1
|
Brandão JM, Sichieri R, Paravidino VB, Ribas SA, Cunha DB. Treatment of childhood obesity based on the reduction of ultra-processed foods plus energy restriction: A randomised controlled trial based on the Brazilian guidelines. Clin Obes 2024:e12648. [PMID: 38400699 DOI: 10.1111/cob.12648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 06/27/2023] [Accepted: 01/31/2024] [Indexed: 02/25/2024]
Abstract
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.
Collapse
Affiliation(s)
- Joana Maia Brandão
- Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rosely Sichieri
- Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vitor Barreto Paravidino
- Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Physical Education and Sports, Naval Academy-Brazilian Navy, Rio de Janeiro, Brazil
| | - Simone Augusta Ribas
- Departament of Nutrition in Public Health, School of Nutrition, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diana Barbosa Cunha
- Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
2
|
Méio MDBB, Moreira MEL, Villela LD, de Rodrigues MCC, de Almeida Di Maio Ferreira FCP, de Paula Barros LB, Nehab SRG, Ribas SA, Teixeira MT, Amorim MHM, Gomes-Junior SCS. Physical and social activities constraint and its effects on Body Mass Index of former Neonatal Intensive Care children. Early Hum Dev 2023; 183:105817. [PMID: 37413948 DOI: 10.1016/j.earlhumdev.2023.105817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE It is reported weight gain in children due to the confinement measures during the Covid-19 pandemic. We aimed to describe the effect of these measures on the nutritional status of former Neonatal Intensive Care Unit children. METHODS Cross-sectional study, including former Neonatal Intensive Care Unit children. The outcome was the Body mass index (BMI). RESULTS We enrolled 126 children (74.6 % preterm; 31 % small-for-gestational-age). Weight excess was greater in the youngest group (≤5 years: 33.8 %; >5 years: 15.2 %). Prematurity was associated with weight excess in both groups (≤5 years: p value 0.006; >5 years: p value 0.046; Pearson test). Mealtime changes, lack of physical activity, socioeconomic factors and the perinatal morbidities significantly influenced the mean BMI. Birth length Z score less than -1.28 was negatively associated with BMI, while gestational age at birth presented a positive association with BMI (linear regression model). CONCLUSIONS The BMI increase due to the confinement measures associated with the gestational age at birth and in those born with intrauterine growth restriction is a matter of concern, as it might indicate a risk for future obesity.
Collapse
Affiliation(s)
- Maria Dalva Barbosa Baker Méio
- Post-graduation of Applied Clinical Research, Instituto Fernandes Figueira, Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, RJ, Brazil.
| | - Maria Elisabeth Lopes Moreira
- Post-graduation of Applied Clinical Research, Instituto Fernandes Figueira, Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Letícia Duarte Villela
- Department of Neonatology, Coordinator of the Follow-Up Clinic, Instituto Fernandes Figueira, Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Maura Calixto Cecherelli de Rodrigues
- Department of Pediatrics and at the High-risk Newborn Follow-up Clinic, Hospital Universitário Pedro Ernesto, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Sylvia Reis Gonçalves Nehab
- Department of Neonatology, Follow-Up Clinic, Instituto Fernandes Figueira, Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Simone Augusta Ribas
- External Collaborator - Professor of the Extension Project Outpatient Follow-up of High-Risk Newborns, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Michelle Teixeira Teixeira
- Hospital Universitário Gaffrée Guinle, Universidade Federal do Estado do Rio de Janeiro - UNIRIO, Rio de Janeiro, RJ, Brazil.
| | - Maria Helena Miranda Amorim
- Universidade UNIGRANRIO, Bolsista PIBIC at Instituto Fernandes Figueira, Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, RJ, Brazil.
| | - Saint Clair S Gomes-Junior
- Post-graduation of Applied Clinical Research, Instituto Fernandes Figueira, Fundação Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
3
|
Diniz Largueza CB, Mocellin MC, Nunes JC, Ribas SA. Effect of intake of iron-fortified milk on levels of ferritin and hemoglobin in preschoolers: A systematic review and meta-analysis. Clin Nutr ESPEN 2023; 54:1-11. [PMID: 36963849 DOI: 10.1016/j.clnesp.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/21/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND Food fortification is often the simplest way to increase iron intake on a broad and sustainable basis. It is one of the most cost-effective global development efforts. OBJECTIVE To systematize data from randomized and nonrandomized controlled trials investigating the effect of consumption of iron-fortified milk (IFM) on serum iron status in preschoolers. METHODS The trials were systematically searched in five electronic databases that evaluated the effect of iron-fortified milk (IFM) consumption on hemoglobin and ferritin in children aged 1-6 years. The randomized the meta-analysis model was used to calculate total and stratified effects. RESULTS Seven trials representing 1210 preschoolers showed a significant effect of IFM on hemoglobin [difference in means (MD) 0.33 g/dL (95% CI 0.23, 0.44; I2 = 3.85%, p (Q statistic) < 0.01)] and ferritin concentrations [effect size (SMD) 0.57 (95% CI 0.19, 0.95; I2 = 84.63%, p (Q statistic) < 0.01)]. In stratified analyses, hemoglobin showed an increase when subjects received iron with other co-interventions [MD 0.35 g/dL (95% CI 0.22, 0.48; I2 = 11.01%; p (Q statistic) = 0.36)]; and when the iron dose was above 5 mg/day [MD 0.34 g/dL (95% CI 0.23, 0.45; I2 = 2.33%; p (Q statistic) = 0.37)] and the intervention time was over 6 months [MD 0.39 g/dL (95% CI 0.18, 0.60; I2 = 37.90%; p (Q statistic) = 0.20)]. For ferritin, stratified analyses showed a larger effect size when they used dose higher than 5 mg/day [SMD 0.60 (95% CI 0.02, 1.18; I2 = 91.06, p (Q statistic) < 0.01)] and intervention was conducted longer than 6 months [SMD 0.96 (95% CI - 0.16, 1.76; I2 = 93.38%, p (Q statistic) < 0.01)]. CONCLUSIONS Our findings indicate that although milk iron fortification modestly increases serum hemoglobin levels or the effect size of serum ferritin of participants, it cannot be considered in the coadjuvant treatment for anemia. Register: CRD42020213604.
Collapse
Affiliation(s)
- Caroline Bekman Diniz Largueza
- Postgraduate Program in Food and Nutritional Security, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Michel Carlos Mocellin
- Fundamental Nutrition Department, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Juliana Côrtes Nunes
- Post-graduate Program in Food and Nutritional Security, Food Science Department, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Simone Augusta Ribas
- Post-graduate Program in Food and Nutritional Security, Program in Food and Nutritional Security, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
4
|
Passini CSM, Cavalcanti MB, Ribas SA, de Carvalho CMP, Bocca C, Lamarca F. Conflict of Interests in the Scientific Production on Vitamin D and COVID-19: A Scoping Review. Front Public Health 2022; 10:821740. [PMID: 35903374 PMCID: PMC9320027 DOI: 10.3389/fpubh.2022.821740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/06/2022] [Indexed: 11/25/2022] Open
Abstract
The use of scientific evidence to support the process of formulating and implementing public policies might be biased by studies funded by the pharmaceutical and food industry, which more often than not meet corporate interests. This review aimed to analyze the occurrence of conflict of interest (COI) in academic production regarding vitamin D and COVID-19, considering the facility offered during the pandemic for academic publications of heterogeneous quality. A scoping review of observational studies published in Medline, Lilacs, and Google Scholar databases was carried out. The selected studies were published between December 2019 and August 2021, focused on the relationship between vitamin D and prevention or treatment of COVID-19 in non-institutionalized individuals, with no language restrictions. Twenty-nine studies met eligibility criteria. COI was disclosed in five papers and further identified by review authors in eight other papers, meaning COI was present in thirteen papers (44.8%). Studies were funded by companies in the diagnostics, pharmaceutical and food sectors. Conclusions favorable to vitamin D supplementation were more prevalent in papers where COI was identified (9/13, 69.2%) than among papers where COI was not found (4/16, 25.0%). Omissions of disclosure of COI, funding source, and sponsor functions were observed. The identification of possible corporate political activities in scientific papers about vitamin D published during the COVID-19 pandemic signals a need for greater transparency and guideline development on the prevention of COI in scientific production.
Collapse
Affiliation(s)
| | - Maria Birman Cavalcanti
- School of Nutrition, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Simone Augusta Ribas
- Department of Public Health Nutrition, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Graduate Program in Food and Nutrition Security (PPGSAN), Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | | | - Cláudia Bocca
- Department of Public Health Nutrition, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Graduate Program in Food and Nutrition Security (PPGSAN), Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Fernando Lamarca
- Department of Applied Nutrition, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Department of Applied Nutrition, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
- *Correspondence: Fernando Lamarca
| |
Collapse
|
5
|
Ribas SA, Paravidino VB, Soares FVM. Comparison of growth curves in very low birth weight preterm infants after hospital discharge. Eur J Pediatr 2022; 181:149-157. [PMID: 34231052 DOI: 10.1007/s00431-021-04188-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/22/2021] [Accepted: 06/26/2021] [Indexed: 10/20/2022]
Abstract
Monitoring preterm infants' growth is essential to ensure the best prognosis for their growth and development. We aimed to compare growth curves in very low birth weight preterm infants after hospital discharge. In this retrospective longitudinal study, 178 preterm infants' growth was assessed by z-scores for weight for age and length to age and compared between Fenton and Kim and Intergrowth-21st charts from hospital discharge until 50 weeks postnatal, and between Intergrowth-21st and WHO charts, 50 and 64 weeks postnatal. The Kappa test was used to evaluate the agreement of the number of cases classified above or below the -2 Z-score concerning weight-for-age and length-for-age indicators to each proposed curve. Our results found that the agreement between Fenton and Kim and Intergrowth-21st curves was almost perfect for most of the weeks investigated, except 35-38 (k = 0.79) and 47-50 (k = 0.61) weeks postnatal. When evaluating the agreement between WHO and Intergrowth-21st, it was substantial for most of the weeks investigated, except for 55-58 and 69-64 weeks postnatal, in which the agreement was almost perfect (k = 0.84; k = 0.81, respectively). Furthermore, we observed that Fenton and Kim curve identified 8.4% and WHO, 5.8% more cases of preterm infants below -2 z than Intergrowth-21st.Conclusion: Although the agreement of the curves was substantial to almost perfect, the Fenton and Kim and WHO curve seem to identify more cases of preterm infants compared to the Intergrowth-21st, a finding that deserves more in-depth investigation in clinical practice. What is Known: • The adequate interpretation of postnatal growth depends on the standard growth chart. • Studies comparing the classification of anthropometric indicators of preterm infants between growth curves consider only the period from birth to hospital discharge. What is New: • This is the first study that compares the classification of weight-for-age and length-for-age indicators of VLBW preterm infants between Intergrowth-21st and Fenton and Kim curves until 64 weeks postnatal. • Substantial to almost perfect agreement of length-for-age indicator was found between the two growth curves of preterm infants during outpatient follow-up.
Collapse
Affiliation(s)
- Simone Augusta Ribas
- Department of Nutrition in Public Health, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Vitor Barreto Paravidino
- Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Physical Education and Sports, Naval Academy, Rio de Janeiro, Brazil
| | | |
Collapse
|
6
|
Teixeira MT, Vitorino RS, da Silva JH, Raposo LM, Aquino LAD, Ribas SA. Eating habits of children and adolescents during the COVID-19 pandemic: The impact of social isolation. J Hum Nutr Diet 2021; 34:670-678. [PMID: 33811690 PMCID: PMC8251498 DOI: 10.1111/jhn.12901] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 12/17/2022]
Abstract
Background The social isolation enforced as a result of the new coronavirus (COVID‐19) pandemic may impact families’ lifestyle and eating habits. The present study aimed to assess the behaviour and dietary patterns of Brazilian children and adolescents during the social isolation imposed by the COVID‐19 pandemic. Methods The present study was conducted using an online, anonymous cross‐sectional survey with 589 children and 720 adolescents from Brazil during a nationwide social isolation policy. The Mann–Whitney U‐test or the Kruskal–Wallis with the Dunn post‐hoc method and a radar chart were used to compare the weekly consumption of each food by age group and isolation status. p < 0.05 was considered statistically significant. Analyses were conducted using R statistical software, version 4.0.2 (R Foundation for Statisitical Computing). Results We found that isolated families showed breakfast eating habits and the consumption of raw salad, vegetables, beans and soft drinks. Lower‐class isolated families and those from the Northeast region consumed fruits, juices, vegetables and beans less frequently. Compared to children, adolescents were less isolated (p = 0.016), less active (p < 0.001), exposed to longer screen time (p < 0.001), showed an inadequate sleeping pattern (p = 0.002) and were from lower‐class families (p < 0.001). Conclusions Social isolation affected the eating habits of children and adolescents. Non‐isolated families presented a lower consumption of healthy food, especially those among the lower class, from Northeast Brazil, as well as adolescents.
Collapse
Affiliation(s)
- Michelle Teixeira Teixeira
- Department of Public Health Nutrition, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Raquel Santiago Vitorino
- Department of Quantitative Methods, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Julia Holandino da Silva
- Department of Quantitative Methods, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Letícia Martins Raposo
- School of Nutrition, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luana Azevedo de Aquino
- Department of Public Health Nutrition, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Simone Augusta Ribas
- Department of Public Health Nutrition, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
7
|
Ribas SA, Paravidino VB, Brandão JM, Santana da Silva LC. The Cardiovascular Health Integrated Lifestyle Diet (CHILD) Lowers LDL-Cholesterol Levels in Brazilian Dyslipidemic Pediatric Patients. J Am Coll Nutr 2021; 41:352-359. [PMID: 33683168 DOI: 10.1080/07315724.2021.1887006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To analyze the impact of the CHILD-2 diet on the lipid profile of Brazilian children and adolescents with dyslipidemia. METHODS This is a quasi-experimental study, where 149 participants (5-17 years) with mild-to-moderate hypercholesterolemia were divided into two groups (GI: low or normal weight; n = 58 and GII: overweight; n = 91). Both groups underwent the CHILD-2 diet, characterized by 25-30% total fat and less than 7% of low-saturated fat (SF) for 6 months. Changes from baseline in the lipid profile, including Total cholesterol (TC), LDL-C, triacylglycerols and glucose concentrations, dietary and anthropometric data were examined at 3 and 6 months. Longitudinal analyses were performed using linear mixed-effects models in SAS. RESULTS Serum LDL-C concentrations reduced over time compared with baseline (Δ = -5.1 mg/dL; p < 0.01), with no difference between groups (p = 0.35). TC concentrations decreased by -2.0 mg/dL (p < 0.01); but no difference was observed between groups. We found no significant changes in body mass index/age Z scores after a dietary intervention compared with baseline in both groups (p = 0.94). CONCLUSION Despite the modest reduction, our findings confirm that children with dyslipidemia can benefit from the CHILD-2 diet combined with a healthy lifestyle.
Collapse
Affiliation(s)
- Simone Augusta Ribas
- Department of Nutrition in Public Health, School of Nutrition, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vitor Barreto Paravidino
- Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Physical Education and Sports, Naval Academy, Brazilian Navy, Rio de Janeiro, Brazil
| | - Joana Maia Brandão
- Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luiz Carlos Santana da Silva
- Laboratory of Inborn Errors of Metabolism, Institute of Biological Sciences, Federal University of Pará, Pará, Brazil
| |
Collapse
|
8
|
Tavares AKMM, Ribas SA, Paravidino VB, Sgambato MR, Rodrigues RDRM, da Rocha CMM, Sichieri R, Cunha DB. 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. Nutrition 2020; 82:111051. [PMID: 33290971 DOI: 10.1016/j.nut.2020.111051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/21/2020] [Accepted: 10/28/2020] [Indexed: 11/17/2022]
Abstract
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.
Collapse
Affiliation(s)
| | - Simone Augusta Ribas
- Department of Nutrition in Public Health, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vitor Barreto Paravidino
- Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Physical Education and Sports, Naval Academy - Brazilian Navy, Rio de Janeiro, Brazil
| | - Michele Ribeiro Sgambato
- Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Rosely Sichieri
- Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diana Barbosa Cunha
- Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
9
|
Brandao JM, Sichieri R, Ribas SA, Verly-Jr E, Pereira RA, Castro IRRD, Hassan BK, Oliveira ASDD, Marques ES, Cunha DB. Treatment of Childhood Obesity Based on Brazilian Dietary Guidelines Plus Energy Restriction (PAPPAS HUPE Study): Protocol for a Randomized Clinical Trial. JMIR Res Protoc 2020; 9:e16170. [PMID: 32502969 PMCID: PMC7308900 DOI: 10.2196/16170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/13/2019] [Accepted: 11/13/2019] [Indexed: 11/24/2022] Open
Abstract
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
Collapse
Affiliation(s)
- Joana Maia Brandao
- Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rosely Sichieri
- Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Simone Augusta Ribas
- Department of Nutrition and Public Health, School of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eliseu Verly-Jr
- Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rosangela Alves Pereira
- Department of Social and Applied Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Bruna Kulik Hassan
- Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Emanuele Souza Marques
- Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diana Barbosa Cunha
- Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
10
|
Ribas SA, de Rodrigues MCC, Mocellin MC, Marques ES, da Rosa GPC, Maganha CR. Quality of complementary feeding and its effect on nutritional status in preterm infants: a cross-sectional study. J Hum Nutr Diet 2020; 34:3-12. [PMID: 32337779 DOI: 10.1111/jhn.12762] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/13/2020] [Accepted: 03/24/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The first 2 years of life represent a critical phase for growth and development, with the quality of the diet at this stage having repercussions throughout adulthood. The present study aimed to develop an Index for Measuring the Quality of Complementary Feeding (IMQCF) for infants, as well as to evaluate diet quality and its effects on the nutritional status of preterm infants. METHODS This cross-sectional study was conducted at a Brazilian University Hospital. The data were extracted by care protocol of outpatient preterm infants at 2 years of corrected age (CA). Dietary data were collected from 24-h recalls. The diet quality was assessed by the IMQCF composed of nine items based on a Brazilian Food Guide for children aged <2 years. Response options were scored 0-100, with scores closer to 100 representing a better quality diet. Association with growth indicators (Z-scores for weight- and length-for-age (WAZ and LAZ) were evaluated via tests of mean difference and multiple linear regression. RESULTS The median complementary feeding (CF) score was 72.2 (61.1-77.8) A shorter breastfeeding duration or infant formula use and the early introduction of wheat-based foods, ultra-processed foods and cow's milk in the preterm's diet were the main factors interfering in the adequacy of diet. There was an association between the quality of the diet score and WAZ (0.44; 95% confidence interval = 0.03-0.85; P = 0.03). CONCLUSIONS The introduction of poor quality food in the first 2 years of life interfered with the CF quality of preterm infants and can affect nutritional status at 2 years of CA, possibly in the long term.
Collapse
Affiliation(s)
- S A Ribas
- Department of Nutrition in Public Health, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - M C C de Rodrigues
- Department of Pediatrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - M C Mocellin
- Fundamental Nutrition Department, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - E S Marques
- Institute of Social Medicine, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - G P C da Rosa
- School of Nutrition, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - C R Maganha
- School of Nutrition, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
11
|
Ribas SA, Sichieri R, Moreira ASB, Souza DO, Cabral CTF, Gianinni DT, Cunha DB. Phytosterol-enriched milk lowers LDL-cholesterol levels in Brazilian children and adolescents: Double-blind, cross-over trial. Nutr Metab Cardiovasc Dis 2017; 27:S0939-4753(17)30225-9. [PMID: 29111079 DOI: 10.1016/j.numecd.2017.09.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/27/2017] [Accepted: 09/26/2017] [Indexed: 11/18/2022]
Abstract
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.
Collapse
Affiliation(s)
- S A Ribas
- Nutrition Division, State University of Rio de Janeiro, Brazil.
| | - R Sichieri
- Institute of Social Medicine, State University of Rio de Janeiro, Brazil
| | - A S B Moreira
- Nutrition Institute, Rio de Janeiro State University, Brazil
| | - D O Souza
- Nutrition Division, State University of Rio de Janeiro, Brazil
| | - C T F Cabral
- Nutrition Division, State University of Rio de Janeiro, Brazil
| | - D T Gianinni
- Nutrition Division, State University of Rio de Janeiro, Brazil
| | - D B Cunha
- Institute of Social Medicine, State University of Rio de Janeiro, Brazil
| |
Collapse
|
12
|
Ribas SA, Silva LCSD. [Cardiovascular risk and associated factors in schoolchildren in Belém, Pará State, Brazil]. CAD SAUDE PUBLICA 2014; 30:577-86. [PMID: 24714947 DOI: 10.1590/0102-311x00129812] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 09/09/2013] [Indexed: 11/21/2022] Open
Abstract
This cross-sectional study aimed to identify risk factors for cardiovascular disease in a stratified cluster sample of 557 schoolchildren (6-19 years) in Belém, Pará State, Brazil. Potential risk factors were obesity, hypertension, dyslipidemia, diabetes, smoking, physical inactivity, and atherogenic diet. Socio-demographic and lifestyle variables were tested in a binary logistic regression model. The most prevalent risk factors were overweight (20.4%), dyslipidemia (48.1%), and physical inactivity (66.2%). Children below ten years of age and those from higher-income families and with higher maternal schooling showed greater odds of developing overweight; meanwhile, those with overweight were more prone to developing hypercholesterolemia and hypertriglyceridemia. The findings point to the need to implement strategies to prevent overweight in early childhood, through balanced nutrition and regular physical activity, in order to effectively reduce the prevalence of risk factors in schoolchildren.
Collapse
|
13
|
Ribas SA, Santana da Silva LC. Anthropometric indices: predictors of dyslipidemia in children and adolescents from north of Brazil. NUTR HOSP 2013; 27:1228-35. [PMID: 23165566 DOI: 10.3305/nh.2012.27.4.5798] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 03/02/2012] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Atherosclerosis represents a disease that begins in childhood, and alterations in lipid concentration play a fundamental role in the development of this condition. OBJECTIVE To evaluate which of the currently applied obesity parameters (the body index mass, the percentage of body fat, the waist circumference and the upper arm fat area) can predict the risk for dyslipidemia in Brazilian children and adolescents. METHODS Cross-sectional study, standardized anthropometric data and lipid profile were collected from 874 subjects between the ages of 6 and 19 years. Logistic regression models were used to evaluate the degree of association between the anthropometric measurements and the lipid profile, controlling for potentially confounding variables, such as age and gender. RESULTS Individuals with excess body weight, elevated percentage of body fat, waist circumference and upper arm fat above the 90th percentile showed a positive correlation with alterations in the lipid profile. After adjusting for age and income, a body mass index above the 85th percentile and an elevated percentage of body fat were the variables most strongly associated with dyslipidemia in the youngest subjects (odds ratio (OR) = 2.00, p < 0.001 and OR = 1.47, p = 0.014, respectively). Children (64.5%) and adolescents aged 10-12 years (51.0%) had the highest rates of dyslipidemia. CONCLUSION Compared with other variables, such as the percentage of body fat, the body mass index was the best predictor of dyslipidemia in children and adolescents.
Collapse
Affiliation(s)
- S A Ribas
- Nutrition Division, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | |
Collapse
|
14
|
Ribas SA, Silva LCSD. Dislipidemia em escolares na rede privada de Belém. Arq Bras Cardiol 2009; 92:412-7, 429-34, 446-51. [DOI: 10.1590/s0066-782x2009000600006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 06/10/2008] [Indexed: 11/21/2022] Open
|