Dirce Maria Marchioni

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.

The influence of breakfast and dairy products on dietary calcium and vitamin D intake in postpubertal adolescents and young adults

BACKGROUND Given the importance of both calcium and vitamin D for bone health and the high prevalence of vitamin D from around the world, the present study aimed to evaluate calcium and vitamin D intake in a group of healthy Brazilian adolescents and young adults and to examine the influence of breakfast and dairy products in the total intake of these nutrients. METHODS   One hundred and sixty adolescents and young adults, aged 16-20 years old, from a public school, participated in the present study. Three-day dietary records were used to assess calcium and vitamin D intakes. Serum 25(OH)D levels were measured using a radioimmunoassay kit. The results were expressed as the mean (SD). RESULTS Only 3.8% of the subjects met the daily adequate intake recommendation for calcium, and none for vitamin D [682.2 (132.2)mg day(-1) and 124.0 (28.0)IU day(-1) , respectively]. 25(OH)D serum levels were insufficient in 51.5% and deficient in 9.7% of the individuals [72.5 (22.3) nmol L(-1) ]. There was a significant positive correlation between dairy product intake with both calcium and vitamin D (r=0.597 and r =0.561, respectively; P=0.000). Adolescents who ate breakfast had a significant higher mean calcium, vitamin D and dairy product intake than adolescents who did not report this meal. CONCLUSIONS The majority of adolescents and young adults did not consume recommended intakes of calcium and vitamin D and also presented 25(OH)D insufficiency. The results indicate that a regular breakfast and the consumption of dairy products represent important strategies in improving calcium and vitamin D intake in the diet.

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.

Meat Consumption in Sao Paulo – Brazil: Trend in the Last Decade

Objective To characterize trends in meat consumption, and verify the percentage of excessive red and processed meat consumption in the last decade in São Paulo, Brazil. Design Cross-sectional weighted data from the Health Survey for São Paulo, conducted in São Paulo, Brazil among people aged 12 years and older. Setting Diet was assessed by two 24-hour recalls in each survey. Usual meat consumption was estimated by Multiple Source Method. Wald tests were used to compare means across survey years. Data were collected from adolescents, adults, and elderly using a representative, complex, multistage probability-based survey in 2003 and in 2008 in São Paulo, southeast of Brazil. Subjects 2631 Brazilians were studied in 2003 and 1662 in 2008. Results Daily mean of red and processed meat consumption was 100 g/day in 2003, and 113 g/day in 2008. Excessive red and processed meat consumption was observed in almost 75% of the subjects, especially among adolescents in both surveys. Beef represented the largest proportion of meat consumed, followed by poultry, pork and fish in both surveys. Conclusions Daily red and processed meat consumption was higher in 2008 than in 2003, and almost the entire population consumed more than what is recommended by World Cancer Research Fund. Public health strategies are needed, in order to reduce red and processed meat consumption to the recommended amounts, for a healthy diet.

Association between Polyphenol Intake and Hypertension in Adults and Older Adults: A Population-Based Study in Brazil

Background/Objective Hypertension is an important risk factor for cardiovascular disease, and diet has been identified as a modifiable factor for preventing and controlling hypertension. Besides, epidemiological studies have suggested an inverse association between polyphenol intake and cardiovascular diseases. The aim of this study was to evaluate the association between the intake of polyphenols and hypertension in a general population of Sao Paulo. Methods Data came from the ‘Health Survey of Sao Paulo (ISA-Capital)’ among 550 adults and older adults in Sao Paulo, Brazil. Diet was assessed by two 24-hour dietary recalls (24HR). Usual intakes were calculated using the Multiple Source Method. Polyphenol intake was calculated by matching food consumption data from the 24HR with the Phenol-Explorer database. The associations between the hypertension and tertiles of the total and classes of polyphenols intake were tested by multivariate logistic regression analysis. Results After multivariate adjustment for potential confounding factors the findings showed an inverse and linearly association between the hypertension and highest tertiles of tyrosols (OR = 0.33; 95%CI 0.18, 0.64), alkylphenols (OR = 0.45; 95%CI 0.23, 0.87), lignans (OR = 0.49; 95%CI 0.25, 0.98), as well as stilbenes (OR = 0.60; 95%CI 0.36, 0.98), and other polyphenols (OR = 0.33; 95%CI 0.14, 0.74). However, total polyphenol intake, and phenolic acids were significantly associated only in the middle tertile with hypertension and flavonoids were not significant associated. Conclusion There is an inverse and linearly association between the highest tertile of some classes of polyphenols, such as, tyrosols, alkylphenols, lignans, stilbenes, other polyphenols and hypertension.

Dietary intake and food contributors of polyphenols in adults and elderly adults of Sao Paulo: a population-based study.

A comprehensive estimation of polyphenol intake is needed to gain a better understanding of the association between polyphenol-rich food intake and the potential effects of this intake on chronic diseases. The aim of this study was to estimate the intake of polyphenols and the major dietary contributors in the population of Sao Paulo. Data were obtained from the Health Survey-São Paulo (ISA-Capital 2008) and were reported for 1103 adults and elderly adults. Food intake was estimated by one 24-h dietary recall (24HR). Polyphenol intake was calculated by matching food consumption data from the 24HR with the polyphenol content in foods listed in the Phenol-Explorer database. The mean total intake of polyphenols was 377·5 (se 15·3) mg/d. The main polyphenol classes were phenolic acids (284·8 (se 15·9) mg/d) and flavonoids (54·6 (se 3·5) mg/d). Intakes were higher in the elderly adults than in other adults (P<0·001) and higher in individuals with lower educational level (P=0·01) and current smokers (P=0·02). The main dietary contributors for total polyphenols were coffee (70·5 %), citrus fruits (4·6 %) and tropical fruits (3·4 %). Coffee was the major source of polyphenols, providing 266·2 (se 16·5) mg/d, and contributed 92·3 % of the phenolic acids and 93·1 % of the alkylmethoxyphenols. These findings will be useful for assessing the potential role on health of polyphenols and specific polyphenol-rich foods, such as coffee, and enable a comparison with people from other countries.

High intake of heterocyclic amines from meat is associated with oxidative stress.

High meat intake has been related to chronic diseases such as cancer and CVD. One hypothesis is that heterocyclic amines (HCA), which are formed during the cooking process of meat, can generate reactive species. These compounds can cause oxidation of lipids, proteins and DNA, resulting in oxidative stress, cell damage and loss of biological function. This association has been seen in vitro; however, it remains unclear in vivo. The aim of the present study was to investigate the association between oxidative stress and HCA intake, and oxidative stress and meat intake. Data were from the Health Survey for Sao Paulo--ISA-Capital (561 adult and elderly). Food intake was estimated by one 24-h dietary recall (24HR) complemented by a detailed FFQ with preferences of cooking methods and level of doneness for meat. HCA intake was estimated linking the meat from the 24HR to a database of HCA. Oxidative stress was estimated by malondialdehyde (MDA) concentration in the plasma, after derivatisation with thiobarbituric acid and quantification by HPLC/diode array. Analyses were performed using multivariate logistic regressions adjusted for smoking, sex, age, BMI, skin colour, energy intake, fruit and vegetable intake, and physical activity. A positive association between HCA intake and MDA concentration (OR 1·17; 95% CI 1·01, 1·38) was observed, showing that HCA from meat may contribute to increase oxidative stress, and may consequently increase the risk of chronic diseases.

Indices for the assessment of nutritional quality of meals: a systematic review.

This systematic review aimed to synthesise information on indices developed to evaluate nutritional quality of meals. A strategy for systematic search of the literature was developed using keywords related to assessment of meal quality. Databases searched included ScienceDirect, PubMed, Lilacs, SciELO, Scopus, Cochrane, Embase and Google Scholar. The literature search resulted in seven different meal quality indices. Each article was analysed in order to identify the following items: authors, country, year, study design, population characteristics, type of meal evaluated, dietary assessment method, characteristics evaluated (nutrients or food items), score range, index components, nutritional references, correlations performed, validation and relationship with an outcome (if existing). Two studies developed instruments to assess the quality of breakfast, three analysed lunch, one evaluated dinner and one was applied to all types of meals and snacks. All meal quality indices reviewed were based on the evaluation of presence or absence of food groups and relative contributions of nutrients, according to food-based guidelines or nutrient references, adapting the daily dietary recommendations to one specific meal. Most of the indices included three items as components for meal quality assessment: (I) total fat or some specific type of fat, (II) fruits and vegetables and (III) cereals or whole grains. This systematic review indicates aspects that need further research, particularly the numerous approaches to assessing meals considering different foods and nutrients, and the need for validation studies of meal indices.

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.

Is the food frequency consumption essential as covariate to estimate usual intake of episodically consumed foods

Backgrounds/Objectives:The aim of this paper is to verify the performance of the frequency of consumption as variable for prediction of the usual intakes of foods.Subjects/Methods:In total, 725 individuals who answered two nonconsecutive 24-h recall and one food frequency questionnaire (FFQ) in the ‘Healthy Survey-Sao Paulo-Brazil’. An additional indicator variable indicating if one is usual consumer was created before analyzing. The Multiple Source Method and National Cancer Institute method were used to estimate usual intake of selected food considering different models of prediction: with no covariates; with FFQ; with FFQ plus indicator variable; and with only indicator variable.Results:For foods that are consumed every day or almost every day, the inclusion of the FFQ and/or the indicator variable as covariates resulted in similar percentiles of consumption when compared with the model with no covariates. For episodically consumed foods, the models with FFQ plus indicator variable and with only indicator variable estimated similar percentiles of intake.Conclusions:The use of the indicator variable instead the FFQ appears as a good alternative to estimate usual intake of episodically consumed foods.