Ágatha Nogueira Previdelli

Índice de Qualidade da Dieta Revisado para população brasileira

The revised version of the Brazilian Healthy Eating Index is an indicator of dietary quality developed according to current nutritional recommendations. Dietary data were obtained from a population-based survey, the 2003 Inquérito de Saúde e Alimentação (ISA - Health and Diet Survey)-Capital. The Revised Index consists of 12 components: nine food groups included in the 2006 Brazilian Dietary Guidelines, in which daily portions are expressed in terms of energy density; two nutrients (sodium and saturated fats), and SoFAAS (calories from solid fat, alcohol and added sugar). The Revised Brazilian Healthy Eating Index allows for the measurement of dietary risk factors for chronic diseases, evaluating and monitoring the diet at both individual and population levels.

A revised version of the Healthy Eating Index for the Brazilian population

The revised version of the Brazilian Healthy Eating Index is an indicator of dietary quality developed according to current nutritional recommendations. Dietary data were obtained from a population-based survey, the 2003 Inquérito de Saúde e Alimentação (ISA - Health and Diet Survey)-Capital. The Revised Index consists of 12 components: nine food groups included in the 2006 Brazilian Dietary Guidelines, in which daily portions are expressed in terms of energy density; two nutrients (sodium and saturated fats), and SoFAAS (calories from solid fat, alcohol and added sugar). The Revised Brazilian Healthy Eating Index allows for the measurement of dietary risk factors for chronic diseases, evaluating and monitoring the diet at both individual and population levels.

Avaliacao da confiabilidade e validade do Indice de Qualidade da Dieta Revisado

OBJECTIVE Evaluate validity and reliability of the Brazilian Healthy Eating Index Revised according to the psychometric properties. METHODS Cross-sectional study of a random sample of 2,375 individuals of both sexes, aged 12 or older from the city of São Paulo, Southeastern Brazil, drawn from the Health Survey carried out in 2003. Information on the population characteristics was acquired using a questionnaire. Food intake was obtained using 24h Recall, used to calculate the Brazilian Healthy Eating Index Revised (BHEI-R). The following aspects were evaluated: (1) content validity, by comparing the components with the Dietary Guidelines for the Brazilian Population; (2) construct validity, factor analysis using principal components method and verifying whether the index can measure diet quality regardless of energy intake; (3) discriminating validity; and (4) the reliability of the BHEI-R by analyzing the internal consistency of the items using Cronbachs alpha coefficient. RESULTS The correlations between the component scores and energy intake were weak (r < 0.30). Principal component analysis indicated the presence of four factors with eigenvalues > 1 that represented 67% of the index variance. The discriminating validity of the BHEI-R was observed by comparing the individuals by sex and smoking habit, and identifying statistically significant differences between the means of the components of the BHEI-R and the final score. The Cronbachs alpha value (α = 0.7) indicated the presence of internal consistency between the components of the BHEI-R. The SoFAAS component followed by the total fruit component and whole fruit component presented greater correlation with the final index scores. CONCLUSIONS The Brazilian Healthy Eating Index Revised showed itself to be reliable and structurally valid when used to evaluate and monitor the diet quality of Brazilians.

Sub-relato da ingestão energética e fatores associados em estudo de base populacional

Objetivou-se identificar a prevalencia de sub-relato da ingestao energetica e os fatores associados em amostra de 331 individuos, proveniente do estudo de base populacional Inquerito de Saude no Municipio de Sao Paulo, Brasil. A ingestao energetica foi avaliada pela media de dois recordatorios de 24 horas coletados em dias nao consecutivos. O gasto energetico total foi calculado por equacao preditiva, considerando sub-relatores os individuos com ingestao energetica inferior a 2 desvios-padrao da razao ingestao energetica/gasto energetico total predito. A analise de regressao de Poisson foi utilizada para identificar os fatores associados a subnotificacao. A prevalencia de sub-relatores da ingestao energetica foi de 15,1%, sendo que os individuos com excesso de peso e insatisfeitos com o peso corporal apresentaram maior probabilidade de serem sub-relatores quando comparados aos sem excesso de peso e aos satisfeitos com peso corporal, respectivamente. Conclui-se que esses fatores deveriam ser considerados na elaboracao de tecnicas para melhorar a acuracia do inquerito dietetico.This study aimed to identify the prevalence of underreporting of energy intake and associated factors in a sample of 331 individuals from the population-based Health Survey in the City of São Paulo, Brazil. Energy intake was assessed by averaging two 24-hour recalls collected on nonconsecutive days. Total energy expenditure was calculated by the predictive equation, and under-reporters were defined as individuals with energy intake less than 2 standard deviations from the energy intake/predicted total energy expenditure ratio. Poisson regression was used to identify factors associated with underreporting. Prevalence of underreporting of energy intake was 15.1%, whereas individuals with overweight and dissatisfied with body weight were more likely to underreport when compared to individuals without excess weight and who were satisfied with body weight, respectively. We conclude that these factors should be considered when developing techniques to improve the accuracy of dietary assessment.

Trends in diet quality among adolescents, adults and older adults: A population-based study

This study aimed to monitor diet quality and associated factors in adolescents, adults and older adults from the city of São Paulo, Brazil. We conducted a cross-sectional population-based study involving 2376 individuals surveyed in 2003, and 1662 individuals in 2008 (Health Survey of São Paulo, ISA-Capital). Participants were of both sexes and aged 12 to 19 years old (adolescents), 20 to 59 years old (adults) and 60 years old or over (older adults). Food intake was assessed using the 24-h dietary recall method while diet quality was determined by the Brazilian Healthy Eating Index (BHEI-R). The prevalence of descriptive variables for 2003 and 2008 was compared adopting a confidence interval of 95%. The means of total BHEI-R score and its components for 2003 and 2008 were compared for each age group. Associations between the BHEI-R and independent variables were evaluated for each survey year using multiple linear regression analysis. Results showed that the mean BHEI-R increased (54.9 vs. 56.4 points) over the five-year period. However, the age group evaluation showed a deterioration in diet quality of adolescents, influenced by a decrease in scores for dark-green and orange vegetables and legumes, total grains, oils and SoFAAS (solid fat, alcohol and added sugar) components. In the 2008 survey, adults had a higher BHEI-R score, by 6.1 points on average, compared to adolescents. Compared to older adults, this difference was 10.7 points. The diet quality remains a concern, especially among adolescents, that had the worst results compared to the other age groups.

Brazilian healthy eating index revised (BHEI-R) of women before and during adjuvant treatment for breast cancer.

INTRODUCTION Different therapeutic modalities for cancer trigger side effects that affect the selection of food by changing dietary patterns. AIMS To evaluate changes in the diet quality of women in adjuvant treatment for breast cancer. METHODS Sociodemographic, clinical and anthropometric data of 78 women were collected. The Brazilian Healthy Eating Index Revised and its components were obtained from food frequency questionnaire applied before and after the treatment. At baseline, participants were classified according to tertiles of diet quality. RESULTS AND DISCUSSION The score of the Brazilian Healthy Eating Index Revised (BHEI-R) in the lowest tertile was 48.4 to 75.2 points, the second tertile was 75.7 to 81.8 points, and the upper tertile was 82.0 to 95.7 points. During treatment, of the women classified in the first tertile, 62% improved their diet score quality passing to the upper tertiles. Women classified in the second tertile, did not significantly alter the diet quality during the treatment, although 46% went to the third tertile. Patients classified in the third tertile significantly reduced the average score of the Index by 7.3 points during the treatment. Among these women, 38% and 20% decreased their score for the second and first tertiles respectively, where the reduction in the diet quality was due to reducing the score of components Total fruits, Total vegetables, Dark Green and orange vegetables and Legumes, Total grains and Solid fats, Alcohol and Added sugar. CONCLUSION Dietary changes, which were observed after breast cancer diagnosis, significantly altered the quality of diet among the women participating in the study. Future nutrition interventions are important to aid in food choices during the treatment.

Evaluation of the reliability and validity of the Brazilian Healthy Eating Index Revised

OBJECTIVE Evaluate validity and reliability of the Brazilian Healthy Eating Index Revised according to the psychometric properties. METHODS Cross-sectional study of a random sample of 2,375 individuals of both sexes, aged 12 or older from the city of São Paulo, Southeastern Brazil, drawn from the Health Survey carried out in 2003. Information on the population characteristics was acquired using a questionnaire. Food intake was obtained using 24h Recall, used to calculate the Brazilian Healthy Eating Index Revised (BHEI-R). The following aspects were evaluated: (1) content validity, by comparing the components with the Dietary Guidelines for the Brazilian Population; (2) construct validity, factor analysis using principal components method and verifying whether the index can measure diet quality regardless of energy intake; (3) discriminating validity; and (4) the reliability of the BHEI-R by analyzing the internal consistency of the items using Cronbachs alpha coefficient. RESULTS The correlations between the component scores and energy intake were weak (r < 0.30). Principal component analysis indicated the presence of four factors with eigenvalues > 1 that represented 67% of the index variance. The discriminating validity of the BHEI-R was observed by comparing the individuals by sex and smoking habit, and identifying statistically significant differences between the means of the components of the BHEI-R and the final score. The Cronbachs alpha value (α = 0.7) indicated the presence of internal consistency between the components of the BHEI-R. The SoFAAS component followed by the total fruit component and whole fruit component presented greater correlation with the final index scores. CONCLUSIONS The Brazilian Healthy Eating Index Revised showed itself to be reliable and structurally valid when used to evaluate and monitor the diet quality of Brazilians.

Using Two Different Approaches to Assess Dietary Patterns: Hypothesis-Driven and Data-Driven Analysis

The use of dietary patterns to assess dietary intake has become increasingly common in nutritional epidemiology studies due to the complexity and multidimensionality of the diet. Currently, two main approaches have been widely used to assess dietary patterns: data-driven and hypothesis-driven analysis. Since the methods explore different angles of dietary intake, using both approaches simultaneously might yield complementary and useful information; thus, we aimed to use both approaches to gain knowledge of adolescents’ dietary patterns. Food intake from a cross-sectional survey with 295 adolescents was assessed by 24 h dietary recall (24HR). In hypothesis-driven analysis, based on the American National Cancer Institute method, the usual intake of Brazilian Healthy Eating Index Revised components were estimated. In the data-driven approach, the usual intake of foods/food groups was estimated by the Multiple Source Method. In the results, hypothesis-driven analysis showed low scores for Whole grains, Total vegetables, Total fruit and Whole fruits), while, in data-driven analysis, fruits and whole grains were not presented in any pattern. High intakes of sodium, fats and sugars were observed in hypothesis-driven analysis with low total scores for Sodium, Saturated fat and SoFAA (calories from solid fat, alcohol and added sugar) components in agreement, while the data-driven approach showed the intake of several foods/food groups rich in these nutrients, such as butter/margarine, cookies, chocolate powder, whole milk, cheese, processed meat/cold cuts and candies. In this study, using both approaches at the same time provided consistent and complementary information with regard to assessing the overall dietary habits that will be important in order to drive public health programs, and improve their efficiency to monitor and evaluate the dietary patterns of populations.

Underreporting of energy intake and associated factors in a population-based study

Objetivou-se identificar a prevalencia de sub-relato da ingestao energetica e os fatores associados em amostra de 331 individuos, proveniente do estudo de base populacional Inquerito de Saude no Municipio de Sao Paulo, Brasil. A ingestao energetica foi avaliada pela media de dois recordatorios de 24 horas coletados em dias nao consecutivos. O gasto energetico total foi calculado por equacao preditiva, considerando sub-relatores os individuos com ingestao energetica inferior a 2 desvios-padrao da razao ingestao energetica/gasto energetico total predito. A analise de regressao de Poisson foi utilizada para identificar os fatores associados a subnotificacao. A prevalencia de sub-relatores da ingestao energetica foi de 15,1%, sendo que os individuos com excesso de peso e insatisfeitos com o peso corporal apresentaram maior probabilidade de serem sub-relatores quando comparados aos sem excesso de peso e aos satisfeitos com peso corporal, respectivamente. Conclui-se que esses fatores deveriam ser considerados na elaboracao de tecnicas para melhorar a acuracia do inquerito dietetico.This study aimed to identify the prevalence of underreporting of energy intake and associated factors in a sample of 331 individuals from the population-based Health Survey in the City of São Paulo, Brazil. Energy intake was assessed by averaging two 24-hour recalls collected on nonconsecutive days. Total energy expenditure was calculated by the predictive equation, and under-reporters were defined as individuals with energy intake less than 2 standard deviations from the energy intake/predicted total energy expenditure ratio. Poisson regression was used to identify factors associated with underreporting. Prevalence of underreporting of energy intake was 15.1%, whereas individuals with overweight and dissatisfied with body weight were more likely to underreport when compared to individuals without excess weight and who were satisfied with body weight, respectively. We conclude that these factors should be considered when developing techniques to improve the accuracy of dietary assessment.

The diet quality index evaluates the adequacy of energy provided by dietary macronutrients

Objective To investigate the relationship between macronutrient intake adequacy and the national diet quality index score. Methods The study analyzed a representative sample of 1,662 individuals from the municipality of Sao Paulo who participated in a cross-sectional study called Health Survey-Capital (2008/2009). Two 24-hour recalls were collected. Habitual intake was determined by the Multiple Source Method. The Brazilian index was calculated as suggested, and macronutrient adequacy was given by the World Health Organization and Food and Agriculture Organization recommendations. A generalized linear model verified the relationship between the Brazilian index and macronutrient adequacy. All analyses with a descriptive level below 0.05 were considered significant. The analyses were performed by the software Stata 12.0, survey mode. Results The vast majority (91%) of the population had inappropriate macronutrient intakes, and the total median Brazilian index score was 61.3 points (interquartile range=10.1). The total Brazilian index score of individuals with high lipid intake was worse than that of individuals with proper lipid intake (β=0,96; p=0,004), while those with high protein intake had a better score (β=1,10; p=0,003) than those with proper protein intake. Conclusion The revised Brazilian Healthy Eating Index assesses diet quality properly regarding high lipid intake, but it has some limitations regarding high protein intake according to the World Health Organization and Food and Agriculture Organization recommendations. New studies should investigate the possibility of adapting this index to the World Health Organization and Food and Agriculture Organization recommendations.