Dirce Maria Lobo Marchioni

Avaliação do consumo alimentar e da ingestão de nutrientes na prática clínica

The assessment of food consumption in clinical practice is often carried out to develop and implement nutritional advice. Factors as the patient health conditions, the evolution of his/her clinical condition as well as the reasons that motivated the search for advice will guide the selection of the best method of assessment of food consumption or nutrient intake to employ. The chosen method might drive the professional to offer a food plan that aims to promote health, to prevent illness, and to alter the nutritional state of the patient. Despite the easily available national literature on methods and techniques to estimate food consumption, it is not uncommon that professionals still have doubts about what methods are the most appropriated in daily practice. This study aimed to present a critical analysis, taking into account the clinical applicability, of the food assessment methods and its characteristics.

Estimando a prevalência da ingestão inadequada de nutrientes

In assessing food intake patterns in groups of individuals, it is usually important to know how many of these individuals present nutrient intakes above or below a determined criterion. This information is relevant for planning healthcare actions, both in monitoring and in assessing such interventions, and also for the purposes of regulating commercial activities. This paper discusses a new methodology for estimating the prevalence of inadequate nutrient intake, with the Dietary Reference Intakes as the reference values. The utilization of diet surveys that allow the most accurate quantitative estimate possible is dealt with. These should use repeated measurements of food intake, on non-consecutive days. The food intake should be adjusted for between-person and within-person variance, so as to obtain a corrected distribution for the nutrient intake values. After constructing this distribution curve based on the corrected estimated parameters (average and standard deviation), the EAR method (Estimated Average Requirement) can be used as a cutoff point for verifying the proportion of individuals that has inadequate nutrient intake. This corresponds to the area of the curve below this reference value. It is concluded that this new approach minimizes the error in the calculation of the prevalence of inadequate nutrient intake, since it takes into consideration the random characteristics of the diet.

Questionário de freqüência alimentar para adultos com base em estudo populacional

The objective of the study was to develop a food frequency questionnaire for each of the following groups: female adults, male adults and male and female adults, based on dietary data obtained in a population-based study comprising individuals from different income levels. Dietary data was obtained from a 24-hour Dietary Recall applied to a probabilistic sample of 1,477 subjects in the city of Sao Paulo (Southeastern Brazil) in 2003. Food items accounting for at least 90% of total daily calorie intake and nutrients were selected. The reference time frame was the year preceding the interview and subjects had the choice of four serving sizes.

Validaçäo de questionários de freqüência alimentar - QFA: consideraçöes metodológicas

O Questionario de Frequencia Alimentar (QFA) tornou-se o metodo dominante nos estudos epidemiologicos para avaliacao do consumo dietetico, em especial para avaliar a relacao da dieta com a ocorrencia de doencas cronicas nao transmissiveis. O QFA e um instrumento que tem como objetivo a avaliacao da dieta habitual de grupos populacionais e apresenta como vantagens a rapidez na aplicacao e a eficiencia na pratica epidemiologica para identificar o consumo habitual de alimentos, alem do baixo custo. Comparado a outros instrumentos, substitui a medicao da ingestao alimentar de um ou varios dias pela informacao global da ingestao de um periodo amplo de tempo. Constitui ferramenta util nos estudos sempre que seu desenvolvimento tenha sido precedido por procedimentos metodologicos cuidadosamente planejados que garantirao confiabilidade e precisao dos dados. Para tanto, sao necessarios estudos de validacao que permitam estimar os erros de medicao proprios do metodo. Sem o reconhecimento destes erros, a relacao dieta-doenca podera estar prejudicada. Este artigo pretende abordar de forma sistematica consideracoes metodologicas para a realizacao de estudos de validacao de QFA.

Estado nutricional e fatores associados ao déficit de crescimento de crianças freqüentadoras de creches públicas do Município de São Paulo, Brasil

This study reports the nutritional status of children attending daycare centers in the Municipality of Sao Paulo, Brazil. A representative sample of 827 children under 84 months of age was evaluated. Anthropometric measurements and information on socioeconomic characteristics and morbidity were collected. The most prevalent nutritional deficit was stunting (7.0%; 95%CI: 3.60-10.40). Univariate analysis showed a significant association between stunting and age ( 7), OR = 3.02(95%CI: 1.46-6.22); and number of siblings (> 2) OR = 4.81 (95%CI: 1.72-13.44). In the multivariate analysis, only diarrhea one month prior to the data collection, OR = 2.54 (95%CI: 1.20-5.38) and > 2 siblings, OR = 7.40 (95%CI: 2.20-24.93), remained associated with stunting.

Evolução nutricional de crianças atendidas em creches públicas no Município de São Paulo, Brasil

OBJECTIVE To assess changes in the anthropometric characteristics of children receiving care in public day care facilities in the municipality of São Paulo, Brazil. METHODS Using a sampling procedure, 21 day care centers and 849 children were selected for the study. The children in the study were to be weighed and measured at three points over a one-year period: in October of 1999, April of 2000, and October of 2000. Of the 849 children selected, 821 of them were weighed and measured in October of 1999, and 420 of them were weighed and measured at all three points. The data in this paper refer to those 420 children. McNemars chi-square test was used to analyze any changes at the end of the year in the proportions of children who were malnourished or overweight. Two-way analysis of variance was used to compare the mean height-for-age, weight-for-age, and weight-for-height z scores at the three observations. RESULTS At the first observation, the prevalences found were: low height-for-age, 7.1%; low weight-for-age, 2.8%; low weight-for-height, 0.2%; and overweight, 5.7%. By the end of the year, the prevalence of low height-for-age had decreased to 3.1% (P = 0.007), of low weight-for-age had decreased to 1.7% (P = 0.56), of low weight-for-height had increased to 0.5% (P = 0.99), and of overweight had increased to 6.9% (P = 0.33). Both malnutrition and overweight were more prevalent in children younger than 24 months than they were among older children studied, at both the beginning and the end of the study period. The changes in the mean indices of height-for-age, weight-for-height, and weight-for-age over the one-year period were significantly positive, except for weight-for-height in children younger than 24 months. CONCLUSIONS Our results indicate that receiving care in the public day care facilities had a positive impact on the nutritional status of the children over the one-year study period. However, the physical growth of the children in these day care centers should be monitored in order to prevent malnutrition from turning into another public health problem: excessive weight gain.

Aplicação das Dietary Reference Intakes na avaliação da ingestão de nutrientes para indivíduos

A avaliacao do estado nutricional e uma das praticas clinicas fundamentais para tomar-se a decisao quanto aodiagnostico nutricional de um individuo e a conduta dietetica a ser-lhe prescrita. A adequacao da ingestao denutrientes e um dos componentes da avaliacao nutricional e e feita a partir de valores de referencia que seconstituem em estimativas das necessidades fisiologicas desses nutrientes e metas de ingestao dos mesmos.Colocam-se hoje a disposicao dos profissionais um novo conjunto de valores de referencia que constituemum avanco importante no modo de interpretar a adequacao dietetica: as

Prevalence and correlates of calcium and vitamin D status adequacy in adolescents, adults, and elderly from the Health Survey—São Paulo

OBJECTIVE In addition to the importance of adequate calcium and vitamin D status for health and prevention of several chronic diseases, a high prevalence of both nutrient inadequacy and 25-hydroxyvitamin D (25[OH]D) insufficiency has been observed. The aim of this study was to estimate calcium and vitamin D status correlates and adequacy from a population-based epidemiologic study. METHODS This is a subsample of a cross-sectional study of a representative sample of individuals living in São Paulo that includes 636 participants. A 24-h dietary record and a blood sample were collected. Nutrient adequacy was estimated by adjusting for the within-person variance of the nutrient intake. Serum concentration of 25(OH)D was measured by high-performance liquid chromatography and considered adequate when ≥ 50 nmol/L. RESULTS Calcium and vitamin D intake decrease according to life stages in both men and women, and increases with family income and educational level. The prevalence of calcium intake inadequacy is higher than 70% and almost 100% for vitamin D. The highest 25(OH)D concentration was observed in the fall-51.7 (20.4) nmol/L-and lowest in the summer-30.1 (8.8) nmol/L. Sex, body mass index, physical activity, alcohol and smoking habits, life stage, family income, skin color, waist circumference, and season of the year could explain 22% of the variability of 25(OH)D. CONCLUSIONS The present study demonstrates important inadequacies regarding the nutritional status of calcium and vitamin D and indicates an urgent need not only for health professionals, but also for government and food industries to undertake new initiatives that could result in a real improvement in terms of calcium and vitamin D nutrition.

Determinantes do consumo de frutas e hortaliças em adolescentes por regressão quantílica

OBJECTIVE To analyze fruit and vegetable intake in adolescents and to identify associated factors. METHODS A population-based cross-sectional study was conducted with a representative sample of 812 adolescents of both sexes in the city of São Paulo, Southeastern Brazil, in 2003. Food consumption was measured with the 24-hour dietary recall. Fruit and vegetable intake was described in percentiles. Quantile regression models were used to investigate the association between this intake and explanatory variables. RESULTS Of all adolescents interviewed, 6.4% consumed the minimum recommendation of 400 g/day of fruits and vegetables and 22% did not consume any type of fruits and vegetables. According to quantile regression models, adjusted for energy intake, age group and sex, per capita household income and head of households level of education were positively associated with fruit and vegetable intake, whereas smoking habit showed a negative association. Income was significantly associated with lower intake percentiles (p20 to p55); smoking, with intermediate percentiles (p45 to p75); and head of households level of education, with higher percentiles (p70 to 95). CONCLUSIONS Fruit and vegetable intake among adolescents of São Paulo was below the Ministry of Healths recommendations and it is influenced by per capita household income, head of familys level of education and smoking habit.OBJETIVO: Analisar o consumo de frutas, legumes e verduras (FLV) de adolescentes e identificar fatores associados. METODOS: Estudo transversal de base populacional com amostra representativa de 812 adolescentes de ambos os sexos de Sao Paulo, SP, em 2003. O consumo alimentar foi medido pelo recordatorio alimentar de 24 horas. O consumo de FLV foi descrito em percentis e para investigar a associacao entre a ingestao de FLV e variaveis explanatorias; foram utilizados modelos de regressao quantilica. RESULTADOS: Dos adolescentes entrevistados, 6,4% consumiram a recomendacao minima de 400 g/dia de FLV e 22% nao consumiram nenhum tipo de FLV. Nos modelos de regressao quantilica, ajustados pelo consumo energetico, faixa etaria e sexo, a renda domiciliar per capita e a escolaridade do chefe de familia associaram-se positivamente ao consumo de FLV, enquanto o habito de fumar associou-se negativamente. Renda associou-se significativamente aos menores percentis de ingestao (p20 ao p55); tabagismo aos percentis intermediarios (p45 ao p75) e escolaridade do chefe de familia aos percentis finais de consumo de FLV (p70 ao p95). CONCLUSOES: O consumo de FLV por adolescentes paulistanos mostrou-se abaixo das recomendacoes do Ministerio da Saude e e influenciado pela renda domiciliar per capita, pela escolaridade do chefe de familia e pelo habito de fumar.

Reproducibility of a food frequency questionnaire for adolescents

To assess the reproducibility of a validated 76-item food frequency questionnaire designed to estimate diet in adolescents (Adolescent Food Frequency Questionnaire--AFFQ) in the city of Sao Paulo, Brazil, a test-retest study was conducted (n = 49). Intraclass correlation coefficient (ICC), weighted kappa, and percentage of agreement were used in both crude and energy-adjusted nutrient intakes. Bland Altman plots were used to examine the limits of agreement for energy and macronutrients. The ICC ranged from 0.48 (carbohydrates) to 0.65 (vitamin C) in crude values and from 0.25 (total fat) to 0.58 (vitamin C) in adjusted values. Kappa values ranged from 0.28 (protein and fiber) to 0.56 (unsaturated fat). Bland Altman showed a trend towards larger difference in energy according to increased intake values and a bias towards extreme values for fat intake. The percent of individuals classified in the same category on the two occasions was on average 54.2%. By conclusion, the Adolescent Food Frequency Questionnaire showed reasonable reproducibility and can be used in studies that aim to classify groups into intake categories.