Role of diet quality in bone health in children and adolescents: a systematic review

CONTEXT

Poor diet quality and unhealthy dietary patterns have been linked to poor bone health, yet few studies have investigated the role of diet quality in bone health in pediatric populations.

OBJECTIVE

This systematic review aims to assess the available evidence on the association between diet quality and bone health markers in children and adolescents.

DATA SOURCES

The PubMed, Scopus, and Virtual Health Library databases were searched electronically from October to November 2022, without any restrictions on date or language. The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist was used to assess the quality of the studies.

DATA EXTRACTION

Published observational studies in children and adolescents (ages 2 to 19 years) that investigated the association between diet quality and bone health were eligible for inclusion. Two researchers independently analyzed and selected all articles using the Rayyan app. Initially, 965 papers were identified. A total of 12 observational studies qualified, including 8 cross-sectional and 4 longitudinal studies. The sample comprised 7130 individuals aged 3 to 17.9 years, representing both sexes. Bone health was evaluated by measures of bone mineral density and bone mineral content.

DATA ANALYSIS

Seven studies (58.3%) showed significant associations between diet quality and bone health markers, all of which evaluated diet quality by identifying dietary patterns. Diet quality as evaluated by all dietary indexes was not associated with bone health markers.

CONCLUSIONS

Adherence to a healthy diet may benefit bone health in children and adolescents. These findings emphasize the importance of developing effective public health policies that encourage healthy eating habits from childhood to preserve bone health. Longitudinal research using a specific tool to assess diet quality in relation to bone health is warranted. Future studies should also measure bone-regulating hormones and markers of bone turnover.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022368610.

Obesogenic neighborhood environment is associated with body fat and low-grade inflammation in Brazilian children: could the mother's BMI be a mediating factor?

OBJECTIVE

To evaluate the direct and indirect associations of obesogenic and leptogenic neighborhood environments with body fat, and pro- and anti-inflammatory adipokines in Brazilian children.

DESIGN

Cross-sectional study. The body fat distribution was assessed using dual-energy X-ray absorptiometry (DXA). Concentrations of leptin and adiponectin were measured. Four hundred meters (0·25 miles) road network buffer was the neighborhood unit used to assess the environmental characteristics around households. Obesogenic and leptogenic environments were the latent variables obtained from the observed characteristics. The mother's BMI, ultra-processed food consumption, and physical activity before and after school, were tested as mediating variables. A hybrid model of structural equations was used to test the direct and indirect associations of obesogenic and leptogenic environments with body fat, leptin and adiponectin concentrations.

SETTING

Urban area of Viçosa, Minas Gerais, Brazil.

PARTICIPANTS

Children aged 8- and 9-years (n 367).

RESULTS

Obesogenic environment was directly associated with the mother's BMI (β: 0·24, P = 0·02) and the child's body fat (β: 0·19, P = 0·02). The mother's BMI and body fat mediated the association of the obesogenic environment with leptin concentrations (β: 0·05, P = 0·02).

CONCLUSIONS

Obesogenic neighborhood environment was directly associated with body fat and mother's BMI, and indirectly associated with leptin concentrations in Brazilian children, mediated by the mother's BMI and body fat.

Characteristics of the obesogenic environment around schools are associated with body fat and low-grade inflammation in Brazilian children

OBJECTIVE

To assess the association of obesogenic environmental characteristics around schools with body adiposity and adipokine concentrations in Brazilian children.

DESIGN

Cross-sectional study. Body adiposity was assessed using the dual-energy X-ray absorptiometry. Concentrations of leptin, adiponectin, retinol-binding protein 4 (RBP4) and chemerin were measured. Predominantly ultra-processed food (UPF) stores, public physical activity (PA) facilities, green spaces, walkability, traffic accidents and crime were evaluated. The neighbourhood unit was the 400 m (0·25 miles) road network buffer around schools. The association of environmental characteristics with body adiposity and adipokine concentrations was assessed by linear regression models using generalised estimating equations.

SETTING

Urban schools (n 24), Viçosa, Minas Gerais, Brazil.

PARTICIPANTS

Children aged 8 and 9 years (n 378).

RESULTS

A higher density of predominantly UPF stores and a lower percentage of green space were associated with higher total (β: 0·12; 95 % CI 0·06, 0·18 and β: -0·10; 95 % CI -0·16, -0·04, respectively) and android body fat (β: 0·28; 95 % CI 0·13, 0·43 and β: -0·18; 95 % CI -0·32, -0·04, respectively). In addition, the densities of PA facilities and crime were inversely associated with leptin concentrations. Traffic accidents density and percentage of green spaces around schools had, respectively, a positive and an inverse association with concentrations of adiponectin and RBP4.

CONCLUSIONS

Obesogenic environmental characteristics around schools were associated with total and android body fat, as well as with pro-inflammatory adipokine concentrations in Brazilian children from a medium-sized city.

Community food environment and childhood obesity in a medium-sized Brazilian city: An approach to school and neighborhood environments

OBJECTIVE

We aimed to analyze the relationship of community food environments with childhood obesity in a medium-sized Brazilian city.

METHODS

This is a cross-sectional study with 366 schoolchildren aged 8 and 9 years. Children's body mass index (BMI), waist circumference and concentrations of total cholesterol (TC), high cholesterol density lipoprotein (HDL-c), low cholesterol density lipoprotein (LDL-c) and triglycerides (TG) were measured. The parent's nutritional status was assessed by calculating the BMI. All food stores within a 200- and 400-m radius buffers of schools and households were evaluated. The food stores were classified as healthy, unhealthy, and mixed according to the predominance of foods commercialized. Binary logistic regression models were proposed for each category.

RESULTS

Over seventy percent (70.2%) of the food stores were categorized as "unhealthy". The prevalence of obesity was 15.6%. In the 200-m buffer around schools, there was an inverse and direct association between obesity and the presence of healthy food stores and unhealthy food stores, respectively. Around the households, there was an inverse association between the presence of healthy food stores and obesity in both buffers.

CONCLUSION

The community food environment may be protective or potentiating childhood obesity, depending on the access and types of food sold.

Higher serum uric acid is associated with body fat, retinol-binding protein 4, and antioxidative status in Brazilian children

OBJECTIVE

The aim of this study was to evaluate the association of serum uric acid (SUA) with adiposity, adipokines, and anti- and oxidative markers in Brazilian children.

METHODS

This was a cross-sectional investigation with 378 children ages 8 to 9 y in Viçosa, Minas Gerais, Brazil. Information on sociodemographic and lifestyle characteristics was obtained via questionnaires, and body fat was determined by dual energy x-ray absorptiometry. We compared the distributions of adiposity (total and central), adipokines (adiponectin, chemerin, leptin, and retinol-binding protein 4 [RBP4]), anti- and oxidative markers (plasma ferric reducing antioxidant power [FRAP], superoxide dismutase [SOD], and malondialdehyde [MDA]) by SUA categories using linear regression.

RESULTS

SUA was positively associated with total and central fat. Every standard deviation (SD) of SUA was related, respectively, to a 3.4 (95% confidence interval [CI], 2.4-4.4), 4 (95% CI, 2.8-5.1), 4.2 (95% CI, 2.9-5.5), and 3.5 (95% CI, 2.4-4.6) units higher of total, truncal, android, and gynoid fat. We found a positive association of SUA with RBP4 and FRAP, and a negative association with MDA. Every SD of SUA was related, respectively, to 0.1 (95% CI, 0.01-0.1) and 7.8 (95% CI, 5.5-10.1) units higher of RBP4 and FRAP; and to -0.3 (95% CI, -0.5 to -0.1) units lower of MDA.

CONCLUSIONS

SUA was positively associated with adiposity, RBP4, and antioxidative status in Brazilian children.

Obesogenic environment around schools is associated with atherogenic risk in Brazilian children

INTRODUCTION

Cardiometabolic risk factors often emerge in childhood, increasing the risk of cardiovascular diseases in adulthood. The school environments represent an important active space in a child's routine and may influence their health status.

METHODS

In this cross-sectional study, we aimed to evaluate the clustering of cardiometabolic risk factors and its association with the obesogenic and leptogenic environment around schools. A total of 378 children (181 boys; 197 girls) aged 8 and 9 years, enrolled in all urban schools of Viçosa, Minas Gerais, Brazil, were evaluated. Concentrations of high-density lipoprotein-cholesterol (HDL-c) and triglycerides (TG), and the insulin resistance (HOMA-IR), waist circumference (WC), and mean arterial pressure (MAP) were measured. The neighborhood income, walkability index, predominantly ultra-processed food stores, public spaces for leisure and/or physical activities, traffic accidents, crime and green spaces densities were assessed in 400 road network buffers around schools. To test association of the obesogenic and leptogenic environment around schools with cardiometabolic risk clustering, binary logistic regression models were performed with generalized estimating equations.

RESULTS

"Obesogenic school environments" had greater densities of ultra-processed food stores, crime and traffic accidents, and higher walkability. The "↓ Atherogenic risk" cluster consisted of higher HDL-c values. There was an inverse association between the obesogenic environment around schools and a child's "↓ atherogenic risk" clustering (OR = 0.63; p < 0.001).

CONCLUSION

We concluded that public policies aimed at modifying the environment around schools, by providing healthier food options and safe conditions for active mobility, are essential to prevent child's atherogenic risk.

Neighborhood obesogenic environment and cardiometabolic risk in Brazilian children: The mediation role of the mother's body mass index

OBJECTIVE

We aimed to evaluate the association of neighborhood obesogenic and leptogenic environments with cardiometabolic risk clustering among Brazilian schoolchildren, mediated by child's ultra-processed food consumption and the mother's body mass index (BMI).

METHODS

A total of 367 children aged 8-9 years, enrolled in urban schools of Viçosa, Minas Gerais, Brazil, were evaluated. Waist circumference, insulin resistance, blood pressure, high-density lipoprotein-cholesterol, and triglycerides concentrations were measured. The child's ultra-processed food consumption assessment was performed by applying three 24-hour dietary recall. The mother's weight and height values were used to calculate the BMI. The neighborhood income, walkability index, predominantly ultra-processed food stores, public spaces for leisure, and/or physical activities, traffic accidents, crime, and green spaces densities were assessed in four hundred road network buffers around households. From neighborhood and cardiometabolic risk variables, four latent variables were obtained from confirmatory factor analysis: neighborhood "obesogenic", and "leptogenic" environments; "high cardiometabolic risk," and "low atherogenic risk". A structural equation model was used to test the direct and indirect associations between neighborhood environment and cardiometabolic risk clusters.

RESULTS

The neighborhood obesogenic environment had a significant total association (Standardized Coefficient = 0.172, p = .011) and was indirectly associated with the child's "high cardiometabolic risk" cluster, mediated by the mother's body mass index (Standardized Coefficient = 0.066, p = .049).

CONCLUSIONS

Our results reinforce the role of the urban environment on maternal obesity and child's cardiometabolic risk and provide evidence for public health policies aimed to prevent such conditions.

Associations of adiposity and adipokine concentrations with anti- and oxidative markers in Brazilian children

OBJECTIVE

The aim of this study was to evaluate the association of body fat, anti- and inflammatory adipokines with anti- and oxidative markers.

METHODS

We conducted a cross-sectional study with 378 schoolchildren ages 8 to 9 y in Viçosa, Minas Gerais, Brazil. We obtained information on sociodemographic and lifestyle characteristics via questionnaires, measured height and weight, and estimated body fat by dual energy x-ray absorptiometry. Blood sample was collected to analyze the adipokines (adiponectin, leptin, chemerin, and retinol-binding protein 4) by enzyme-linked immunosorbent assay based on the sandwich principle; and anti- and oxidant markers (plasma ferric reducing antioxidant power [FRAP], superoxide dismutase [SOD], and malondialdehyde [MDA]) by enzymatic methods. Concentrations of anti- and oxidant markers were compared by percent body fat quartiles and adipokine concentrations terciles using of linear regression adjusted for potential confounders.

RESULTS

Total and central body fat were positively associated with FRAP. Every 1 standard deviation (SD) of total fat was associated with 4.8 higher FRAP (95% confidence interval [CI], 2.7-7). Additionally, every 1 SD of truncal, android, and gynoid fat were associated with, respectively, 5, 4.6, and 4.6 higher FRAP (95% CI, 2.9-7.1; 2.6-6.7; and 2.4-6.8, respectively). However, adiponectin was inversely associated with FRAP; every adiponectin SD was related to -2.2 lower FRAP (95% CI, -3.9 to -0.5). Chemerin was positively associated with SOD [5.4 (95% CI, 1.9-8.8) SOD units per chemerin SD].

CONCLUSIONS

The body fat measures and adiposity-related inflammation (chemerin) were positively associated with antioxidative markers in children, whereas the adiponectin (anti-inflammatory marker) was inversely associated with FRAP (antioxidative marker).

Retail food outlets and metabolic syndrome: a systematic review of longitudinal studies

CONTEXT

The community food environment covers the type, quantity, density, location, and access to retail food outlets, and its influence on eating behavior, obesity, and metabolic syndrome has been investigated.

OBJECTIVE

To evaluate the evidence on longitudinal associations between objectively measured retail food outlets and metabolic syndrome components in children, adolescents, and adults.

DATA EXTRACTION

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality and risk of bias were assessed with the Newcastle-Ottawa Scale.

DATA SOURCES

The Scopus, Embase, Web of Science, Scielo, PubMed, MEDLINE, and Lilacs databases were searched without any restriction on publication dates.

DATA ANALYSIS

Of the 18 longitudinal studies included, significant associations were reported in 9 between retail food outlets and metabolic syndrome components in adults (6 positive associations, 2 negative, and 1 both positive and negative), and in 3 studies of children and adolescents (2 negative associations and 1 both positive and negative). Six studies with adults found no association.

CONCLUSION

Limited evidence was found for longitudinal associations between retail food outlets and metabolic syndrome components. In future studies, researchers should consider the use of standardized retail food outlet measurements and accurate analysis to better understand the influence of the community food environment on metabolic syndrome.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no: CRD42020177137.

Vitamin D is associated with the hypertriglyceridemic waist phenotype in Brazilian children

BACKGROUND

Prevalence of cardiometabolic risk factors is increasing and vitamin D insufficiency/deficiency has become a worldwide public health problem, even in tropical countries. Therefore, we identified the prevalence of hypertriglyceridemic waist phenotype (HWP) and evaluate its relationship with vitamin D insufficiency/deficiency.

METHODS

A cross-sectional study with 378 children aged 8 and 9 enrolled in all urban schools in the city of Viçosa, MG, Brazil. Anthropometric measurements, body composition (dual energy X-ray absorptiometry), biochemical tests and clinical evaluation were performed. Poisson regression was used to analyze the association between vitamin D and HWP.

RESULTS

Prevalence of HWP was 16.4%. This prevalence was higher among children with vitamin D insufficiency and deficiency and in those with a greater number of other cardiometabolic risk factors. Multiple regression analysis showed that children with vitamin D insufficiency and deficiency had, respectively, prevalence 85% (95% CI: 1.03-3.30) and 121% (95% CI: 1.11-4.45) higher of HWP than the vitamin D sufficiency group.

CONCLUSION

Vitamin D insuffiency and deficiency were associated with a higher prevalence of HWP among children, regardless of the presence of other cardiometabolic risk factors, indicating an additional risk of inadequate vitamin D status to cardiometabolic health in childhood.

The dietary inflammatory index is associated with anti- and pro-inflammatory adipokines in Brazilian schoolchildren

PURPOSE

To investigate the relationship of Children's Dietary Inflammatory Index (C-DII™) scores with body fat distribution and serum adipokines in Brazilian schoolchildren.

METHODS

This population-based cross-sectional study enrolled 378 schoolchildren aged 8 and 9 years from Viçosa, Minas Gerais, Brazil. Food consumption was assessed using three 24-h dietary recalls from which C-DII scores were calculated. Serum adipokines [adiponectin, leptin, retinal-binding protein 4 (RBP4), and chemerin] were analyzed in blood samples. Sociodemographic characteristics and sedentary behavior were assessed using a semi-structured questionnaire. Total, truncal, android and gynoid body fat were evaluated by dual-energy X-ray absorptiometry (DXA). We compared the distributions of adiposity measures and serum adipokines by C-DII categories with linear regression, adjusting for potential confounders.

RESULTS

The mean sample C-DII was 0.59 ± 0.94 and ranged from - 2.16 to + 2.75. The C-DII was not associated with central and total body fat. However, the C-DII was modestly inversely associated with adiponectin and RBP4, and modestly directly associated with chemerin. These results remained significant after adjusting for body fat. Every 1 SD of C-DII was related, respectively, to a - 0.8 (- 1.5, - 0.03) and to a - 0.1 (- 0.2, - 0.05) units lower mean of adiponectin and RBP4, and to 7.2 (0.3, 14.1) units higher of chemerin.

CONCLUSION

Higher C-DII score was modestly inversely and directly associated with anti- and pro-inflammatory adipokines, respectively, in Brazilian children. The development of public health policies is needed to promote healthy eating habits during childhood to prevent the early onset of systemic inflammation and ill health effects later in life.

Predictive capacity of triglyceride-glucose (TyG) index for insulin resistance and cardiometabolic risk in children and adolescents: a systematic review

Insulin resistance (IR) in childhood plays a key role in the development of metabolic changes in adulthood, therefore, it is important to diagnose it early. We aimed to investigate studies that evaluated the TyG index for prediction of IR risk and other cardiometabolic risk factors, as well as, the proposed cutoff points in childhood and adolescence. This is a systematic review elaborated according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). The search was performed in Lilacs, PubMed and CAPES Journal Portal, using the terms "TyG index OR triglyceride-glucose index OR triglyceride and glucose index AND children OR adolescent*". Eight articles were included in this review. All were cross-sectional studies with individuals aged ≥2 and ≤20 years old, from the United States, Korea, Mexico, Brazil, and Iran. We concluded that the TyG index was positively associated with other IR prediction methods and appears to be advantageous for predicting IR risk and other cardiometabolic risk factors in children and adolescents (review registration: PROSPERO CRD42018100726).

Cutoff point estimation for serum vitamin D concentrations to predict cardiometabolic risk in Brazilian children

BACKGROUND/OBJECTIVES

To evaluate serum 25(OH)D concentrations and determine a cutoff point for cardiometabolic risk in children.

SUBJECT/METHODS

This is a cross-sectional study with a representative sample of 378 8-9-year-old children from all urban schools in the city of Viçosa, MG, Brazil. Sociodemographic data and information on lifestyle, and food consumption were collected. Biochemical evaluation included glucose, triglycerides, leptin, calcidiol [25(OH)D], and parathormone. Body composition was assessed by dual energy X-ray absorptiometry. Cardiometabolic risk was considered when nontraditional risk markers were detected, including triglyceride × glycemia index (TyG index), hyperleptinemia, and hypertriglyceridemic waist phenotype (HWP). The receiver operating characteristic curve (ROC) was used to define the cutoff point for serum 25(OH)D to predict cardiometabolic risk.

RESULTS

25(OH)D showed better predictive capacity for grouping of cardiometabolic risk markers than for either single or paired markers. The area under the curve for grouping of risk markers was 0.636 (95% CI: 0.585, 0.685, P < 0.001). The cutoff point to predict cardiometabolic risk was defined as 32.0 ng/mL.

CONCLUSION

25(OH)D presented good predictive capacity for cardiometabolic risk and 25(OH)D concentration higher than 32 ng/mL was associated with a 49% reduction of cardiometabolic risk prevalence in prepubertal Brazilian children.

The consumption of ultra-processed products is associated with the best socioeconomic level of the children's families

The aim of this study was to evaluate the intake of ultra-processed foods and associated factors in prepubertal children. It is a cross-sectional study with 378 children aged 8 and 9 years enrolled in public and private schools in Viçosa-MG. Food intake was assessed by three 24-hour dietary recalls. Dietary data were entered into the Diet Pro® 5i software to quantify energy intake. The Two-Step Cluster technique was used to analyze food consumption groups, with the Stata 13 software package. The foods were grouped and classified as "healthy" and "unhealthy" eating markers. The association between the sociodemographic variables and the groups formed was examined by Poisson Regression. Two food groups were formed: "healthy" and "unhealthy". The caloric intake of ultra-processed foods was lower in the "healthy" group (20.5%) than in the "unhealthy" group (24.1%; P = 0.043). The multivariate model showed that private school children (PR = 1.25, P <0.001), who did not receive Bolsa Familia (PR = 1.13, P = 0.036) and had working mothers (PR = 1.38, P <0.001) had increased probability of unhealthy food consumption. Ultra-processed food intake was associated with greater purchasing power of families of prepubertal children.

Association of Dietary Patterns with Excess Weight and Body Adiposity in Brazilian Children: The Pase-Brasil Study

Background

Obesity is a multifactorial disease and a serious public health problem. Some of the associated factors are modifiable and, among them, the diet is highlighted.

Objective

To evaluate the association of dietary patterns of schoolchildren with obesity and body adiposity.

Methods

A cross-sectional study was carried out with 378 children aged 8 and 9 years, enrolled in urban schools in the city of Viçosa, Minas Gerais, Brazil. A semi-structured questionnaire was applied to the children and their caregivers on sociodemographic characteristics and life habits. Three 24-hour food recalls were used to identify dietary patterns; the Principal Component Analysis was employed. Weight and height were measured for the calculation of the body mass index (BMI) of the children and their mothers, waist circumference and neck circumference. Body composition was also evaluated through dual-energy X-ray absorptiometry (DXA). For all performed tests, the level of significance was set at 5%.

Results

Five dietary patterns (DP) were identified: “unhealthy”, “snacks”, “traditional”, “industrialized” and “healthy”. There was an association between excess weight (prevalence ratio [PR]: 1.38, 95% confidence interval [95%CI]: 1.02 to 1.87) and body fat (PR: 1.32, 95%CI : 1.07 to 1.64) with industrialized DP. There was an association between excess body fat (PR: 1.31, 95%CI: 1.01 to 1.74) and lower adherence to traditional DP. The other patterns were not associated with obesity and body adiposity.

Conclusion

Children with excess weight and body adiposity showed greater adherence to the industrialized DP and lower adherence to the traditional DP. We suggest that early assessments of dietary habits should be undertaken for monitoring and modifying these habits when necessary.

Increased C-Reactive Protein in Brazilian Children: Association with Cardiometabolic Risk and Metabolic Syndrome Components (PASE Study)

C-reactive protein (CRP) is a marker of subclinical inflammation that has been found to be associated with cardiovascular disease risk. However, few studies have investigated the relationship between CRP and cardiometabolic markers in a representative sample of prepubescent children. The objective was to evaluate the high-sensitive CRP (hs-CRP) and its association with traditional and nontraditional cardiometabolic risk factors, as well as metabolic syndrome (MetS) components in Brazilian children. This is a cross-sectional representative study, with participants of the Schoolchildren Health Assessment Survey (PASE). Children from 8 to 9 years old (n=350) enrolled in public and private schools in the municipality of Viçosa, Minas Gerais, Brazil, were evaluated. Sociodemographic evaluation was performed through a semistructured questionnaire. Anthropometric, body composition, clinical, and biochemical measures were analyzed for cardiometabolic risk assessment. The total mean of serum hs-CRP concentration was 0.62 (±1.44) mg/L. hs-CRP was significantly correlated with several anthropometric, biochemical, and clinical parameters in this population (P < 0.05). hs-CRP was positively associated with the accumulation of cardiometabolic risk factors and MetS components (P < 0.05). Children with excessive weight; abdominal obesity; increased gynoid and android body fat; low HDL-c; hyperglycemia; and elevated uric acid, homocysteine, and apoB had higher chances of presenting increased hs-CRP (P < 0.05). In this study, Brazilian children with cardiometabolic risk already presented elevated serum hs-CRP concentration. hs-CRP was associated with the increase of traditional and nontraditional cardiometabolic risk factors, as well as the accumulation of MetS components.

Analysis of the national school feeding program in the municipality of Viçosa, state of Minas Gerais

OBJECTIVE

To analyze the implementation of the Brazilian National School Feeding Program as a food and nutritional security policy in public schools.

METHODS

This a cross-sectional study, with a quantitative and qualitative approach, carried out with 268 schoolchildren aged eight to nine years from the public school system of Viçosa, state of Minas Gerais, Brazil, in 2015. Interviews were carried out using semi-structured questionnaires with the children, parents, cooks, nutritionists, trainer of the Technical Assistance and Rural Extension Company, and president of the School Feeding Council. In order to analyze the implementation of the National School Feeding Program in Viçosa, we evaluated the direct weighing of the food served in the schools using mechanical balances with a capacity of up to 10 kg and the perception of the social players involved in the implementation of the National School Feeding Program. The children were questioned about the acceptance of and adherence to the food offered, in addition to the habit of bringing food from home. Parents reported knowledge about the School Feeding Program and Council. The qualitative analysis consisted of content analysis and quantitative analysis using the chi-square test, Fisher’s exact test, and Mann-Whitney test. We adopted the statistical significance of 5% for quantitative analysis.

RESULTS

Children reported low adherence to the school feeding program and most of them used to bring food from home. Irregularities were identified in the implementation of the National School Feeding Program, such as: inadequate number of nutritionists, suspension of Council meetings, inadequate infrastructure in the areas of preparation and distribution of meals, lack of training of cooks, lack of nutritional adequacy of the food offered, and lack of actions on food and nutritional education. The Program complied with the recommendations for purchasing food from family farms.

CONCLUSIONS

The National School Feeding Program presented many irregularities in Viçosa. It is important to monitor the problems identified for better reformulation and planning of the Program, in order to guarantee the food and nutritional security of the children served.

[Association between serum zinc level and hypercholesterolemia and insulin resistance in Brazilian children]

The objective of the study was to assess the association between serum zinc level and cardiometabolic factors in prepubertal Brazilian children. This was a cross-sectional study in a representative sample of schoolchildren 8 to 9 years of age in public and private urban schools in Viçosa, Minas Gerais State, Brazil. Body composition was assessed with dual-energy x-ray absorptiometry. The study measured serum glucose, insulin, total cholesterol, high and low density lipoprotein cholesterol, triglycerides, apolipoproteins A (Apo A) and B, uric acid, leptin, homocysteine, ultrasenstive C-reactive protein, and serum zinc. Arterial pressure was measured with automatic inflation equipment. Zinc deficiency was observed in 1.3% of the children. Girls showed the worst cardiometabolic profile, with higher prevalence of increased android fat, triglycerides, insulin resistance, leptin, zinc, and Apo A. In the first tertile of serum zinc concentration, prevalence of insulin resistance was 96% higher (PR = 1.96; 95%CI: 1.04-3.66) and hypercholesterolemia was 23% lower (PR = 0.77; 95%CI: 0.61-0.96) than in the reference category (grouped 2nd and 3rd tertiles of serum zinc concentration). Despite the low prevalence of zinc deficiency, insulin resistance was more prevalent in children in the lowest third of serum zinc concentration. It is important to prevent cardiometabolic alterations in childhood, especially insulin resistance, with an emphasis on serum zinc level.

EFFECT OF EICOSAPENTAENOIC ACID AND DOCOSAHEXAENOIC ACID SUPPLEMENTATIONS TO CONTROL COGNITIVE DECLINE IN DEMENTIA AND ALZHEIMER'S DISEASE: A SYSTEMATIC REVIEW

INTRODUCTION

there is a lack of consensus on the benefits of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplementations on cognition in dementia and/or Alzheimer's disease (AD) elderly.

OBJECTIVE

this study presents a systematic review of the results of randomized clinical trials about this topic. The adopted search criteria were randomized clinical trials involving elderly over 65 years of age with no limit to the year of publication of the study.

RESULTS

we identified 139 articles, and from the eligible ones a reverse search was conducted. The quality of the trials was assessed using the Jadad scale. Of the four selected studies, three were related to mild to moderate AD elderly, of both genders. Mini Mental State Examination, Alzheimer's Disease Assessment Scale Cognitive, and Clinical Dementia Rate were the main tests used to assess cognitive performance.

CONCLUSION

EPA and/or DHA supplementations did not affect scores obtained on the cognitive tests. However, supplementation with EPA and/or DHA improved verbal fluency and attention in patients who had only very mild dementia or AD or presented APOEε4 negative genotype. In case of advanced AD elderly patients, EPA and/or DHA supplementations did not reduce cognitive decline rates.