Ultra-processed foods, adiposity and risk of head and neck cancer and oesophageal adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition study: a mediation analysis

PURPOSE

To investigate the role of adiposity in the associations between ultra-processed food (UPF) consumption and head and neck cancer (HNC) and oesophageal adenocarcinoma (OAC) in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

METHODS

Our study included 450,111 EPIC participants. We used Cox regressions to investigate the associations between the consumption of UPFs and HNC and OAC risk. A mediation analysis was performed to assess the role of body mass index (BMI) and waist-to-hip ratio (WHR) in these associations. In sensitivity analyses, we investigated accidental death as a negative control outcome.

RESULTS

During a mean follow-up of 14.13 ± 3.98 years, 910 and 215 participants developed HNC and OAC, respectively. A 10% g/d higher consumption of UPFs was associated with an increased risk of HNC (hazard ratio [HR] = 1.23, 95% confidence interval [CI] 1.14-1.34) and OAC (HR = 1.24, 95% CI 1.05-1.47). WHR mediated 5% (95% CI 3-10%) of the association between the consumption of UPFs and HNC risk, while BMI and WHR, respectively, mediated 13% (95% CI 6-53%) and 15% (95% CI 8-72%) of the association between the consumption of UPFs and OAC risk. UPF consumption was positively associated with accidental death in the negative control analysis.

CONCLUSIONS

We reaffirmed that higher UPF consumption is associated with greater risk of HNC and OAC in EPIC. The proportion mediated via adiposity was small. Further research is required to investigate other mechanisms that may be at play (if there is indeed any causal effect of UPF consumption on these cancers).

Treatment of childhood obesity based on the reduction of ultra-processed foods plus energy restriction: A randomised controlled trial based on the Brazilian guidelines

Reducing ultra-processed foods (UPF) improves diet quality and may curb energy consumption. This study aimed to compare an intervention based on the reduction of UPF, according to the Dietary Guideline for the Brazilian Population (DGBP), with and without advice on energy intake. A parallel and randomised controlled trial was carried out with children with obesity from 7 to 12 years old. Both control (CG) and intervention groups (IG) participated monthly in 6 standardised educational activities based on the 10 steps of the DGBP. An individualised food plan was also provided to the IG. The rate of change for body mass index (BMI), waist circumference, body weight, and UPF consumption were investigated based on mixed-effect models. At the end of the study, the BMI declined in the IG (Δ = -0.27 kg/m2 ) compared to the CG (Δ = + 0.53 kg/m2 ) (p = .0002). Both groups showed a decline in grams of UPF until the fourth month and a gradual increase in the following months. Combining the qualitative approach of the DGBP with counselling on energy restriction through the diet plan proved to be effective in reducing childhood obesity. Clinical Trial Registration: This trial is registered at the Brazilian Registry of Clinical Trials (REBEC), under the RBR-3st5sn registry, available at http://www.ensaiosclinicos.gov.br/rg/RBR-3st5sn/. The datasets generated by the current study are not publicly available but are available from the corresponding author on reasonable request.

Evolution of adolescents' dietary patterns in Northeast Brazil from 2008 to 2018

OBJECTIVE

To evaluate the evolution of the dietary patterns of adolescents in the northeast region of Brazil.

METHODS

Secondary analysis of data from the Pesquisa de Orçamentos Familiares (POF - Household Budget Surveys), collected by the Brazilian Institute of Geography and Statistics (IBGE) in the years 2008-2009 and 2017-2018. A total of 3,095 adolescents were evaluated in 2008-2009 and 3,015 in 2017-2018. Food consumption was assessed using two dietary records in 2008-2009 and two 24-hour recalls in 2017-2018, applied on non-consecutive days. Based on these data, principal components factor analysis (PCFA) was performed, followed by orthogonal rotation of the varimax type, to derive dietary patterns, stratified by sex. The results were described as means or percentage frequencies, with their respective 95% confidence intervals.

RESULTS

Three main dietary patterns were identified among adolescents from the northeast region of Brazil. Among boys, in 2008-2009, the patterns were called snacks, traditional Brazilian, and coffee; and in 2017-2018, traditional Brazilian, snacks, and mixed, in this order of representativeness of the group's eating habits. Among female adolescents, in 2008-2009, the patterns were snacks, traditional Brazilian, and coffee; and in 2017-2018, traditional Brazilian, snacks, and processed meats.

CONCLUSION

The dietary patterns identified in 2008-2009 and 2017-2018 were similar in both genders; however, the snacks pattern, which explained most of the data variability in 2008-2009, was replaced by the traditional Brazilian.

A choice architecture intervention targeting school meals and water frequency intake: A school-based randomized trial

Our aim was to evaluate the impact of choice architecture on school meals and water intake frequency. We conducted a school-based randomized trial in seven elementary municipal public schools (control = 3; intervention = 4) in Rio de Janeiro, Brazil. The interventions group received the following modifications: (1) banner of the daily school meal menu and two superheroes, (2) waterproof tablecloths, (3) posters on healthy eating habits, (4) displays with playful names, (5) new containers for fruits, and (6) colored footprints for one month. Changes in school meals and daily water frequency consumption were evaluated through intention-to-treat analyses, using generalized estimating equations models for repeated measures, considering the classes' cluster effect. Data from 974 students in the fifth and sixth elementary school grades were analyzed (control = 356; intervention = 618). At baseline, 47.1% of students were female, with a mean age of 12 years (SD = 1.4), 39.2% reported daily consumption of school meals, and 45.7% consumed water from the school drinking fountain three or more times a day. We observed an increase in the odds of daily water intake in the intervention group compared to the control (OR = 1.4 95% CI = 1.1-1.9), no changes in the school meals (OR = 1.2 95% CI = 0.9; 1.6). Low-complexity strategies based on choice architecture applied in the school environment can be promising in increasing water intake frequency among elementary students in public schools. TRIAL REGISTRATION: This study was registered on the Clinicaltrials.gov platform under the number NCT03136016. Access: https://clinicaltrials.gov/ct2/show/NCT03136016.

Dietary patterns, obesity markers and leukocyte telomere length among Brazilian civil servants: cross-sectional results from the Pro-Saude study

OBJECTIVE

Dietary patterns express the combination and variety of foods in the diet. The partial least squares method allows extracting dietary patterns related to a specific health outcome. Few studies have evaluated obesity-related dietary patterns associated with telomeres length. This study aims to identify dietary patterns explaining obesity markers and to assess their association with leukocyte telomere length (LTL), a biological marker of the ageing process.

DESIGN

Cross-sectional study.

SETTING

University campuses in the state of Rio de Janeiro, Brazil.

PARTICIPANTS

478 participants of a civil servants' cohort study with data on food consumption, obesity measurements (total body fat, visceral fat, BMI, leptin and adiponectin) and blood samples.

RESULTS

Three dietary patterns were extracted: (1) fast food and meat; (2) healthy and (3) traditional pattern, which included rice and beans, the staple foods most consumed in Brazil. All three dietary patterns explained 23·2 % of food consumption variation and 10·7 % of the obesity-related variables. The fast food and meat pattern were the first factor extracted, explaining 11-13 % variation of the obesity-related response variables (BMI, total body fat and visceral fat), leptin and adiponectin showed the lowest percentage (4·5-0·1 %). The healthy pattern mostly explained leptin and adiponectin variations (10·7 and 3·3 %, respectively). The traditional pattern was associated with LTL (β = 0·0117; 95 % CI 0·0001, 0·0233) after adjustment for the other patterns, age, sex, exercise practice, income and energy intake.

CONCLUSION

Leukocyte telomere length was longer among participants eating a traditional dietary pattern that combines fruit, vegetables and beans.

Blood pressure variation and ultra-processed food consumption in children with obesity

To investigate the influence of ultra-processed food (UPF) consumption on systolic (SBP) and diastolic (DBP) blood pressure in children with obesity, using dietary and urinary markers. We conducted a secondary analysis of a randomized clinical trial involving children with obesity, aged 7 to 12 years. Over a period of six months, the children and their guardians attended monthly individual consultations and educational activities aimed at promoting a reduction in UPF consumption. During each visit, measurements of blood pressure, body weight, height, and 24-h dietary recall were recorded. Additionally, spot urine samples were collected at baseline, and at the second and fifth-month follow-ups. A total of 96 children were included in the analysis. Energy intake, UPF intake and blood pressure showed a quadratic pattern of change, with a decrease in the first two months and an increase thereafter. There was an association between UPF consumption and DBP. The intake of UPF was correlated with the urinary sodium-to-potassium (Na/K) ratio (r = 0.29; p = 0.008) and the dietary Na/K ratio (r = 0.40; p < 0.001). For every 100 g increase in UPF, DBP increased by 0.28 mmHg (p-value = 0.01). After further adjustment for changes in body mass index (BMI), and physical activity, the increase in DBP was 0.22 mmHg.    Conclusion: Our findings indicate that reducing UPF consumption may have an impact on blood pressure in children with obesity. Additional adjustment for BMI and physical activity did not influence the results. Therefore, reducing UPF consumption can be considered as a strategy against hypertension. What is Known: • Ultra-processed food consumption is associated with an increased risk of cardiovascular disease; however, this evidence is still limited in children. • Intake of calories from ultra-processed food in relation to the total calories is increasing worldwide. What is New: • Ultra-processed food consumption has an effect on the diastolic blood pressure, independent of changes in weight. • The intake of ultra-processed food was correlated to the dietary sodium-to-potassium ratio (r = 0.40; p < 0.001).

A multicomponent family intervention, combined with salt reduction for children with obesity: a factorial randomized study protocol

BACKGROUND

Clinical trials to treat childhood obesity show modest results, weight regain and high dropout rates. Children with obesity often live in families with habits that contribute to unhealthy weight gain. This study will test whether a family intervention with a Brazilian-adapted Planetary Healthy Diet (PHD) and reduced portion sizes, along with increased physical activity and reduced sedentary behavior, can reduce excessive weight gain. The protocol promotes the intake of in natura products and water and reduces ultra-processed foods, sugar, and sodium. It encourages family lifestyle changes and physical activities, with randomized allocation to experimental and control groups. The responsible family member will be evaluated during follow-up. The control group will receive a print of the Brazilian dietary guideline.

METHODS

A factorial crossover design will also allocate families to receive reduced sodium salt plus anti-inflammatory herbs and a placebo salt. Both the control and intervention groups will be randomly assigned to the sequence of both salts. The approach aims to reduce body weight expectations and evaluate salt's impact on blood pressure. It includes a 1-month intervention, 1-month washout, and 1-month intervention with monthly clinic visits and teleservice by health professionals. The primary outcomes will be the variation in the Body Mass Index (BMI) of the children. BMI and the variation in the blood pressure of the pair (child/mother or father) as well as waist circumference (WC) and waist-to-height ratio (WHtR) will also be measured.

DISCUSSION

The project will test the effectiveness of the use of the recommendations of the PHD, physical activity and a salt-reduced sodium. The results of the present study will allow the refinement of interventions aimed at the treatment of childhood obesity and may help develop guidelines for the treatment of obesity in Brazilian children.

TRIAL REGISTRATION

The study is registered in the Brazilian Registry of Clinical Trials (RBR-10 mm62vs). Registered 10 February 2023.

Adherence to school meals and co-occurrence of the healthy and unhealthy food markers among Brazilian adolescents

The aim of this study was to analyze the association between adherence to school meals and the co-occurrence of the regular consumption of healthy and unhealthy eating markers among Brazilian adolescents. Data from 67,881 adolescents in Brazilian public schools who participated in the 2015 National School Health Survey, were used. From the 7-day FFQ, the dependent variable was constructed, co-occurrence of regular consumption (≥ 5x/week) of healthy and unhealthy food markers, which was categorized as regular consumption of none, one or two, or three eating markers. We performed an ordinal logistic regression with adjustment for sociodemographic, eating habits outside of school, and school characteristics variables. The prevalence of the co-occurrence of the regular consumption of three healthy eating markers was 14.5%, and that of three unhealthy markers was 4.9%. High adherence to school meals (every day) was positively associated with regular consumption of healthy eating markers and inversely associated with regular consumption of unhealthy eating markers. The school meals provided by PNAE contribute to the promotion of healthy eating habits among Brazilian adolescents.

Association of the retail food environment, BMI, dietary patterns, and socioeconomic position in urban areas of Mexico

The retail food environment is a key modifiable driver of food choice and the risk of non-communicable diseases (NCDs). This study aimed to assess the relationship between the density of food retailers, body mass index (BMI), dietary patterns, and socioeconomic position in Mexico. Cross-sectional dietary data, BMI and socioeconomic characteristics of adult participants came from the nationally representative 2012 National Health and Nutrition Survey in Mexico. Geographical and food outlet data were obtained from official statistics. Densities of food outlets per census tract area (CTA) were calculated. Dietary patterns were determined using exploratory factor analysis and principal component analysis. The association of food environment variables, socioeconomic position, BMI, and dietary patterns was assessed using two-level multilevel linear regression models. Three dietary patterns were identified-the healthy, the unhealthy and the carbohydrates-and-drinks dietary pattern. Lower availability of fruit and vegetable stores was associated with an unhealthier dietary pattern whilst a higher restaurant density was associated with a carbohydrates-and-drinks pattern. A graded and inverse association was observed for fruit and vegetable store density and socioeconomic position (SEP)-lower-income populations had a reduced availability of fruit and vegetable stores, compared with higher-income populations. A higher density of convenience stores was associated with a higher BMI when adjusting for unhealthy dietary patterns. Upper-income households were more likely to consume healthy dietary patterns and middle-upper-income households were less likely to consume unhealthy dietary patterns when exposed to high densities of fruit and vegetable stores. When exposed to a high concentration of convenience stores, lower and upper-lower-income households were more likely to consume unhealthy dietary patterns. Food environment and sociodemographic conditions within neighbourhoods may affect dietary behaviours. Food environment interventions and policies which improve access to healthy foods and restrict access to unhealthy foods may facilitate healthier diets and contribute to the prevention of NCDs.

Environment modification at school to promote physical activity among adolescents: a cluster randomized controlled trial

OBJECTIVE

To assess the effect of modifications of the school environment on physical activity in Brazilian adolescent students.

METHODS

Seven public schools in Duque de Caxias (Brazil) were randomized into control and intervention groups. The intervention group underwent modifications in the school environment (painting of hopscotch and school courts) and the provision of sports equipment (balls, basketball table, soccer goalpost, volleyball nets, and others) to stimulate physical activity. Additionally, footsteps towards the court and materials were painted, and a superhero character called Super Active was introduced. Total physical activity was measured using a validated questionnaire for adolescents. Generalized linear models were used to evaluate the effect of the intervention, adjusted by sex.

RESULTS

The sample consisted of 975 adolescents, with a mean age of 11.52 years (standard deviation - SD 1.43), and 56.7% were boys. After the one-month intervention, both groups' total physical activity time increased. The estimated changes from baseline were not different between the intervention and control groups (Δ=102.75 and Δ=99.76, respectively; p=0.52).

CONCLUSION

The painting, supply of equipment and other strategies to encourage physical activity in the school environment did not promote a positive effect on improving physical activity among adolescents. Future research is necessary to evaluate the effect of the intervention in the long-term period, particularly in other population contexts in middle-income countries.

Dietary patterns of Brazilian adults in 2008-2009 and 2017-2018

OBJECTIVES

To identify dietary patterns among Brazilian adults based on the National Dietary Surveys (INA - Inquéritos Nacionais de Alimentação) in 2008-2009 and 2017-2018, and to verify in the second period the adherence to the patterns according to sociodemographic factors and Brazilian regions.

METHODS

We analyzed the first of two days of adults' food consumption (19-59 years) in INA data from 2008-2009 (n = 21,630) and 2017-2018 (n = 28,901). Dietary patterns were derived by exploratory factor analysis from 19 food groups, considering the complexity of the sample design. We evaluated the factor scores according to sex, age group, region, per capita income, and education for the INA data in 2017-2018.

RESULTS

We identified three patterns in the two surveys: (1) "traditional", characterized by rice, beans, and meat; (2) "breads and butter/margarine", characterized by breads, oils, and fats (including margarine/butter) and, coffee and teas in 2008-2009; and (3) "western", characterized by sodas, pizzas, snacks, flour, pasta, and sweets in 2017-2018. The "traditional" pattern had greater adherence among men, residents of the Midwest region and individuals with incomplete primary education. "Bread and butter/margarine" pattern had greater adherence among males, individuals aged between 40 and 59 years, from the Southeast region, and with income between 1 and 2 minimum wages per capita. Male individuals, aged between 19 and 39 years, from the South region, with per capita income greater than two minimum wages, and education level equal to or greater than primary education showed greater adherence to the "western" pattern.

CONCLUSION

The dietary patterns identified in 2008-2009 and 2017-2018 were similar, and we observed the maintenance of the "traditional" pattern, which includes rice, beans, and meat. Adherence to the dietary patterns varies according to sex, age group, region, per capita income, and education level.

Association Between Family Physical Violence Victimization and Food Consumption Among Brazilian Adolescents

Few studies have evaluated the relationship between stressful events, such as child abuse and food consumption. Thus, the objective of this study is to assess whether family physical violence victimization is associated with food consumption in adolescents. We used data from the Brazilian National Adolescent School-based Health Survey, carried out in 2015, in a representative sample of 102,072 students attending ninth grade from public and private schools. We used Venn diagrams and logistic regression analysis to, respectively, graphically represent and evaluate the association between the consumption of ultra-processed food (soft drinks, sweets/candies, and salty biscuits, packaged snacks, or processed meat) and in natura food (beans, fruits and vegetables) with victimization from family physical violence. We found a lower consumption of in natura and higher consumption of ultra-processed foods among adolescent victims when compared with nonvictims of family physical violence. The probability of consuming 4 or more times a week increased by 44% for salty biscuits, packaged snacks, or processed meats; 38% for soft drinks; and 22% for sweets among adolescents who reported violence. On the contrary, the probability of consuming 4 or more times a week decreased by 25% for beans, 19% for vegetables, and 13% for fruits among adolescent victims of family physical violence. We conclude that family physical violence victimization is associated with high consumption of ultra-processed food and low consumption of in natura food among Brazilian adolescents. Therefore, issues related to violence in childhood and adolescence should be addressed in interventions aimed at altering food consumption and consequent prevention, control, and treatment of nutrition-related outcomes to increase their effectiveness.

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.

Resistant starch type-2 enriched cookies modulate uremic toxins and inflammation in hemodialysis patients: a randomized, double-blind, crossover and placebo-controlled trial

BACKGROUND

The aim of this study was to evaluate the effect of resistant starch (RS) enriched cookies supplementation on mRNA expression of nuclear transcription factors (nuclear erythroid 2-related factor, Nrf2; nuclear factor kappa-B, NF-κB), involved with inflammation and on uremic toxins levels produced by the gut microbiota in hemodialysis (HD) patients.

METHODS

A randomized, double-blind, placebo-controlled crossover study with 26 HD patients was conducted. The patients were assigned to either resistant starch enriched cookies (16 g of RS per day) or placebo cookies supplementation during the first four weeks. After the washout period, patients were supplemented again, in the form of a crossover, for another 4 weeks. Nrf2, NF-κB, and antioxidant enzymes mRNA expression were measured by rt-PCR and protein expression by western blotting assay from isolated peripheral blood mononuclear cells (PBMC). Oxidative stress and inflammatory biomarkers, as well as uremic toxins, were evaluated. Intention-to-treat analysis was performed, using the proc mixed procedure in SAS.

RESULTS

In RS group, post-treatment mean mRNA Nrf2 expression was market increased from baseline values, associated with a high expression of NQO1 protein. Besides, IS plasma levels were reduced in the RS group. No significant difference was observed in the placebo group.

CONCLUSION

Our results suggested that resistant starch enriched cookies may be a good nutritional strategy to reduce indoxyl sulfate levels derived from the gut microbiota and also attenuate the inflammation in hemodialysis patients.

Impact of a randomized school-based intervention program on blood pressure levels

Abstract Objectives: to evaluate the impact of a health program performed in a school setting on the blood pressure levels of schoolchildren in the public school system in Vitória/ES-Brazil. Methods: a randomized community trial was performed with 237 schoolchildren (6 to 12 years) from two public schools, randomly defined as the intervention and control school. Participants of the intervention group attended 11 education sessions over 4 months (July to October 2014). To test for differences between groups, the chi-square (categorical variables), and the paired t test or Wilcoxon (continuous variables) was used. The rate of variation of systolic blood pressure (SBP) and diastolic blood pressure (DBP) throughout the follow-up, according to allocation group, was evaluated using linear generalized models for time-repeated measures. Results: there was a reduction in the means of SBP (0.5 mmHg) and DBP (0.6 mmHg) in the intervention group and an increase in the control group, with a significant difference in the BP variation between groups over the follow-up period (p<0.05). Conclusion: a low-cost and easily implemented intervention may be one of the factors associated with the lowest blood pressure levels in the group studied, and reproduction in a school environment is feasible.

Effect of phytosterol capsule supplementation associated with the National Cholesterol Education Program Step 2 diet on low-density lipoprotein in children and adolescents with dyslipidemia: A double-blind crossover trial

OBJECTIVE

To evaluate the effect of phytosterol capsule supplementation associated with the National Cholesterol Education Program (NCEP) Step 2 diet on LDL-C levels in children and adolescents with dyslipidemia.

METHODS

This is a randomized, double-blind, crossover trial conducted with children and adolescents (n = 31; mean ± SD, age 9.0 ± 2.22 years, BMI zscore 1.65 ± 1.47 kg/m²) with dyslipidemia. After a run-in period, the participants were randomly allocated to control or intervention groups. The intervention group received capsules containing 1.5 g/day of phytosterols, and the control group received capsules containing 2 g/day of sunflower oil for 8 weeks. Patients in both groups were instructed to follow the NCEP Step 2 diet during the study. The primary outcome was LDL-C and secondary outcomes were total cholesterol (TC), HDL-C, triglyceride, insulin, blood pressure, and anthropometric measures. Intention-to-treat analyses were performed using the proc mixed procedure in SAS.

RESULTS

The rate of change for LDL-C was not different between intervention and control groups (p=0.30). No significant reduction was also observed for TC (p=0.47), HDL-C (p=0.97), insulin (p=0.27), triglycerides (p=0.38), systolic blood pressure (p=0.11), and diastolic blood pressure (p=0.57) compared to control group. Although we observed a high adherence to the capsule intake (95.7% in phytosterol and 93.8% in the control group), the low adherence to the diet may have contributed to explaining the results.

CONCLUSION

Daily phytosterol capsules supplementation associated with the NCEP Step 2 diet did not reduce LDL-cholesterol concentrations in children and adolescents with dyslipidemia.

Association of body image dissatisfaction with body mass index trajectory: the Adolescent Nutritional Assessment Longitudinal Study cohort

ABSTRACT Objective To examine the association of body image dissatisfaction (BID) with body mass index (BMI) trajectory among students from a metropolitan area of Rio de Janeiro. Methods Data were analyzed for 809 middle school students followed from 2010 to 2013, and 1131 high school students followed from 2010 to 2012. BID was assessed using a body silhouettes scale. Type of school (public and private) was used as a proxy of socioeconomic status. Results In the middle school cohort, girls from private schools who wanted to have smaller and bigger silhouettes gained fewer BMI units than those who were satisfied with their body image ( p < 0.05). In the high school, girls from private schools who wished to have bigger and smaller silhouettes experienced greater BMI increase than girls who were satisfied with their body image ( p < 0.05). Also, in the high school cohort, boys from public schools who wished to have smaller and bigger silhouettes experienced smaller BMI increase than boys who were satisfied ( p < 0.05). Conclusion BID may be related to the BMI trajectory in girls from private schools and in boys from public schools.

Treatment of Childhood Obesity Based on Brazilian Dietary Guidelines Plus Energy Restriction (PAPPAS HUPE Study): Protocol for a Randomized Clinical Trial

Background

The Food Guide for the Brazilian Population relies on natural or minimally processed foods mainly of plant origin such as beans and rice with low oil, salt, and sugar content and limited consumption of ultraprocessed foods. Reduction of ultraprocessed foods improves diet quality and energy consumption.

Objective

The goal of this study is to evaluate the effectiveness of an intervention for the treatment of obesity in children, with counseling based on the Brazilian Food Guide plus control of total energy intake.

Methods

A parallel, randomized clinical trial will include children aged 7 to 12 years. Randomization will be performed in blocks of 10 individuals using computer-generated random sequence numbers. Both the control and intervention groups will participate in 6 standardized educational activities based on the 10 steps of the Brazilian Food Guide. These activities will be conducted at the University Hospital Toy Library, located in the pediatric outpatient clinic. For the intervention group, in addition to the educational activities, an individualized food plan based on the nutritional recommendations of the Brazilian Society of Pediatrics will be prescribed and discussed with the mothers and fathers. The primary outcome of the study will be variations in body mass index, and secondary outcomes will include analysis of insulin resistance, blood pressure, body fat percentage, and waist and neck circumference.

Results

This project was funded by the National Council for Scientific and Technological Development in December 2017 (grant no 408333/2017-0). Recruitment began in August 2018 and by September 2019, we had enrolled the 101 participants. In addition to the patients referred by the national system of regulation, recruitment was made by medical outpatient referral and external indication. This is an ongoing study. We expect the results to be published in November 2020.

Conclusions

At the end of the project, in case of a positive result, a protocol for the treatment of obesity based on the Brazilian Food Guide will be proposed to the Unified Health System. A successful method to reduce childhood obesity is expected.

Trial Registration

Brazilian Registry of Clinical Trials RBR-3st5sn; http://www.ensaiosclinicos.gov.br/rg/RBR-3st5sn

International Registered Report Identifier (IRRID)

DERR1-10.2196/16170

Gender differences in the impact of sleep duration on common mental disorders in school students

BACKGROUND

Common mental disorders (CMD) in children and adolescents can be initial and non-specific manifestations of more serious mental diseases and often persist into adulthood. Therefore, early detection is important, as is the identification of the factors that impact development. Insufficient sleep represents one of the most common and potentially remediable risks to mental health in children and adolescents for whom chronic sleep loss has become normal. This study aims to investigate the influence of sleep duration on CMD in schoolchildren and adolescents.

METHODS

The data for this longitudinal study were derived from the community trial Parents, Students, Community Health Agents and Teachers for Healthy Eating (PAAPAS) in 2016 (N = 2743), with fifth and sixth graders from 18 public schools of Duque de Caxias, Rio de Janeiro, Brazil. CMD were assessed by the General Health Questionnaire (GHQ-12) at baseline and at a 9-month follow-up. Sleep duration was evaluated at baseline and was categorized as short, adequate or long according to age group. The effect of sleep duration on common mental disorders was analysed by sex using linear mixed-effects models.

RESULTS

At baseline, the frequency of CMD was 33.2% and was higher in boys than in girls and higher among students with short sleep duration. There was an increase in the CMD score over time among girls with short sleep duration (p < 0.01). Among boys, a similar trajectory of the CMD score was observed in the subgroups with short and long sleep duration, but there was a significant reduction in the subgroup with long sleep duration (p = 0.05).

CONCLUSION

Changes in common mental disorder patterns differ according to sex, and short sleep duration seems to be problematic for students' mental health. The promotion of health strategies that involve the family and school environment, such as later school hours, could help change this scenario.

Papass clinical trial protocol: a multi-component school-based intervention study to increase acceptance and adherence to school feeding

Background

One of the largest school feeding programs in the world is the National School Feeding Program of Brazil. However, results from the 2012 National School Health Survey indicated that only 22.8% of 9th grade students in Brazilian public school system consumed school meals. The literature presents few studies aiming to promote healthy food consumption in the school environment from interventions, which found inconclusive results. Thus, this study aims to present a protocol to evaluate the effectiveness of multi-component school-level interventions to increase adherence and acceptance to school feeding.

Methods

School-based multi-component clinical trial with students from 4th-9^h grade from 3 municipal schools of Sumidouro, Rio de Janeiro, Brazil, in 2019. The study design will be parallel, with 3 arms: Control group (without intervention); Intervention group 1 (changes in school environment) and Intervention group 2 (changes in menu and school environment). Interventions in the environment will be based on the principles of choices architecture and, the modification in the dishes that make up the menus offered to the students, on the factors that contribute to poor adherence and acceptance to school feeding, identified by focus groups. Adherence to school feeding will be assessed through a specific question in the questionnaire directed to the frequency of consuming school meals in the week, applied by researchers in three moments. Acceptance will be assessed from the acceptability test application with dishes served to students during the year. Statistical analyses will be performed using generalized linear models, which will be used to assess the impact of the intervention, and will include 3 main variables: intervention, time and the intervention x time interaction.

Discussion

This study will investigate if the impact of the implementation of interventions in the environment and in the dishes served to students may increase adherence and acceptance to school feeding. Positive results could show the effect of implementing interventions throughout Sumidouro’s public school system, as well as throughout the country, aiming to improve the consumption of school meals.

Trial registration

Brazilian Registry of Clinical Trials, RBR-7mf794. Date of registration: December 27, 2018.

Socio-economic and demographic characteristics associated with risk behaviour patterns for chronic non-communicable diseases in Brazil: data from the National Health Survey, 2013

OBJECTIVE

To identify risk behaviour patterns for chronic non-communicable diseases (NCD) in the Brazilian population and to investigate associated socio-economic and demographic factors.

DESIGN

Factor analysis was used to identify patterns considering the following risk behaviours: consumption of soft drinks/artificial juice, sweet foods, red meat with apparent fat, chicken skin; inadequate consumption of fruits and vegetables; alcohol abuse; smoking; absence of physical activity during leisure time; and time spent watching television. The χ 2 test was used to compare ratios. All analyses accounted for weighting factors and the study's complex sampling design effect. The socio-economic and demographic variables evaluated were gender, age, schooling level and macro region of residence.

SETTING

National Health Survey, a household survey with national representation, conducted in 2013 in Brazil.ParticipantsIndividuals (n 60202) aged 18 years or over.

RESULTS

Four risk behaviour patterns were identified: 'Physical inactivity in leisure time and Inadequate consumption of fruits and vegetables', 'Saturated fat', 'Alcohol and Smoking' and 'Sedentary behaviour and Sugar', explaining 52·01 % of the total variance. Overall, greater adherence to 'Saturated fat' and 'Alcohol and Smoking' patterns was observed among men and those with lower education level. The 'Sedentary behaviour and Sugar' and 'Physical inactivity in leisure time and Inadequate consumption of fruits and vegetables' patterns had greater adherence among younger individuals, and the first was associated with higher education whereas the second with less education among individuals residing in the North and Northeast regions.

CONCLUSIONS

Risk behaviour patterns for NCD were heterogeneous, reflecting the socio-economic and demographic differences in Brazil.

Trends in obesity prevalence among Brazilian adults from 2002 to 2013 by educational level

Background

Obesity ranks as a major public health problem in many countries in the world. The obesity-socioeconomic status relationship is not well established in middle-income countries.

Methods

The aim of this study was to estimate the obesity and overweight trends from 2002 to 2013 by sex, age, and educational levels among Brazilian adults. The panel prevalence trend study was conducted, considering the sample weights and study design. Three nationwide surveys were analyzed: the Household Budget Survey 2002/2003 and 2008/2009, and the National Health Survey 2013. The total sample was 234,791 adults aged 20–59 years.

Results

The prevalence of obesity increased from 7.5 to 17.0% from 2002 to 2013 among adults aged 20–39 years and from 14.7 to 25.7% among those aged 40–59 years, slightly higher among young women. In each survey, education was positively associated with the prevalence of obesity among men, whereas this association was negative among women. The greatest increase in the prevalence of obesity was 90% (11.9 to 22.5%) and occurred from 2008 to 2013 among women with secondary educational level, whereas at the pre-primary level there was a 42% (20.4 to 29.0%) increase.

Conclusions

Obesity prevalence in Brazil continued to increase, mostly among women with secondary education. Policies aimed at reducing the prevalence of obesity should consider sociodemographic characteristics in the population.

High protein diet promotes body weight loss among Brazilian postpartum women

There is evidence in the general population that adhering to a high protein and low carbohydrate diet may help in losing weight. However, there is little evidence among postpartum women. The aim of this study is to evaluate the effect of a high protein diet on weight loss among postpartum women. A parallel-randomized controlled trial with 94 postpartum women was conducted in a maternity ward in Mesquita county (recruitment from February 2009 to December 2010) and in a polyclinic in Rio de Janeiro city (recruitment from December 2010 to December 2011). Women were randomized to the intervention group (IG) or control group (CG), and both groups received an isocaloric diet (1,800 kcal). Additionally, the IG received approximately 25 g of protein obtained from 125 g per week of sardine to increase daily dietary protein content and was advised to restrict carbohydrate intake. The CG received nutritional counselling to follow the national nutrition guidelines (15% protein, 60% carbohydrates, and 25% lipids). A linear mixed-effects model was used to test the effect of high protein intake and macronutrient intake on weight loss during the postpartum period. Body weight decreased in the IG compared with the CG (ß = -0.325; p = 0.049) among overweight and obese postpartum women. The percentage of energy intake from lipid (ß = -0.023; p = 0.050) was negatively associated with body weight, and carbohydrate intake (ß = 0.020; p = 0.026) was positively associated with body weight over time among all women. Protein intake and lower carbohydrate intake may be used as a dietary strategy to improve body weight loss during the postpartum period.

Changes in breakfast frequency and composition during adolescence: The Adolescent Nutritional Assessment Longitudinal Study, a cohort from Brazil

OBJECTIVES

To estimate changes over time of breakfast frequency and foods/food groups consumed at breakfast.

METHODS

Cohort of 809 students aged 10-16 years old from Rio de Janeiro, Brazil, enrolled in 2010, and followed for three years. Breakfast skippers were those not eating breakfast. Those with breakfast frequency of 4 or less times per week were considered irregular breakfast eaters. Changes over time of breakfast frequency and breakfast foods/food groups were analyzed by generalized estimating equations.

RESULTS

At baseline, overweight/obese girls had higher prevalence of irregular breakfast than those non-overweight/obese (40% vs. 26%; p = 0.005); among boys, there was no significant difference in the prevalence of irregular breakfast according to weight status. After three years, among girls there was an increase in the risk of irregular breakfast consumption (RR = 1.29; 95% CI: 1.08; 1.54) and breakfast skipping (RR = 1.63; 95% CI: 1.12; 2.38). Also, overweight/obese boys (RR = 1.40, 95% CI: 1.03, 1.89) and non-overweight/obese girls (RR = 1.54, 95% CI: 1.17, 2.04) had higher risk of irregular breakfast in three years, compared to baseline. After three years, boys changed the consumption of foods/food groups at breakfast and presented higher risk of decreased intake of fruits (RR = 1.60, 95% CI: 1.20, 2.13), sandwiches and snacks (RR = 1.58, 95% CI: 1.12, 2.22), chips (RR = 1.43, 95% CI: 1.01, 2.13), and ham (RR = 1.52, 95% CI: 1.12, 2.07), and lower risk of cheese intake (RR = 0.73, 95% CI: 0.53, 1.00). Girls had higher risk of decreased intake of fruits (RR = 2.08, 95% CI: 1.47, 2.95), milk (RR = 1.49, 95% CI: 1.07, 2.08), chocolate powder (RR = 1.54, 95% CI: 1.11, 2.14) and ham (RR = 1.65, 95% CI: 1.16, 2.36).

CONCLUSIONS

Changes in breakfast patterns are different according to sex. Also, different changes in breakfast frequency according to BMI category were found. Consumption patterns of some foods/food groups have a tendency to become changed from initial to middle adolescence.

Breakfast patterns and their association with body mass index in Brazilian adults

The objective was to investigate the relationships between body mass index (BMI), skipping breakfast, and breakfast patterns in Brazilian adults. We analyzed data of 21,003 individuals aged between 20 to 59 from the Brazilian National Dietary Survey 2008-2009. Breakfast was defined as the eating occasion between 5 and 10a.m. with the highest usual food consumption (exceeding 50Kcal/209.2kJ). Dietary patterns were derived by the factor analysis of 18 food groups (usual intake). Controlling for confounders linear regressions of BMI were used to verify the associations considering the survey design. Skipping breakfast was not associated with BMI. Three breakfast patterns were observed (48% variability): Brazilian Northern (positive loading for meats, preparations with corn, eggs, tubers/roots/potatoes, dairy products, savory snacks/crackers, fruit juices/fruit drinks/soy-based drinks); Western (positive for fruit juices/fruit drinks/soy-based drinks, sandwiches/pizza, baked/deep-fried snacks, chocolate/desserts, cakes/cookies) and Brazilian Southeastern (cold cut meat, milk, cheese, coffee/tea, bread). The Brazilian Southeastern pattern was inversely associated with BMI, while the Brazilian Northern pattern was directly associated with it. Therefore, the results suggest a role for breakfast quality in the association with BMI. Thus, a Brazilian Southeastern breakfast usual intake may be inversely associated with BMI.

Effective strategies for prevention, control, and treatment of obesity in primary health care setting for adolescents, adults, and elderly people: A protocol for systematic review and meta-analysis

BACKGROUND

It is unquestionable that obesity is a global epidemic and one of the main public health problems in the world. The management of obesity in Primary Health Care has an important role if being considered the magnitude and serious consequence of this problem. Despite this, there is no effective standard protocol for the treatment of this disease. Studies that synthesize and assess the effectiveness of strategies for prevention, control, and treatment of obesity in Primary Health Care setting are still scarce. The objective of this study is review and synthesize study evidence for obesity management strategies among adolescents, adults and elderly developed at the Primary Health Care worldwide.

METHODS

Seven electronic databases (Medline, Lilacs, Embase, Psycinfo, Cochrane, WHOLIS and Open Gray) will be searched with no date limit for identification of clinical trials examining the effectiveness of prevention, control and treatment of obesity in Primary Health Care. As primary outcome will be changes in body weight. As secondary outcomes will be body mass index, body adiposity, waist circumference, and waist-hip ratio. Two independent authors will perform the selection of studies, data extraction, and the assessment of risk of bias.

RESULTS

The results will be published in a peer-reviewed journal.

CONCLUSION

This systematic review will be first to synthesize scientific evidence for obesity management strategies at Primary Health Care among adolescents, adults, and elderly. The review will benefit healthcare professionals and policymakers.

ETHICS AND DISSEMINATIONS

Ethical approval is not required in this study because the data used include peer-reviewed publications, which do not comprise any information that could identify subjects.

TRIAL REGISTRATION NUMBER

PROSPERO (CRD42018092416).

Ultra-processed food consumption and adiposity trajectories in a Brazilian cohort of adolescents: ELANA study

Background/objectives

In Brazil, the increase in obesity rates has been accompanied by increased consumption of ultra-processed food (UPF). The objective of this paper was to evaluate body mass index (BMI) and body fat percentage (%BF) trajectories in adolescents over a 3-year follow-up according to the frequency of UPF consumption.

Subjects/methods

Data of three consecutive years (2010, 2011, and 2012) were obtained from the Adolescent Nutritional Assessment Longitudinal Study (ELANA) that aimed to assess changes in anthropometric indicators of nutritional status, and 1035 adolescents enrolled in the 1st year of high school from six schools (four private and two public) in the metropolitan area of Rio de Janeiro, Brazil were included. At three follow-ups, they had their weights and heights measured. Body composition was measured at the first and second follow-ups. Mixed linear regression models were used to estimate BMI and %BF trajectories based on quartiles of UPF intake, adjusting for type of school, sex, physical activity, and underreporting.

Results

Compared to their counterparts in the 1st quartile, adolescents in the 4th quartile of UPF consumption had a lower daily intake of fruits, cooked vegetables, and raw vegetables and a higher intake of total sugar and physical activity levels (p < 0.001). There was an inverse association between UPF consumption and BMI both at baseline and at follow-up. Values for %BF followed the same trend. Adolescents in the 4th quartile had the greatest level of physical activity and lowest total energy intake.

Conclusion

This study confirmed that greater intake of UPF is a marker of an unhealthy diet, but did not support the hypothesis of a high rate of change in BMI associated with greater UPF consumption, even after adjusting for physical activity.

Design of a school randomized trial for nudging students towards healthy diet and physical activity to prevent obesity: PAAPAS Nudge study protocol

OBJECTIVE

To evaluate the effectiveness of nudge activities at school on the students' body mass index (BMI).

DESIGN

School-based factorial randomized community trial.

SETTING

Eighteen public schools in the municipality of Duque de Caxias, metropolitan area of Rio de Janeiro, Brazil.

PARTICIPANTS AND INTERVENTION

The 18 schools will be randomized into 4 group arms: group 1-control (without any activity); group 2-will receive educational activities in the classroom; group 3-will receive changes in the school environment (nudge strategies); group 4-will receive educational activities and changes in the school environment. Activities will occur during the 2018 school-year.

MAIN OUTCOME MEASURE(S)

The primary (BMI) and secondary (body fat percentage) outcomes will be assessed at baseline and after the study using a portable electronic scale with a segmental body composition monitor. The height will be measured by a portable stadiometer.

ANALYSIS

Statistical analyses for each outcome will be conducted through linear mixed models that took into account the missing data and cluster effect of the schools.

Phytosterol-enriched milk lowers LDL-cholesterol levels in Brazilian children and adolescents: Double-blind, cross-over trial

BACKGROUND AND AIMS

Despite evidence of the lipid-lowering effect of plant sterols among adults with hypercholesterolemia, data regarding phytosterol use in children are limited. In this paper, we examined the effects of daily consumption of a phytosterol-enriched milk compound on the lipid profiles of Brazilian children and adolescents with dyslipidemia.

METHODS AND RESULTS

This was a randomized, double blind, crossover clinical trial. Twenty eight dyslipidemics outpatients (aged 6-9 years) from an University Hospital were randomly allocated to control or intervention group. The intervention group received milk enriched with 1.2 g/day of plant sterol and the control group received the equivalent amount of skim milk during the period of 8 weeks. Changes from baseline in the mean lipid profile, including total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and triglyceride (TG) concentrations. Serum lipid profiles, glucose levels, dietary and anthropometric data were determined at weeks 0, 4, 8, 16, and 20. Details regarding the safety and tolerance of phytosterol were obtained, using an open-ended questionnaire. Intention-to-treat analysis were performed, using the proc mixed procedure in SAS. After 8 weeks, the mean concentrations of TC and LDL-C were significantly reduced in the intervention group as compared to the control group with reductions of 5.9% (p = 0.09) and 10.2% (p = 0.002), respectively. In addition, TG concentrations were reduced by 19.7% (p = 0.09). No serious side effects were reported during the study.

CONCLUSION

Our results confirm that plant sterols are an effective and safe treatment of infantile dyslipidemia.

TRIAL REGISTRATION

RBR-3h7f9k.

Programa para registro de recordatório alimentar de 24 horas: aplicação no Estudo de Riscos Cardiovasculares em Adolescentes

RESUMO: Introdução: O Estudo de Riscos Cardiovasculares em Adolescentes (ERICA) é um estudo multicêntrico nacional cujo objetivo é traçar o perfil de risco cardiovascular, incluindo obesidade, alterações do metabolismo lipídico, glicídico e da pressão arterial de cerca de 75 mil adolescentes brasileiros. Objetivo: Descrever o instrumento desenvolvido para coleta de dados de recordatório alimentar de 24 horas (REC24h) no ERICA e relatar os resultados obtidos no estudo piloto. Métodos: Para o desenvolvimento do programa computacional que norteou a entrevista para aplicação do REC24h utilizou-se a técnica denominada Multiple Pass Method . O REC24h-ERICA utiliza a base de dados composta por 1.626 itens alimentares incluindo as formas de preparo e as unidades de medidas caseiras pré-definidas. Os dados de recordatório alimentar são coletados através de entrevista e digitados diretamente no REC24h-ERICA, evitando assim o uso de papel. Resultados: O estudo piloto incluiu 1.367 adolescentes, dos quais 1.047 (77%) responderam ao REC24h. Os pesquisadores não encontraram dificuldades para uso do programa, a duração média das entrevistas foi de 20 minutos e foram inseridos 50 alimentos novos pelos entrevistadores de campo. Conclusão: O programa desenvolvido mostrou-se adequado para uso em grandes estudos populacionais, mesmo em um país como o Brasil, onde existe grande diversidade de padrões alimentares.

Familial aggregation and dietary patterns in the Brazilian population

The aim of the study was to identify dietary patterns in Brazil and verify aggregation among members of the same family based on the Brazilian National Dietary Survey, a nationwide dietary survey conducted in 2008-2009 in individuals over 10 years of age. Dietary intake was estimated with a food record. Dietary patterns were identified by factor analysis, and familial aggregation was verified by linear regression. Three major dietary patterns were identified: (1) a traditional snack featuring coffee, rolls, oils and fats, and cheese; (2) traditional main meal, based on rice, beans and other legumes, and meat; and (3) fast food type snacks, namely sandwiches, processed meats, soft drinks, snacks, and pizza. Pattern 2 showed the strongest association (β = 0.37-0.64). Patterns 1 and 3 showed positive associations for all pairs of family members, with β ranging from 0.27 to 0.44 and 0.32 to 0.42, respectively. The study showed familial aggregation of dietary patterns in the Brazilian population.

Dietary patterns in pregnancy and birth weight

OBJECTIVE

To analyze if dietary patterns during the third gestational trimester are associated with birth weight.

METHODS

Longitudinal study conducted in the cities of Petropolis and Queimados, Rio de Janeiro (RJ), Southeastern Brazil, between 2007 and 2008. We analyzed data from the first and second follow-up wave of a prospective cohort. Food consumption of 1,298 pregnant women was assessed using a semi-quantitative questionnaire about food frequency. Dietary patterns were obtained by exploratory factor analysis, using the Varimax rotation method. We also applied the multivariate linear regression model to estimate the association between food consumption patterns and birth weight.

RESULTS

Four patterns of consumption – which explain 36.4% of the variability – were identified and divided as follows: (1) prudent pattern (milk, yogurt, cheese, fruit and fresh-fruit juice, cracker, and chicken/beef/fish/liver), which explained 14.9% of the consumption; (2) traditional pattern, consisting of beans, rice, vegetables, breads, butter/margarine and sugar, which explained 8.8% of the variation in consumption; (3) Western pattern (potato/cassava/yams, macaroni, flour/farofa/grits, pizza/hamburger/deep fried pastries, soft drinks/cool drinks and pork/sausages/egg), which accounts for 6.9% of the variance; and (4) snack pattern (sandwich cookie, salty snacks, chocolate, and chocolate drink mix), which explains 5.7% of the consumption variability. The snack dietary pattern was positively associated with birth weight (β = 56.64; p = 0.04) in pregnant adolescents.

CONCLUSIONS

For pregnant adolescents, the greater the adherence to snack pattern during pregnancy, the greater the baby’s birth weight.

Readiness for behavioral change and variation in food consumption among adolescents from a school-based community trial in Duque de Caxias, RJ

OBJECTIVE

To investigate the influence of the stage of readiness for changes in food consumption variation among adolescents participating in school-based community trial in Duque de Caxias (RJ), Brazil.

METHODS

It is a secondary analysis of a one-year randomized community trial to prevent excessive weight gain in students attending the 5th grade in 20 public schools in the municipality of Duque de Caxias. The activities conducted discouraged the consumption of sweetened beverages and cookies and encouraged the consumption of fruits and beans. A food frequency questionnaire was applied at the beginning and at the end of the study. The stages of readiness for behavioral change vary in a scale from (1) "I don't think of changing diet" to (5) "I'm already changing my diet successfully". For the longitudinal analyses, we used generalized linear mixed models.

RESULTS

There was a greater change in the consumption of fruit and soft drinks among participants in the intervention group who were in the action stage, compared to participants who did not think about changing their diet.

CONCLUSION

The proposed strategy may be used to identify population groups with motivation for changes in dietary behavior.

Dietary patterns associated with anthropometric indicators of abdominal fat in adults

This study aimed to identify dietary patterns and assess their association with abdominal fat. A cross-sectional study was conducted in the Central West Region of Brazil with a probabilistic sample of 208 adults of both sexes. Data on food intake was obtained using a food frequency questionnaire and factor analysis (principal components) was conducted to identify dietary patterns. Waist circumference (WC) and waist-to-hip ratio (WHR) were used to assess abdominal fat. The association between dietary patterns and body fat distribution was examined using multiple linear regression analysis adjusted for confounders. Three dietary patterns were identified: Western, regional traditional, and prudent. A positive association was found between the Western pattern and WC (p = 0.04) and WHR (p = 0.001) and between the regional traditional pattern and WHR (p = 0.05) among women. A slight association was also found between the latter pattern and WC (p = 0.07) also among women. An association was found between the Western and regional traditional dietary patterns and a larger concentration of abdominal fat among women.

Unbalanced baseline in school-based interventions to prevent obesity: adjustment can lead to bias - a systematic review

BACKGROUND/AIMS

Cluster designs favor unbalanced baseline measures. The aim of the present study was to determine the frequency of unbalanced baseline BMI on school-based randomized controlled trials (RCT) aimed at obesity reduction and to evaluate the analysis strategies. We hypothesized that the adjustment of unbalanced baseline measures may explain the great discrepancy among studies.

METHODS

The source of data was the Medline database content from January 1995 until May 2012. Our search strategy combined key words related to school-based interventions with such related to weight and was not limited by language. The participants' ages were restricted to 6-18 years.

RESULTS

We identified 146 school-based studies on obesity prevention (or overweight or excessive weight change). Of the 146 studies, 36 were retained for the analysis after excluding reviews, feasibility studies, other outcomes, and repeated publications. 13 (35%) of the reviewed studies had statistically significant (p < 0.05) unbalanced measures of BMI at baseline. 11 studies with BMI balanced at baseline adjusted for the baseline BMI, whereas no baseline adjustment was applied to the 5 unbalanced studies.

CONCLUSION

Adjustment for the baseline BMI is frequently done in cluster randomized studies, and there is no standardization for this procedure. Thus, procedures that disentangle the effects of group, time and changes in time, such as mixed effects models, should be used as standard methods in school-based studies on the prevention of weight gain.

Factors associated with dietary patterns in adolescents: a school-based study in Cuiabá, Mato Grosso

OBJECTIVE

To identify dietary patterns among adolescents and to assess their association with socioeconomic and lifestyle characteristics and nutritional status.

METHODS

A probabilistic clustered two-stage sample of students between 14 and 19 years old from public and private high schools from Cuiabá, Mato Grosso, Brazil, was investigated (n = 1.139). A self-administered food frequency questionnaire was used to obtain information on food intake. Nutritional status was classified according to the Body Mass Index (BMI = weight/height²) z-score. Socioeconomic status was inferred by the education level of head of household and by the presence of electrical appliances in the household. Dietary patterns were identified by applying exploratory factor analysis (extraction method: principal component analysis) and their relationship with socioeconomic conditions, lifestyle variables, and nutritional status was estimated by mutually adjusted multilinear regression models.

RESULTS

"Western", "traditional" and "mixed" dietary patterns were identified. Studying in the morning hours and reporting the intake of alcoholic beverages were associated with greater adherence to the "Western" pattern. Male low-income students from public schools who have a BMI in the normal range preferred the "traditional" pattern. The "mixed" pattern was adopted by boys from public schools reporting physical activity.

CONCLUSION

Several factors were associated with dietary patterns of adolescents and the Brazilian traditional diet was associated with normal weight.

Avaliação dos marcadores de consumo alimentar do VIGITEL (2007-2009)

OBJETIVO: Avaliar as questões marcadoras de consumo alimentar do Sistema Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico e sua evolução temporal. MÉTODOS: Foram avaliados 135.249 indivíduos de 27 cidades brasileiras, entrevistados nos anos de 2007 - 2009. Os marcadores de consumo alimentar foram descritos a partir da frequência de consumo de frutas, hortaliças, feijão, leite integral e desnatado, refrigerante normal e diet/light, e consumo de gordura aparente das carnes e a pele do frango. Avaliou-se a evolução temporal desses marcadores e, adicionalmente, testou-se a elaboração de um escore de alimentação saudável e a identificação de padrões alimentares por meio da análise de cluster. RESULTADOS: Observou-se aumento estatisticamente significativo nas frequências de consumo de feijão, leite integral e refrigerante normal e diminuição no consumo de leite desnatado. Mesmo com aumento de 11 para 13% de indivíduos que referiram consumir feijão diariamente, esses percentuais são baixos; assim como o consumo recomendado de 3 porções de frutas e 3 porções de hortaliças por dia, que foi referido por menos de 15% da população em todos os anos, com queda de 5 para 3% para as hortaliças. O refrigerante não diet foi o item com maior aumento no consumo, passando de 60 para 67%. Os itens avaliados apresentaram fraca correlação e não configuram um constructo único de alimentação saudável. CONCLUSÃO: A qualidade da dieta dos brasileiros tem piorado e é necessária melhor qualificação dos marcadores alimentares considerados de risco para doenças crônicas não-transmissíveis.

A comparison of three statistical methods applied in the identification of eating patterns

This work aimed to compare the results of three statistical methods applied in the identification of dietary patterns. Data from 1,009 adults between the ages of 20 and 65 (339 males and 670 females) were collected in a population-based cross-sectional survey in the Metropolitan Region of Rio de Janeiro, Brazil. Information on food consumption was obtained using a semi-quantitative food frequency questionnaire. A factor analysis, cluster analysis, and reduced rank regression (RRR) analysis were applied to identify dietary patterns. The patterns identified by the three methods were similar. The factor analysis identified "mixed", "Western", and "traditional" eating patterns and explained 35% of the data variance. The cluster analysis identified "mixed" and "traditional" patterns. In the RRR, the consumption of carbohydrates and lipids were included as response variables and again "mixed" and "traditional" patterns were identified. Studies comparing these methods can help to inform decisions as to which procedures best suit a specific research scenario.

Population analysis of Scomberomorus cavalla (Cuvier, 1829) (Perciformes, Scombridae) from the Northern and Northeastern coast of Brazil

Scomberomorus cavalla is a pelagic fish species widely distributed on the Atlantic west coast, and a noticeable decrease in its capture level in the USA and Gulf of Mexico is occurring, compared to the levels reached by the species in the past. Likewise, in some areas of Brazil, there has been indication of over-harvesting. However, there are no molecular studies focusing on the management of such an important item. Thus, in the present study, 380 nucleotide base pairs of the mitochondrial DNA D-Loop region of samples from Macapá, Bragança, and Fortaleza were sequenced. Phylogenetic and population analyses revealed that there is only one panmitic population, and low levels of genetic variability were verified. These results, as well as the noticed over-harvesting of S. cavalla, represent very important data to determine the management of such stock in order to prevent a collapse or the risk of future extinction.