e atividade física de escolares brasileiros. Este estudo buscou avaliar o efeito do dia da semana e do número de aplicações na reprodutibilidade do Web-CAAFE. Metodologia: Escolares do 2º ao 5º ano (n = 197) de Florianópolis preencheram o Web-CAAFE por duas vezes no mesmo dia, dos quais 113 o fizeram em três dias não consecutivos. Avaliou-se a reprodutibilidade por meio da correlação intraclasse (CCI) e da regressão logística, para avaliação dos fatores associados à pior reprodutibilidade. Resultados: Observaram-se piores resultados de reprodutibilidade para o preenchimento do consumo nos finais de semana em relação àqueles que responderam em dias da semana (odds ratio - OR = 2,93; p = 0,045) e melhores resultados em meninas em relação aos meninos (OR = 0,29; p < 0,001). O preenchimento do consumo realizado nos segundo e terceiro dias apresentou melhor reprodutibilidade que o realizado no primeiro. Esses resultados são relevantes para o planejamento de futuros estudos que utilizem instrumentos de consumo alimentar em crianças, em especial sobre avaliação de sua validade e reprodutibilidade. Conclusões: Os resultados sugerem que pelo menos dois dias de aplicação do Web-CAAFE fornecem resultados aceitáveis de reprodutibilidade, e que o preenchimento referente ao fim de semana pode reduzi-la.

Food consumption, physical activity level and sedentary behavior in schoolchildren

Abstract Dietary intake inquiry, physical activity (PA) and sedentary behavior (SB) surveys are practical tools for identifying habits among the pediatric population; however, the results of describing these behaviors appear to be restricted to large centers. The objective was to analyze dietary intake, PA and SB level in schoolchildren. Children from 6 to 10 years old, coming from public and private schools were evaluated for anthropometry, dietary pattern, PA and SB level. A total of 1408 children (48.1% male) with a mean age of 8.05 (± 1.53) years participated in the study. Only 4.6%, 4.9% and 17.2% of children met the recommendations for fruit, milk and dairy products, respectively. 40.4% and 59.5% of the children did not meet the recommendation for soft drinks and meat consumption, respectively. More than 75% of children met the recommendation for the consumption of packaged snacks, candies and beans. There was a difference between genders only for candy consumption (p=0.003), with a higher proportion of boys meeting the recommendations. Approximately half and one third of the children complied with the recommendations for moderate to vigorous PA and SB, respectively. Risk behaviors for cardiovascular disease were observed in children, characterized by low consumption of fruits and vegetables, low levels of PA and excessive time in SB.

Parental Perceived Travel Time to and Reported Use of Food Retailers in Association with School Children's Dietary Patterns

Considering the association between the neighborhood food environment and individual eating behaviors, this study aimed to assess the association between parents' reported use of food facilities by their children, and parental perceived travel time to food facilities, with their children's dietary patterns. Parents reported the use of supermarkets, full-service and fast-food restaurants, and perceived travel time to these food retailers. To assess school children's food consumption, a previous day dietary recall was applied. Factor analysis was conducted to identify dietary patterns. To test the association between reported use and perceived travel time to food retailers and school children's dietary patterns, we performed multilevel linear regression analyses. Parents' reported use of supermarkets was associated with children's higher score in the "Morning/Evening Meal" pattern. The use of full-service and fast-food restaurants was associated with children's higher score in the "Fast Food" pattern. Higher parental perceived travel time to full-service and fast-food restaurants was associated with children's lower score in the "Fast Food" pattern. Although the use of full-service and fast-food restaurants was associated with a less healthy dietary pattern, the perception of living further away from these food retailers may pose a barrier for the use of these facilities.

Fatores associados ao consumo alimentar na escola e ao sobrepeso/obesidade de escolares de 7-10 anos de Santa Catarina, Brasil

Resumo O objetivo deste artigo é investigar associação entre a proveniência de lanches consumidos na escola, seu valor nutricional e o sobrepeso/obesidade. Estudo transversal com 3.930 escolares de 7-10 anos de idade, de Santa Catarina. O consumo alimentar na escola foi avaliado com R-24 horas ilustrado, e a origem dos lanches por entrevista estruturada. Refrigerantes e sucos artificiais, frituras, salgadinhos industrializados, lanches prontos, doces, guloseimas e biscoitos recheados foram classificados como “lanches de baixo valor nutricional”, enquanto frutas, sucos naturais, legumes, verduras e sopa de verduras foram os “lanches de alto valor nutricional”. Realizou-se regressão logística univariada e múltipla. O sobrepeso/obesidade se associou significativamente ao consumo de alimentos provenientes da cantina (OR = 1,34; IC = 1,07-1,68), na rede particular. Trazer alimentos de casa foi significativamente associado ao maior consumo de lanches de baixo valor nutricional, nas escolas públicas (OR = 1,56; IC = 1,32-1,83) e nas particulares (OR = 2,64; IC = 1,76-3,97). Os resultados apontam a necessidade de expansão de normativas que minimizem a disponibilidade de alimentos de baixo valor nutricional nas cantinas e que promovam educação nutricional envolvendo a comunidade escolar.

Individual characteristics and public or private schools predict the body mass index of Brazilian children: a multilevel analysis

The aim of this study was to determine the contribution of individual and school characteristics to the variability in body mass index (BMI) z-scores of 7 to 10 years old children. Anthropometric and sociodemographic data from two cross-sectional studies conducted with schoolchildren from the 2nd to the 5th grades of elementary schools were analyses (n = 2,936 in 2002, and n = 1,232 in 2007). Multilevel modeling was used to estimate variations in BMI at child and school levels. The contribution of the school context to the overall variability of BMI z-score was small but significant in 2002 (3.3%-4.4%) and in 2007 (2.4%-5.3%), showing that schoolchildren from private schools had a higher BMI compared to those from public schools. The monthly family income showed, in general, a negative association with BMI z-score in 2002 and a positive association in 2007, for both sexes. The consumption of sweets showed a negative effect in the BMIs of children. In both surveys, overweight/obese mothers and excessive birth weight were positively associated with BMI z-score. Mother's weight status had a higher influence on the overall variability of BMI in both surveys. In conclusion, school and child characteristics contributed to the variance in children's weight status. The results imply that overweight/obesity childhood prevention programs should focus on strategies of family engagement to be more effective.

Promoting Self-Regulation in Health Among Vulnerable Brazilian Children: Protocol Study

The Health and Education Ministries of Brazil launched the Health in School Program (Programa Saúde na Escola - PSE) in 2007. The purpose of the PSE is two-fold: articulate the actions of the education and health systems to identify risk factors and prevent them; and promote health education in the public elementary school system. In the health field, the self-regulation (SR) construct can contribute to the understanding of life habits which can affect the improvement of individuals' health. This research aims to present a program that promotes SR in health (SRH). This program (PSRH) includes topics on healthy eating and oral health from the PSE; it is grounded on the social cognitive framework and uses story tools to train 5th grade Brazilian students in SRH. The study consists of two phases. In Phase 1, teachers and health professionals participated in a training program on SRH, and in Phase 2, they will be expected to conduct an intervention in class to promote SRH. The participants were randomly assigned into three groups: the Condition I group followed the PSE program, the Condition II group followed the PSRH (i.e., PSE plus the SRH program), and the control group (CG) did not enroll in either of the health promotion programs. For the baseline of the study, the following measures and instruments were applied: Body Mass Index (BMI), Simplified Oral Hygiene Index (OHI-S), Previous Day Food Questionnaire (PFDQ), and Declarative Knowledge for Health Instrument. Data indicated that the majority are eutrophic children, but preliminary outcomes showed high percentages of children that are overweight, obese and severely obese. Moreover, participants in all groups reported high consumption of ultraprocessed foods (e.g., soft drinks, artificial juices, and candies). Oral health data from the CI and CII groups showed a prevalence of regular oral hygiene, while the CG presented good oral hygiene. The implementation of both PSE and PSRH are expected to help reduce health problems in school, as well as the public expenditures with children's health (e.g., Obesity and oral diseases).

Utilization of food outlets and intake of minimally processed and ultra-processed foods among 7 to 14-year-old schoolchildren. A cross-sectional study

BACKGROUND

Access to food retailers is an environmental determinant that influences what people consume. This study aimed to test the association between the use of food outlets and schoolchildren's intake of minimally processed and ultra-processed foods.

DESIGN AND SETTING

This was a cross-sectional study conducted in public and private schools in Florianópolis, state of Santa Catarina, southern Brazil, from September 2012 to June 2013.

METHODS

The sample consisted of randomly selected clusters of schoolchildren aged 7 to 14 years, who were attending 30 schools. Parents or guardians provided socioeconomic and demographic data and answered questions about use of food outlets. Dietary intake was surveyed using a dietary recall questionnaire based on the previous day's intake. The foods or food groups were classified according to the level of processing. Negative binomial regression was used for data analysis.

RESULTS

We included 2,195 schoolchildren in the study. We found that buying foods from snack bars or fast-food outlets was associated with the intake frequency of ultra-processed foods among 11-14 years old in an adjusted model (incidence rate ratio, IRR: 1.11; 95% confidence interval, CI: 1.01;1.23). Use of butchers was associated with the intake frequency of unprocessed/minimally processed foods among children 11-14 years old in the crude model (IRR: 1.11; 95% CI: 1.01;1.22) and in the adjusted model (IRR: 1.11; 95% CI: 1.06;1.17).

CONCLUSIONS

Use of butchers was associated with higher intake of unprocessed/minimally processed foods while use of snack bars or fast-food outlets may have a negative impact on schoolchildren's dietary habits.

Sociodemographic and behavioral characteristics of obese students with sleep problems in Southern Brazil

ABSTRACT Objective This study estimated the combined prevalence of insufficient number of hours of sleep per day and excess body adiposity among young students. The sociodemographic and behavioral characteristics associated with this concurrent health conditions were investigated. Methods This is a cross-sectional school-based study of 975 participants aged 11-14 years in Florianópolis, Santa Catarina state, Brazil. Body adiposity was assessed based on tricipital and subscapular skinfold measurements and classified according to Lohman. The total number of hours of sleep per day was reported by the students’ parents/guardians, and it was classified as follows: as <8 hours per day and ≥8 hours per day. Data on sociodemographic characteristics, food consumption, and physical activity were collected using a self-administered questionnaire. The chi-square test and multinomial logistic regression with a 5% significance level were used to evaluate the association between the variables. Results The combined prevalence of insufficient number of hours of sleep per day and excess body adiposity was 25.1% (CI95%:20.7-29.9). The sociodemographic and behavioral factors predictive of these conditions were as follows: 13-14 year age group and household monthly income in the intermediate tertile. Conclusion The concurrent presence of insufficient sleep and excess body adiposity was found in a little more than a quarter of the students investigated. The population subgroups belonging to the 13-14 year age group and intermediate tertile of income were more likely to have concurrent insufficient number of hours of sleep per day and excess body adiposity.

Consistency evaluation of values of weight, height, and body mass index in Food Intake and Physical Activity of School Children: the quality control of data entry in the computerized system

INTRODUCTION

The quality control of data entry in computerized questionnaires is an important step in the validation of new instruments. The study assessed the consistency of recorded weight and height on the Food Intake and Physical Activity of School Children (Web-CAAFE) between repeated measures and against directly measured data.

METHODS

Students from the 2nd to the 5th grade (n = 390) had their weight and height directly measured and then filled out the Web-CAAFE. A subsample (n = 92) filled out the Web-CAAFE twice, three hours apart. The analysis included hierarchical linear regression, mixed linear regression model, to evaluate the bias, and intraclass correlation coefficient (ICC), to assess consistency. Univariate linear regression assessed the effect of gender, reading/writing performance, and computer/internet use and possession on residuals of fixed and random effects.

RESULTS

The Web-CAAFE showed high values of ICC between repeated measures (body weight = 0.996, height = 0.937, body mass index - BMI = 0.972), and regarding the checked measures (body weight = 0.962, height = 0.882, BMI = 0.828). The difference between means of body weight, height, and BMI directly measured and recorded was 208 g, -2 mm, and 0.238 kg/m², respectively, indicating slight BMI underestimation due to underestimation of weight and overestimation of height. This trend was related to body weight and age.

CONCLUSION

Height and weight data entered in the Web-CAAFE by children were highly correlated with direct measurements and with the repeated entry. The bias found was similar to validation studies of self-reported weight and height in comparison to direct measurements.

Changes in Dietary Patterns from Childhood to Adolescence and Associated Body Adiposity Status

The aims of this study were to identify cross-sectional dietary patterns (DPs) in a representative sample of 7–10-year-old schoolchildren, to examine how scores for these DPs tracked over a time period of five years (from age 7–10 years to 12–15 years), and to investigate longitudinal associations between changes in DPs scores and changes in BMI (Body Mass Index) z-scores. Children aged 7–10-years were examined in 2007 (n = 1158) and a subset of the sample participated in a follow-up in 2012 (n = 458). Factor analysis (FA) was applied to derive DPs at baseline. The change in DP from childhood to adolescence was analyzed by comparing factor scores using the complete cases, in which factor loadings were the ones evaluated at baseline. Associations of BMI change with DP change were assessed by multivariate linear regression. At baseline, four DP were identified that explained 47.9% of the food intake variance. On average, the factor scores of “DP II” (salty snacks, French fries, fast-food, sugary beverages) decreased in follow-up, while no changes were observed for “DP I” (rice, cooked beans, beef/poultry, leafy vegetables), “DP III” (fruits, cooked and leafy vegetables, fruit juices, pasta, milk, cheese), and “DP IV” (milk, coffee with milk, cheese, breads/biscuits). No significant linear association was shown between changes in BMI z-scores and changes in DP scores from childhood to adolescence. In conclusion, three out of four DP scores identified at baseline tracked slightly in adolescence.

Validation of the Online version of the Previous Day Food Questionnaire for schoolchildren

ABSTRACT Objective To evaluate the validity of the web-based version of the Previous Day Food Questionnaire Online for schoolchildren from the 2nd to 5th grades of elementary school. Methods Participants were 312 schoolchildren aged 7 to 12 years of a public school from the city of Florianópolis, Santa Catarina, Brazil. Validity was assessed by sensitivity, specificity, as well as by agreement rates (match, omission, and intrusion rates) of food items reported by children on the Previous Day Food Questionnaire Online, using direct observation of foods/beverages eaten during school meals (mid-morning snack or afternoon snack) on the previous day as the reference. Multivariate multinomial logistic regression analysis was used to evaluate the influence of participants’ characteristics on omission and intrusion rates. Results The results showed adequate sensitivity (67.7%) and specificity (95.2%). There were low omission and intrusion rates of 22.8% and 29.5%, respectively when all food items were analyzed. Pizza/hamburger showed the highest omission rate, whereas milk and milk products showed the highest intrusion rate. The participants who attended school in the afternoon shift presented a higher probability of intrusion compared to their peers who attended school in the morning. Conclusion The Previous Day Food Questionnaire Online possessed satisfactory validity for the assessment of food intake at the group level in schoolchildren from the 2nd to 5th grades of public school.

[Validity and reproducibility of an Internet-based questionnaire (Web-CAAFE) to evaluate the food consumption of students aged 7 to 15 years]

The study evaluated the validity and reproducibility of the food consumption section of the questionnaire Food Intake and Physical Activity of School Children (Web-CAAFE), an Internet-based software for the qualitative measurement of food consumption by recalling the previous day. A total of 390 students in grades 2 to 5 (7 to 15 years) of a semi-integral public school participated in the study. The validity was tested by comparing the report in the Web-CAAFE and the direct observation of food consumed in the school in the previous day. The reproducibility was evaluated in a sub-sample of 92 schoolchildren, by comparing repeated reports in the Web-CAAFE on the same day. Probabilities of accuracy in the Web-CAAFE report in relation to the observation (matches, omissions and intrusions and respective 95% confidence intervals) among seven food groups were estimated through multinomial logistic regression. The average for the match rate was 81.4% (variation: 62% sweets and 98% beans); for the omission rate was 16.2% (variation between 2.1% dairy products and 28.5% sweets); for the intrusion rate was 7.1% (variation between 1.3% beans and 13.8% cereals). Sweets, cereals and processed foods, snack foods and fried foods simultaneously exhibited higher rates of omission and intrusion. Students 10 years of age or older had lower probabilities of intruding food items. There were no significant variations in the accuracy of the report between repeated measures. The Web-CAAFE was a valid and reliable instrument for the evaluation of food consumption, when applied to students in grades 2 to 5 of public schools.

Association between screen time and dietary patterns and overweight/obesity among adolescents

ABSTRACT Objective The association between screen time and dietary patterns and overweight/obesity among adolescents was analysed in this study. Methods In this cross-sectional study, 963 Brazilian adolescents, aged between 11 and 14 years were evaluated. Body mass index was used to assess overweight/obesity. Dietary patterns and screen time were assessed using qualitative questionnaires. Principal component analysis was used to obtain dietary patterns. Confounder variables were: type of school (public or private), sexual maturation, mother’s weight and mother’s education. The Chi-square test was used for the crude analysis; for the adjusted analysis was used Poisson regression with sample weighting. Results Overweight/obesity prevalence was 29.8% and statistically higher among boys (34.7%). Higher screen time prevalence was 39.1%. The dietary patterns obtained were: obesogenic; coffee and dairy products; traditional Brazilian meal; fruit and vegetables; bread and chocolate milk. The dietary pattern that more closely represented student food consumption was the obesogenic pattern. Screen time was not significantly associated with overweight/obesity. The obesogenic pattern (in both sexes), the coffee and dairy products pattern, and the bread and chocolate milk pattern (only in girls), were inversely associated with overweight/obesity. In this study, dietary patterns influenced overweight/obesity, although in some cases, in an inverse way from what expected. Conclusion A high prevalence of overweight/obesity and a high proportion of screen time activities among the adolescents were observed. Our results indicate a high consumption of unhealthy dietary pattern among adolescents.

Dietary patterns associated with overweight and obesity among Brazilian schoolchildren: an approach based on the time-of-day of eating events

Several studies reported that the timing of eating events has critical implications in the prevention of obesity, but dietary patterns regarding the time-of-day have not been explored in children. The aim of this study was to derive latent food patterns of daily eating events and to examine their associations with overweight/obesity among schoolchildren. A population-based cross-sectional study was conducted with 7–10-year-old Brazilian schoolchildren (n 1232) who completed the Previous Day Food Questionnaire, illustrated with twenty-one foods/beverages in six daily eating events. Latent class analysis was used to derive dietary patterns whose association with child weight status was evaluated by multivariate multinomial regression. Four mutually exclusive latent classes of dietary patterns were identified and labelled according to the time-of-day of eating events and food intake probability (FIP): (A) higher FIP only at lunch; (B) lower FIP at all eating events; (C) higher FIP at lunch, afternoon and evening snacks; (D) lower FIP at breakfast and at evening snack, higher FIP at other meals/snacks. The percentages of children within these classes were 32·3, 48·6, 15·1 and 4·0 %, respectively. After controlling for potential confounders, the mean probabilities of obesity for these classes were 6 % (95 % CI 3·0, 9·0), 13 % (95 % CI 9·0, 17·0), 12 % (95 % CI 6·0, 19) and 11 % (95 % CI 5·0, 17·0), in the same order. In conclusion, the children eating traditional lunch with rice and beans as the main meal of the day (class A) had the lowest obesity risk, thus reinforcing the importance of both the food type and the time-of-day of its intake for weight status.

The use of multiple imputation method for the validation of 24-h food recalls by part-time observation of dietary intake in school

External validation of food recall over 24 h in schoolchildren is often restricted to eating events in schools and is based on direct observation as the reference method. The aim of this study was to estimate the dietary intake out of school, and consequently the bias in such research design based on only part-time validated food recall, using multiple imputation (MI) conditioned on the information on child age, sex, BMI, family income, parental education and the school attended. The previous-day, web-based questionnaire WebCAAFE, structured as six meals/snacks and thirty-two foods/beverage, was answered by a sample of 7-11-year-old Brazilian schoolchildren (n 602) from five public schools. Food/beverage intake recalled by children was compared with the records provided by trained observers during school meals. Sensitivity analysis was performed with artificial data emulating those recalled by children on WebCAAFE in order to evaluate the impact of both differential and non-differential bias. Estimated bias was within ±30 % interval for 84·4 % of the thirty-two foods/beverages evaluated in WebCAAFE, and half of the latter reached statistical significance (P<0·05). Rarely (<3 %) consumed dietary items were often under-reported (fish/seafood, vegetable soup, cheese bread, French fries), whereas some of those most frequently reported (meat, bread/biscuits, fruits) showed large overestimation. Compared with the analysis restricted to fully validated data, MI reduced differential bias in sensitivity analysis but the bias still remained large in most cases. MI provided a suitable statistical framework for part-time validation design of dietary intake over six daily eating events.

Prevalence of and factors associated with anemia in school children from Maceió, northeastern Brazil

Background

Anemia is a major public health problem in preschool children in Alagoas, Brazil, especially in the younger population, because of a positive correlation between hemoglobin level and age. However, due to the lack of studies, it is not known how widespread this condition is among older children or how it is associated with socioeconomic status. The aim of this study was to investigate the prevalence of and factors associated with anemia in school children from the city of Maceió, Alagoas state, Brazil. The analysis was stratified to identify any effect modification according to whether they attend public or private schools.

Methods

A cross-sectional study was conducted using probability sampling of 1518 children (9.8 ± 0.5 years of age) attending public (n = 931) and private (n = 587) elementary schools in the municipality. Semi-structured questionnaires were used to obtain socioeconomic, demographic, anthropomorphic, hemoglobin (Hb), and dietary data. Anemia (Hb <11.5 g/dL) was the dependent variable. The measure of association used was prevalence ratio (PR) and respective CI95 %, calculated by Poisson regression with robust variance adjustment, for the crude and adjusted analyses.

Results

The prevalence of anemia was found to be higher amongst the public school children than the private school children (10.8 % vs. 7.0 %; PR = 1.54; CI95 %: 1.1; 2.2). At the public schools, the variables that remained significantly associated with anemia after the multivariate analysis were “consumption of fruits/fruit juices < 2 portions/day” (PR = 2.19; CI95 %: 1.18; 4.06) and “male” (PR = 1.51; CI95 %: 1.001; 2.30). At the private schools, these variables were “working mother” (PR = 2.83; CI95 %: 1.23; 6.52) and “monthly school fees < R$ 188.00” (PR = 3.20; CI95 %: 1.46; 7.03).

Conclusions

In the population under study, anemia constitutes a major health problem, especially among children from public schools. Considering the associated factors and the fact that these children are in a school environment, the promotion of healthy eating habits could constitute an important approach for reducing the prevalence of anemia.

[Association between dietary intake, physical activity, socioeconomic factors and body fat percentage among schoolchildren]

The scope of this article was to assess the association between dietary intake, physical activity and socioeconomic factors associated with body fat percentage in 7 to 14-year-old schoolchildren. It is a cross-sectional study with a probability sample of 2,481 students from public and private schools in Florianópolis, Santa Catarina, Brazil. Body fat percentage was investigated by measuring triceps and subscapular skin folds. Poisson regression was performed to test the association between excess body fat and independent variables, estimating prevalence ratios and 95% confidence intervals. The prevalence of excess body fat was 23.9%, though there was no significant difference between sex (p = 0.359) and age (p = 0.202). Excess body fat was associated with different factors in 11 to 14-year-old schoolchildren, namely eating less than three meals a day (OR = 1.62, CI: 1.38 to 1.91) and consumption of high-risk food more than 3 times a day (OR = 0.61 CI: 0.47 to 0.79). No significant difference was observed with physical activity. The high prevalence of excess body fat detected reveals the need for fostering the adoption of healthier behavioral practices (in relation to nutrition and physical activity) by schoolchildren.

Validity of WebCAAFE questionnaire for assessment of schoolchildren's dietary compliance with Brazilian Food Guidelines

OBJECTIVE

To estimate reporting bias of WebCAAFE, a web-based questionnaire for the assessment of food intake (recall of frequency of intake of thirty-two food items the day before) and physical activity in schoolchildren.

DESIGN

Cross-sectional study. Self-reported food intake on WebCAAFE was compared with direct observation of school meals in five public schools. Additional data included school grade, sex, BMI, socio-economic status and access to Internet at home. Poisson regression was used to calculate the reporting bias (WebCAAFE v. direct observation) and the sample size necessary to detect a statistically significant difference between WebCAAFE reports and at least 75 % compliance with the recommendations for a healthy diet.

SETTING

Intentional sample of five elementary public schools in Florianopolis, Brazil.

SUBJECTS

Schoolchildren (n 629) from 2nd to 5th grades.

RESULTS

Moderate bias magnitude was found for most food groups of interest. Frequency of consumption was not related to the bias. Sample sizes necessary to detect the compliance with dietary recommendations varied between four and seventy-four individuals for the different groups investigated.

CONCLUSIONS

After adjusting for moderate bias, WebCAAFE may be used as a food questionnaire for evaluation of schoolchildren's food compliance on a group level, even with a relatively small sample size.

Prevalence and factors associated with central obesity in schoolchildren in Santa Catarina, Brazil

Objective: The aims of this article are to estimate the prevalence and to identify the sociodemographic factors and food consumption associated with central obesity in schoolchildren 6-10 years old of the State of Santa Catarina, Brazil. Methods: It consists in a cross-sectional population-based study involving 4,963 schoolchildren enrolled in the public and private sectors. The dependent variable is central obesity investigated by measuring waist circumference and classified according to percentiles/gender/age. Bivariate and multivariate analyzes were also performed. Results: The prevalence of central obesity was 4,9% (CI95%=4,3;5,5), being more prevalent in boys with statistical significance (p=0,003). The other variables investigated (age the schoolchildren, type of school, maternal education, protective and risk food consumption, number of daily meals) were not associated with outcome. Among the schoolchildren who had central obesity (n=243), 99.3% of the boys and 99.0% of the girls also showed overweight/obesity. Conclusion: The prevalence of central obesity was lower than that reported in national and international studies. In this scenario, the gender (male) variable was strongly associated with the outcome. The identified prevalence is a major concern in nutrition and medical science as the central obesity may remain in adulthood and show strong association with cardiovascular risk. It is noteworthy that there is a need for obesity prevention campaigns that encourage children and their parents to adopt a healthier life style. Finally, other studies should be conducted in order to examine potential factors linked to central obesity.

Validation of a web-based questionnaire to assess the dietary intake of Brazilian children aged 7-10 years

BACKGROUND

The Food Intake and Physical Activity of School Children (CAAFE) comprises an online questionnaire to self-report diet and physical activity of Brazilian schoolchildren.

BACKGROUND

The present study aimed to assess the validity (matches, omissions and intrusions) and moderating factors of the CAAFE.

METHODS

Direct observation was made of foods consumed (five public schools) and child self-reporting on the CAAFE. Additional data included school grade, gender, body mass index, completion of food diary, socioeconomic status and access to computer. Data were analysed using regression.

RESULTS

In total, 602 children participated in the study [mean (SD) age 9.5 (1.24) years; 53.6% boys]. On average, there were 43% matches, 29% intrusions and 28% omissions. Matches doubled in third grade compared to the second grade (P = 0.004); matches almost tripled for afternoon snack compared to morning snack (P < 0.001); and matches were 69% higher for children with access to a computer at home (P < 0.01). Intrusions decreased by almost one-half in fifth compared to fourth grades (P = 0.004). Omissions declined significantly in the third and fourth grades but increased in the fifth grade. Omissions were 47% lower for children in the highest income and lower among children who completed the food diary. No differences were found for gender or body mass index.

CONCLUSIONS

Children older than 8 years old, who owned a computer and completed a food diary, performed better in the CAAFE. A high incidence of disagreement was found in relation to the schools and the type of meal. Overall matches (43%), intrusions (29%) and omissions (28%) indicate that further studies are required to improve the validity of the CAAFE.

Factors associated with the consumption of fruits and vegetables in schoolchildren aged 7 to 14 years of Florianópolis, South of Brazil

Objective: To estimate the prevalence of the fruit and vegetable intake of schoolchildren aged 7 to 14 years from Florianópolis, Santa Catarina, Brazil, and analyze the associated factors. Methods: This cross-sectional study analyzed food intake, socioeconomic, and biological data of 2,836 schoolchildren. The Chi-square test analyzed the dependent (fruit and vegetable intake) and independent variables; the latter with p-value <0.20 were selected for logistic regression analysis. The level of significance was p<0.05. Results: Only 4.8% of the sample had adequate fruit and vegetable intake. The variables associated with adequate fruit and vegetable intake were school ownership status (private versus public), mother's education level, and family income per member. After adjustment only family income per capita remained associated with fruit and vegetable intake. Conclusion: The fruit and vegetable intake of schoolchildren aged 7 to 14 years from Florianópolis, Santa Catarina, Brazil, is inadequate.

Qualitative analysis of the contributions of nutritionists to the development of an online instrument for monitoring the food intake of schoolchildren

BACKGROUND

The Consumo Alimentar e Atividade Fisica de Escolares (CAAFE) questionnaire is an online research tool that has been developed to enable the self-report of physical activity and diet by Brazilian schoolchildren aged 7-10 years. Formative research was conducted with nutritionists during the development of the web-based questionnaire. The suggestions and insights obtained were used to design a tool to monitor schoolchildren's food consumption based on the concept of healthy and unhealthy food indicators. The present study aimed to report the focus group discussions conducted with nutritionists concerning the CAAFE questionnaire.

METHODS

Focus group discussions were conducted using a semi-structured questionnaire, and these were then analysed thematically.

RESULTS

Twenty-four nutritionists participated (four focus groups; average per group: six people); the majority (n = 22) had experience with 7-10-year-old children. Four themes emerged: (i) healthy and unhealthy food indicators; (ii) suggestions for the online instrument; (iii) potential applications; and (iv) challenges for its construction.

CONCLUSIONS

Comments made by nutritionists enabled the construction of an instrument that is able to answer questions related to food consumption in schools and at home.

Median ages at stages of sexual maturity and excess weight in school children

BACKGROUND

We aimed to estimate the median ages at specific stages of sexual maturity stratified by excess weight in boys and girls.

MATERIALS AND METHOD

This was a cross-sectional study made in 2007 in Florianopolis, Brazil, with 2,339 schoolchildren between 8 to 14 years of age (1,107 boys) selected at random in two steps (by region and type of school). The schoolchildren were divided into: i) those with excess weight and ii) those without excess weight, according to the WHO 2007 cut-off points for gender and age. Sexual maturity was self-evaluated by the subjects according to the Tanner sexual development stages, and utilizing median ages for the genitalia, breasts, and pubic hair stages.

RESULTS

In the boys with excess weight, precocity was observed in the stages 4 for genitals and pubic hair and 2 for pubic hair, with the values for excess and normal weight. The median ages at the beginning of puberty (stage 2-sexual development) for boys and girls in Florianopolis were 10.8 and 10.3 years, respectively.

CONCLUSION

Excess weight is associated with lower median ages in the sexual maturity stages in boys and girls and that it should be taken into account when evaluating sexual maturity in children and adolescents.

Assessment of diet and physical activity of brazilian schoolchildren: usability testing of a web-based questionnaire

Background

Information and communication technology (ICT) has been used with increasing frequency for the assessment of diet and physical activity in health surveys. A number of Web-based questionnaires have been developed for children and adolescents. However, their usability characteristics have scarcely been reported, despite their potential importance for improving the feasibility and validity of ICT-based methods.

Objective

The objective of this study was to describe the usability evaluation of the Consumo Alimentar e Atividade Física de Escolares (CAAFE) questionnaire (Food Consumption and Physical Activity Questionnaire for schoolchildren), a new Web-based survey tool for the self-assessment of diet and physical activity by schoolchildren.

Methods

A total of 114 schoolchildren aged 6 to 12 years took part in questionnaire usability testing carried out in computer classrooms at five elementary schools in the city of Florianopolis, Brazil. Schoolchildren used a personal computer (PC) equipped with software for recording what is on the computer screen and the children’s speech during usability testing. Quantitative and qualitative analyses took into account objective usability metrics such as error counts and time to complete a task. Data on the main difficulties in accomplishing the task and the level of satisfaction expressed by the children were assessed by the observers using a standardized form and interviews with the children. Descriptive statistics and content analysis were used to summarize both the quantitative and the qualitative aspects of the data obtained.

Results

The mean time for completing the questionnaire was 13.7 minutes (SD 3.68). Compared to the children in 2nd or 3rd grades, those in 4th or 5th grades spent less time completing the questionnaire (median 12.4 vs 13.3 minutes, P=.022), asked for help less frequently (median 0 vs 1.0 count, P=.005), had a lower error count (median 2.0 vs 8.0 count, P<.001), and obtained a higher overall performance score (median 73.0 vs 68.0, P=.005). Children with a PC at home spent less time completing the questionnaire (median 12.3 vs 14.9 minutes, P<.001), had a lower overall error count (median 2.0 vs 9.0 count, P=.03), and had a higher performance score (median 72.0 vs 64.0, P=.005) compared to the children without a PC at home. The most common difficulty in completing the questionnaire was in using the scroll bar. The majority of children reported a positive evaluation (liked a lot or liked) for the four design elements, which were evaluated.

Conclusions

The results of the present study provided feedback to improve the final version of the CAAFE questionnaire. Quantitative data showed minor errors and system failures, while qualitative data indicated that, overall, the children enjoyed the CAAFE questionnaire. Grade levels and PC use must be taken into account in Web-based tools designed for children.

Excesso de peso em adolescentes: explorando potenciais fatores de risco

OBJETIVO: Estimar a prevalência de excesso de peso e identificar associações com fatores sociodemográficos, biológicos e de estilo de vida em adolescentes de Florianópolis, Santa Catarina. MÉTODOS: Estudo transversal, conduzido em 2007, com amostra probabilística de 1.590 escolares de 11 a 14 anos. Estimou-se a prevalência do excesso de peso, com base no índice de massa corpórea, por meio da referência brasileira e da International Obesity Task Force (IOTF). Análises multivariadas expressas como razão de chance foram usadas para identificar associações com fatores sociodemográficos, biológicos e de estilo de vida dos adolescentes. RESULTADOS: A prevalência de excesso de peso foi de 19,3% (24,5% de meninos e 14,5% de meninas), pela referência IOTF, e de 25,8% (31,8% de meninos e 20,5% de meninas), pelo critério brasileiro. Entre os adolescentes do sexo masculino, o excesso de peso associou-se positivamente com a não realização de refeições estruturadas e com o deslocamento não ativo para a escola. Entre as meninas, o excesso de peso materno, a não realização de refeições estruturadas e diferenças interestágios de maturação sexual compuseram o elenco dos fatores associados ao excesso de peso. CONCLUSÕES: A realização de refeições com alimentos de alto valor nutricional apresentou-se como um fator de proteção para o excesso de peso entre os adolescentes. Essa constatação reforça a necessidade de ações com vistas a modificar comportamentos relacionados ao ambiente familiar, incentivando a incorporação de hábitos alimentares saudáveis e o lazer ativo.

[Changes in food consumption and physical activity in schoolchildren of Florianópolis, Southern Brazil, 2002-2007]

OBJECTIVE

To assess changes in food consumption and physical activity levels in schoolchildren.

METHODS

A study was conducted with a representative sample (n = 4,168) of schoolchildren aged between seven and ten years living in the city of Florianópolis, Southern Brazil. Food consumption and physical activity were assessed in two school-based studies in 2002 (n = 2,936; 51% boys; mean age = 8.5 years) and 2007 (n = 1,232; 50.7% boys; mean age = 8.6 years), using illustrated questionnaires. The chi-square test was used to assess changes in the consumption of eight foods/food groups, in terms of the recommendations of the Brazilian Food Guidelines and physical activity levels (assessed according to tertiles of distribution of score and type of transportation to school). Analyses were performed according to the type of school attended (private or public).

RESULTS

There was a reduction in the proportion of schoolchildren who reported eating fruits, vegetables, beans, meat, snack foods, pizza, French fries and sodas. A higher proportion of private school children met the recommendations that restricted the consumption of sodas, pizza and French fries and promoted the consumption of fruits and vegetables, in both studies. On the other hand, a higher proportion of public school children met the recommendations of meat consumption in 2007. Median values of scores of physical activity decreased in 2007. In both years, private school children were more active. The proportion of schoolchildren who actively commuted to school decreased from 49% to 41% (p < 0.01).

CONCLUSIONS

There was a reduction in the consumption of markers of a healthy diet (beans, meat/fish, fruits and vegetables) and high-energy and low-nutrient foods (sodas, snack foods and pizza/French fries). In addition, there was a decrease in the proportion of schoolchildren who reported actively commuting to school.

Fatores associados ao estado nutricional de escolares de 7 a 10 anos: aspectos sociodemográficos, de consumo alimentar e estado nutricional dos pais

OBJETIVO: Estimar a prevalência de sobrepeso/obesidade em escolares e investigar sua associação com o estado nutricional dos pais, fatores sociodemográficos e de consumo alimentar. MÉTODO: Estudo transversal realizado com 1.223 escolares de 7 a 10 anos de Florianópolis, SC. Foram coletados dados socioeconômicos e medidas antropométricas autorreferidas dos pais, e medidas antropométricas diretas e de consumo alimentar do dia anterior dos escolares. O diagnóstico nutricional dos escolares foi definido a partir do Índice de Massa Corporal (IMC) para idade e sexo de acordo com dados de referência da Organização Mundial de Saúde (2007) e o dos pais segundo os pontos de corte do IMC também da Organização Mundial de Saúde (1995). Realizou-se análise bivariada e multivariada por meio da regressão de Poisson. RESULTADOS: Prevalência de sobrepeso/obesidade de 36,2% nos meninos e 32,7% nas meninas. Nos pais e mães a prevalência foi de, respectivamente, 56,3% e 27,5%. Dos fatores investigados, no modelo final permaneceram associados ao sobrepeso/obesidade nos escolares o estado nutricional das mães (p = 0,001) e dos pais (p = 0,050). A prevalência de sobrepeso/obesidade foi 1,58 vezes maior em escolares com mães e 1,41 vezes maior em escolares com pais com sobrepeso/obesidade, quando comparados a mães e pais sem o problema. CONCLUSÃO: Observou-se elevada prevalência de sobrepeso/obesidade nos escolares, e esta se associou ao estado nutricional de pais e mães. Isso evidencia a necessidade de ações de prevenção do ganho excessivo de peso ainda na infância que atuem também no ambiente familiar do escolar, a fim de reduzir a obesidade neste grupo populacional.

Fatores associados ao consumo adequado de frutas e hortaliças em escolares de Santa Catarina, Brasil

Objetivou-se estimar a frequência do consumo adequado de frutas e hortaliças e identificar os fatores associados em escolares do Estado de Santa Catarina, Brasil. Trata-se de estudo transversal, realizado com 4.964 escolares de escolas públicas e privadas de oito municípios do estado. Foram analisadas variáveis sociodemográficas, comportamentais, antropométricas e de consumo alimentar. A ingestão de frutas e hortaliças cinco ou mais vezes ao dia foi considerado o consumo adequado. Para testar a associação entre o consumo adequado de frutas e hortaliças e as variáveis independentes, foi utilizada a regressão multivariada de Poisson, considerando o nível de significância de 5% (p <0,05). O consumo adequado esteve presente em 2,7% dos escolares, enquanto 26,6% não consumiram frutas e hortaliças sequer uma vez por dia. Somente o consumo de guloseimas manteve-se diretamente associado ao consumo adequado de frutas e hortaliças. Os dados apontam a necessidade de estratégias específicas para o ambiente escolar, a fim de promover o maior consumo de frutas e hortaliças nessa população.

Association of parents' nutritional status, and sociodemographic and dietary factors with overweight/obesity in schoolchildren 7 to 14 years old

To assess the association of parents' nutritional status, and dietary and sociodemographic factors with overweight/obesity in schoolchildren in Florianópolis Island, Santa Catarina State, Brazil, this cross-sectional epidemiological study examined 2,826 schoolchildren 7 to 14 years old, classified according to body mass index curves for age and sex recommended by the International Obesity Task Force. Data were analyzed using Poisson regression. The final model showed overweight/obesity in boys associated directly with father's educational level, mother's age, and parents' nutritional status, and inversely with mother's educational level, and number of daily meals. Among girls, it associated directly with parents' nutritional status and the schoolchildren's age, and inversely with consumption of risk foods. The variables that associated with overweight/obesity differed between the sexes, except parents' nutritional status. Boys and girls with both parents overweight or obese were, respectively, 80% and 150% more likely to exhibit the same diagnosis, indicating the need for interventions that include the family environment.

Validation of a food frequency questionnaire to assess the consumption of carotenoids, fruits and vegetables among adolescents: the method of triads

The aim of this study was to validate the intake of carotenoids, fruits and vegetables estimated by the Food Frequency Questionnaire for Adolescents (FFQA) using the method of triads. Blood samples were collected from 80 elementary school adolescents to assess serum levels of β-carotene. Partial correlation coefficients (r) were calculated between an estimated intake of carotenoids, fruits and vegetables and the serum levels of β-carotene. Validity coefficients were calculated using the method of triads. With the exception of carotenoids, partial r from the food frequency questionnaire (FFQ) were greater than those of the 24-hour recall (24hR). The fruit/vegetable group showed the highest partial r for the FFQ (r = 0.235) and the 24hR (r = 0.137). The highest validity coefficient was obtained for the vegetable group, as assessed by the FFQ (r = 0.873). On average, the validity coefficient values for the FFQ were greater than those obtained for the 24hR or the β-carotene serum levels. The FFQA is an accurate tool for estimating the intake of carotenoids, fruits and vegetables in this population group.

Validação de indicadores do consumo de alimentos e bebidas obtidos por inquérito telefônico em Belém, Pará, Brasil

O objetivo deste trabalho foi avaliar a validade relativa dos indicadores de consumo de alimentos e bebidas obtidos pelo sistema de vigilância por entrevista telefônica (VIGITEL). Foi avaliada uma amostra aleatória (n = 100) da amostra total de aproximadamente dois mil adultos, estudada pelo sistema, em 2009, em Belém, Pará, Brasil. Os indicadores avaliados foram fatores de proteção (consumo adequado de frutas, legumes e verduras) e de risco (consumo de gordura saturada, refrigerante e bebidas alcoólicas) para doenças crônicas não transmissíveis. Compararam-se os resultados obtidos a partir de entrevista telefônica e de três recordatórios de 24 horas (padrão de referência). O padrão de referência evidenciou subestimação na frequência dos indicadores, à exceção de refrigerantes e bebidas alcoólicas. As médias das frequências do consumo foram, em geral, maiores no grupo exposto (entrevistados pelo VIGITEL). Não se pode concluir que o VIGITEL não seja um bom indicador de consumo, pois o padrão de referência também apresenta limitações, portanto o uso daquele como instrumento de monitoramento é justificável.