Edna Massae Yokoo

Relationship between ultra-processed foods and metabolic syndrome in adolescents from a Brazilian Family Doctor Program

OBJECTIVE To estimate the association between food intake and metabolic syndrome (MetS). DESIGN Cross-sectional design conducted from July 2006 to December 2007. SETTING Adolescents assisted by the Family Doctor Program (FDP) in Niterói, a metropolitan area in Rio de Janeiro State, Brazil. SUBJECTS Survey of 210 adolescents. Individuals with three or more of the following components of MetS were classified as having this syndrome: TAG ≥ 110 mg/dl; HDL cholesterol < 50 mg/dl for girls aged 12-19 years and boys aged 12-14 years or <45 mg/dl for boys aged 15-19 years; waist circumference ≥75th percentile; serum glucose >100 mg/dl; and blood pressure ≥90th percentile. A semi-quantitative FFQ was used, and foods were grouped as: unprocessed or minimally processed foods (Group 1), processed culinary and food industry ingredients (Group 2) and ultra-processed foods (Group 3). The associations between food consumption and MetS were adjusted for sociodemographic, behavioural and family history covariates and were estimated using generalized estimation equations with the Poisson regression model. RESULTS MetS was diagnosed in 6·7 % of the adolescents; the most frequent diagnostic criteria included the reduction of HDL cholesterol (46·7 %), elevated serum glucose (17·1 %) and the elevation of waist circumference (16·7 %). Crude analysis showed higher average daily intakes of energy, carbohydrates and ultra-processed foods among adolescents with MetS. After statistical adjustment, the intake of ultra-processed foods (≥3rd quartile) remained associated with MetS (prevalence ratio = 2·5; P = 0·012). CONCLUSIONS High consumption of ultra-processed foods was associated with the prevalence of MetS in this adolescents group.

Alimentos más consumidos en Brasil: Pesquisa Nacional de Alimentación 2008-2009

OBJETIVO: Caracterizar o consumo alimentar mais frequente da populacao brasileira. METODOS: Foram analisados dados referentes ao primeiro dia de registro alimentar de 34.003 individuos com dez anos ou mais de idade que responderam ao Inquerito Nacional de Alimentacao, composto por amostra probabilistica da Pesquisa de Orcamentos Familiares 2008-2009. O padrao de consumo foi analisado segundo sexo, grupo etario, regiao e faixa de renda familiar per capita. RESULTADOS: Os alimentos mais frequentemente referidos pela populacao brasileira foram arroz (84,0%), cafe (79,0%), feijao (72,8%), pao de sal (63,0%) e carne bovina (48,7%), destacando-se tambem o consumo de sucos e refrescos (39,8%), refrigerantes (23,0%) e menor presenca de frutas (16,0%) e hortalicas (16,0%). Essa configuracao apresenta pouca variacao quando se consideram os estratos de sexo e faixa etaria; contudo, observa-se que os adolescentes foram o unico grupo etario que deixou de citar qualquer hortalica e que incluiu doces, bebida lactea e biscoitos doces entre os itens mais consumidos. Alimentos marcadamente de consumo regional incluem a farinha de mandioca no Norte e Nordeste e o cha na regiao Sul. Houve discrepâncias no consumo alimentar entre os estratos de menor e maior renda: individuos no quarto de renda mais elevada referiram sanduiches, tomate e alface e aqueles no primeiro quarto de renda citaram os peixes e preparacoes a base de peixe e farinha de mandioca entre os alimentos mais referidos. CONCLUSOES: Existe um padrao basico do consumo alimentar no Brasil que inclui entre os alimentos mais consumidos arroz, cafe, feijao, pao de sal e carne bovina, associado ao consumo regional de alguns poucos itens. Particularmente entre os adolescentes, alimentos ricos em gordura e acucar sao tambem de consumo frequente.

Validation and Calibration of a Semiquantitative Food Frequency Questionnaire Designed for Adolescents

BACKGROUND Epidemiologic studies must have a reliable method for evaluating food intake; therefore, valid, precise, and practical instruments are essential. OBJECTIVE To assess the relative validity and estimate the calibration factors of a semiquantitative food frequency questionnaire (FFQ) for adolescents. DESIGN Validation and calibration study. SUBJECTS/SETTINGS This study enrolled 169 adolescents from Rio de Janeiro, Brazil. A set of three food records was used as the reference method. STATISTICAL ANALYSES PERFORMED The relative validity was analyzed according to weighted kappa values for the quartile categorization of energy and nutrient intakes, Pearson correlation coefficients, and the Bland-Altman method. To estimate the calibration factors for the FFQ, linear regression models, including the food record means as dependent variables and the FFQ estimations as independent variables were developed for boys and girls. RESULTS The weighted kappa values ranged from 0.28 to 0.44 for the raw data and from 0.16 to 0.39 for the deattenuated and energy-adjusted data. The Pearson correlation coefficients ranged from 0.33 to 0.46, and the mean agreement varied from 62% to 143%. The calibration factors estimated for boys ranged from 0.15 to 0.48, and the factors estimated for girls ranged from 0.14 to 0.47. The mean energy and nutrient intakes estimated by the calibrated FFQ were similar to the means estimated by the food records; however, the standard deviations were smaller for the calibrated FFQ estimations. CONCLUSIONS The tested FFQ is a suitable tool for ranking energy and nutrients intake in the studied group. Calibration factors are needed to estimate energy and nutrient intake means and should be used to correct raw data as well as association measurements based on FFQ data.

Macronutrient consumption and inadequate micronutrient intake in adults

OBJECTIVE To estimate energy and nutrient intake and prevalence of inadequate micronutrient intake among Brazilian adults. METHODS Data from the National Dietary Survey, from the 2008-2009 Household Budget Survey, were used. Food consumption was evaluated through food record on two non-consecutive days. A total of 21,003 individuals (52.5% women), between 20-59 years old, participated in the survey. Usual nutrient intake was estimated according to the National Cancer Institute method. The Estimated Average Requirement (EAR) cut-off points were used to determine the prevalence of inadequate micronutrient intake. For manganese and potassium, the Adequate Intake (AI) was used as cut-off. Sodium intake was compared with the Tolerable Upper Intake Level (UL). The probability approach was used to determine the prevalence of inadequate iron intake. The data were analyzed according to the location of the household (urban or rural) and macro regions of Brazil. RESULTS The mean energy intake was 2,083 kcal among men and 1,698 kcal among women. Prevalence of inadequacy equal to or greater than 70% were observed for calcium among men and magnesium, vitamin A, and sodium among both men and women. Prevalence equal to or greater than 90% were found for calcium in women and vitamins D and E in both genders. Prevalence lower than 5% were found for iron in men and for niacin in men and women. In general, prevalence of inadequate intake was higher in the rural area and in the Northeast region. CONCLUSIONS Energy intake was higher among individuals who live in urban areas and in the North region. The greatest risk groups of inadequate micronutrient intake were women and those living in rural areas and in the Northeast region.

Consumo de macronutrientes e ingestão inadequada de micronutrientes em adultos

OBJETIVO: Estimar o consumo de energia e nutrientes e a prevalencia de ingestao inadequada de micronutrientes entre adultos brasileiros. METODOS: Foram analisados dados do Inquerito Nacional de Alimentacao da Pesquisa de Orcamento Familiar 2008-2009. O consumo alimentar foi avaliado por dois dias de registro alimentar nao consecutivos. Um total de 21.003 individuos (52,5% mulheres) entre 20 e 59 anos de idade participou do estudo. A ingestao usual de nutrientes foi estimada pelo metodo proposto pelo National Cancer Institute. As prevalencias de ingestao inadequada de micronutrientes foram obtidas pelo metodo da necessidade media estimada (EAR) como ponto de corte. Para manganes e potassio, a Ingestao Adequada (AI) foi usada como ponto de corte. A ingestao de sodio foi comparada com o nivel de ingestao maximo toleravel (UL). A prevalencia de inadequacao da ingestao de ferro foi determinada por abordagem probabilistica. Os dados foram analisados de acordo com a localizacao do domicilio (area urbana ou rural) e as macrorregioes do pais. RESULTADOS: A media do consumo energetico foi de 2.083 kcal entre os homens e 1.698 kcal entre as mulheres. Prevalencias de inadequacao maiores ou iguais a 70% foram observadas para calcio entre os homens e magnesio, vitamina A, sodio em ambos os sexos. Prevalencias maiores ou iguais a 90% foram encontradas para calcio entre as mulheres e vitaminas D e E em ambos os sexos. Prevalencias menores que 5% foram encontradas para ferro entre os homens e niacina para homens e mulheres. No geral, a prevalencia de ingestao inadequada foi mais acentuada na area rural e na regiao Nordeste. CONCLUSOES: O consumo de energia e maior entre individuos residentes em areas urbanas e da regiao Norte. Os grupos com maior risco de ingestao inadequada de micronutrientes sao as mulheres e os que residem na area rural e na regiao Nordeste.

Water and sugar-sweetened beverage consumption and changes in BMI among Brazilian fourth graders after 1-year follow-up

OBJECTIVE We examined whether drinking water per se is associated with drinking less of other beverages and whether changes in BMI are associated with the intake of water and other beverages. DESIGN Secondary analysis of a randomized trial of fourth graders followed over 1 year. SETTING Public schools in the metropolitan area of Rio de Janeiro, Brazil. SUBJECTS Participants were 1134 students aged 10-11 years. RESULTS At baseline, a higher frequency of water consumption was associated with a greater daily intake of fruit juice (P = 0.02) and a higher daily frequency of milk (P = 0.005). In the intervention group, the baseline frequency of water consumption was negatively associated with weight change over 1 year but without statistical significance (coefficient = -0.08 kg/m2; 95 % CI -0.37, 0.24 kg/m2), whereas fruit juice intake frequency was positively associated with weight change: each increase in fruit juice intake of 1 glass/d was associated with a BMI increase of 0.16 (95 % CI 0.02, 0.30) kg/m2. CONCLUSIONS Our findings do not support a protective effect of water consumption on BMI, but confirm consumption of juice drinks as a risk factor for BMI gain. Students who reported high water consumption also reported high intake of other beverages; therefore, the promotion of water consumption per se would not prevent excessive weight gain.

Fatores socioambientais associados à distribuição espacial de malária no assentamento Vale do Amanhecer, Município de Juruena, Estado de Mato Grosso, 2005

Malaria is a disease with focal distribution. In Brazil, settlement and gold mining areas in the Legal Amazon region present a great concentration of cases. This paper analyzes the spatial distribution of malaria cases taking into consideration environmental and social factors in the Vale do Amanhecer settlement in the municipality of Juruena, Mato Grosso, Brazil. In 2005, 359 autochthonous cases were notified in the settlement. Using the Kernel method, areas of greater and lesser intensities of case numbers were identified. The areas of greater intensity presented 290 cases and those of lesser intensity, 64 cases. The intensity of distribution varied within the settlement, thus indicating areas of great intensity of cases favoring transmission, like gold mining areas. Therefore, although the settlement was considered to be the main focus for malaria, there were specific factors within it that, once identified, could contribute towards the disease control.

Proposta metodológica para o módulo de consumo alimentar pessoal na pesquisa brasileira de orçamentos familiares

The changes that have been happening in the Brazilian epidemiological scenario in the last decades result from deep social and economic modifications that include, among other things, changes in dietary habits. In Brazil, the only study that investigated family food consumption nationally was the National Family Expenditure Study done from 1974 to 1975. Although useful, national food consumption studies are expensive and only a few countries can conduct them regularly. Nonetheless, household budget surveys are important sources of data on the availability of food at home determined by records of foods purchased. Recent changes in consumption habits, particularly eating out, limit the use of data from household budget surveys to estimate food intake. Thus, the Brazilian government suggested that the next household budget survey to be done in 2008-2009 include a module on individual food consumption. Information on individual food intake will be used to supplement the data regarding food purchases. The objective of this study is to report the development of the methodology to be used in the module of individual food consumption of the household budget survey of 2008-2009. Budget data will be combined with intake data to estimate the usual individual food consumption.

Major food sources contributing to energy intake--a nationwide survey of Brazilians aged 10 years and older.

Identification of major sources of energy in the diet helps to implement dietary recommendations to reduce obesity. To determine the food sources of energy consumed by Brazilians, we used the traditional method of ranking energy contribution of selected food groups and also compared days with and without consumption of specific food groups. Analysis was based on two non-consecutive days of dietary record from the Brazilian National Dietary Survey, conducted among 34,003 Brazilians (aged 10 years or more), taking into account the complex design of the survey. Comparison of days with and without consumption gave more consistent results, with sweets and cookies as the most important contributors to energy intake, increasing 992 kJ/d (95% CI 883, 1096) for those days when consumption of cakes, cookies and desserts was reported compared to days without their consumption. Savoury snacks, cheese and sugar-sweetened beverages (SSB) also increase energy intake by about 600 kJ. The only group associated with decreased energy intake was vegetable (-155 kJ; 95% CI -272, -37). Consumption of beans, milk and fruits increased the energy intake by about 210 kJ. In total, the mean energy intake of the group was 8000 kJ. Except for the consumption of vegetables, all of the other ten food groups analysed were associated with increased energy intake. Sweets and cookies may increase the energy intake by 12% and SSB by 7%, indicating that these two groups are major targets for improving healthy eating by reducing energy intake; whereas vegetable intake is associated with the reduction of energy content of the diet.

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.