Bárbara da Silva Nalin de Souza

Brazil's staple food and incident diabetes

OBJECTIVE The aim of this study was to investigate the association of Brazils staple food, rice, beans and manioc, and the incidence of type 2 diabetes mellitus type 2 (T2DM) in adults assisted by a Brazilian Family Doctor Program (FDP). METHODS The baseline information was collected on visits to 13 units of the FDP from July 2006 to December 2007 (CAMELIA Study). The units were revisited by trained researchers between July and December 2011, who reviewed medical records of all participants of the baseline. Biochemical, anthropometrical and blood pressure measurements, new diagnoses, and medical prescriptions were collected. Individuals ages ≥20 y, who were non-diabetic at baseline were included (N = 409). Food consumption was estimated using a validated semi-quantitative food frequency questionnaire. Incident of diabetes was classified according to fasting serum glucose (≥126 mg/dL), individuals use of antidiabetic drugs, and/or diagnosis of diabetes described in the medical record. Individuals who were negative at baseline and also were negative for the above conditions were classified as non-diabetics. RESULTS Individuals who developed T2DM (N = 30) reported higher consumption of red meat and beans and less consumption of cassava flour, independent of the interval between visits and other potential confounding variables. The cassava flour showed a protective effect (relative risk, 0.910; 95% confidence interval, 0.842-0.982). CONCLUSIONS The consumption of cassava flour, a low-cost product, could be considered in diets for the prevention and control of diabetes. The hypothesis must be investigated in cohorts from different populations and tested in randomized controlled trials.

The impact of the reduction of sodium content in processed foods in salt intake in Brazil

This study aimed at assessing the potential impact of the reduction of sodium content in processed foods in the average salt intake in the Brazilian population. A total of 32,900 participants of the first National Dietary Survey (NDS 2008-2009), age 10 years and older who provided information about food intake over two days were evaluated. The sodium reduction targets established by the Brazilian Ministry of Health in 2010 and 2013 were used as the reference to determine the maximum content of sodium in 21 groups of processed food. The results show that sodium reduction targets in processed food have small impact in mean Brazilian population intake of salt. For 2017, the expected mean reduction is of 1.5%, the average sodium intake being still above the recommended 2,000mg/day maximum. Therefore, it will hardly be possible to reach the necessary reduction in salt intake in Brazil from volunteer agreements like the ones made so far.El objetivo del presente estudio fue evaluar el potencial impacto de la reduccion del contenido en sodio en alimentos procesados en el consumo medio de sodio de la poblacion brasilena. Un total de 32.900 participantes de la primera Encuesta Nacional de Alimentacion (2008-2009), con 10 anos y mas de edad, proporcionaron datos sobre dos dias de consumo, que fueron evaluados. Las metas de reduccion de sodio, indicadas por el Ministerio de Salud en 2010 y 2013, fueron utilizadas como referencia para determinar el contenido maximo de sodio en 21 grupos de alimentos procesados. Los resultados indican que las metas de reduccion de sodio en alimentos procesados tiene un pequeno impacto en el consumo medio de sodio en la poblacion brasilena. En 2017, la reduccion media esperada es de un 1,5%, quedando los valores de consumo medio de sodio todavia por encima del limite maximo recomendado de 2.000mg/dia. Por tanto, dificilmente sera posible alcanzar la reduccion necesaria en el consumo de sodio en Brasil, a partir de acuerdos voluntarios en los terminos de los que se han ido sucediendo hasta el momento.

PAAPPAS community trial protocol: a randomized study of obesity prevention for adolescents combining school with household intervention

BackgroundThe prevalence of childhood obesity is increasing at a high rate in Brazil, making prevention a health priority. Schools are the central focus of interventions aiming the prevention and treatment of childhood obesity, however, randomized trials and cohort studies have not yet provided clear evidence of strategies to reduce prevalence of obesity.The aim of this study is to present a protocol to evaluate the efficacy of combining school and household level interventions to reduce excessive weight gain among students.MethodsThe intervention target fifth and sixth graders from 18 public schools (9 interventions and 9 controls) in the municipality of Duque de Caxias, metropolitan area of Rio de Janeiro, Brazil. A sample size of 2500 students will be evaluated at school for their weight status and those from the intervention group who are overweight or obese will be followed monthly at home by community health agents. Demographic, socioeconomic, anthropometric, eating behavior and food consumption data will be collected at school using a standardized questionnaire programmed in personal digital assistant. At school, all students from the intervention group will be encouraged to change eating habits and food consumption and to increase physical activity and reducing sedentary behavior.DiscussionThis study will provide evidence whether integration of school with primary health care can prevent excessive weight gain among adolescents. Positive results will inform a sustainable strategy to be disseminated in the health care system in Brazil.Trial registrationClinicalTrials.gov, NCT02711488. Date of registration: March 11, 2016.

Dietary habits and inadequate control of blood pressure in hypertensive adults assisted by a Brazilian Family Doctor Program.

OBJECTIVE To estimate dietary habits and other factors associated with inadequate blood pressure (BP) control in hypertensive patients adherent to antihypertensive drug treatment assisted by a Brazilian Family Doctor Program (FDP). DESIGN A cross-sectional study. SETTING FDP units, Niterói, Rio de Janeiro, Brazil. SUBJECTS We included data from both male and female participants aged ≥20 years. Participants completed a standardized questionnaire containing questions related to demographics, socio-economic factors, comorbidities and lifestyle, as well as a validated FFQ and eleven additional qualitative questions to investigate dietary habits. Food items were divided into sixteen groups. Medical consultations were performed, BP measurements were taken, blood and urine samples were assessed and anthropometric and nutritional status was evaluated. RESULTS Individuals with inadequate BP control presented higher BMI values (prevalence ratio (PR) = 1·027, 95% CI 1·009, 1·045) and also consumed more meat (PR = 1·091, 95% CI 1·022, 1·165), which are potentially modifiable variables. Higher levels of serum creatinine (PR = 1·894, 95% CI 1·241, 2·892) were also associated with inadequate BP control, as were skin colour (white). After inclusion of the Na excretion index, which is an indirect measure of salt intake, a slight decrease was observed in the PR for meat, which resulted in loss of statistical significance. CONCLUSIONS The results indicate that salt consumption, skin colour, BMI and serum creatinine are associated with inadequate BP control.

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.