Fernanda Baeza Scagliusi

Orthorexia nervosa behavior in a sample of Brazilian dietitians assessed by the Portuguese version of ORTO-15.

BACKGROUND: Orthorexia nervosa (ON) is described as an obsessive pathological behavior characterized by a strong preoccupation with healthy eating and the avoidance of foods or ingredients considered unhealthy by the subject. Although it is still not officially recognized as an eating disorder, previous studies have discussed its frequency in some groups and a fifteen-question test (ORTO-15) was developed elsewhere to assess ON behavior. OBJECTIVE: The present study aimed to evaluate ON behavior in a sample of Brazilian dietitians after testing the psychometric properties of the Portuguese version of ORTO-15. METHODS: A total of 392 dietitians answered an online version of the test. The answers were analyzed regarding ON tendency, according with the scoring grid proposed by its authors. Exploratory factor analysis was performed and internal consistency was assessed. RESULTS: It was found that three questions of the test presented loadings lower than 0.5. The 12 remaining question formed 3 factors with internal consistency of -0.51, 0.63 and 0.47. The answers of the participants to these questions revealed a tendency to orthorexic behavior, mainly regarding aspects such as: making food choices conditioned by worry about health status, evaluating food rather from nutritional quality than from its taste, believing that consuming healthy food may improve appearance, discrediting the influence of mood on eating behavior and banning food choices considered by them as eating transgressions. CONCLUSION: There is no evidence of the validity and reliability of the ORTO-15 with the initial psychometric evaluation performed. Further analyses are needed. Nevertheless, it was possible to observe a high frequency of orthorexic behavior among the studied Brazilian dietitians. However, additional studies are needed to completely understand dietitians behavior toward ON.

Comportamento de risco para transtorno alimentar em universitárias brasileiras

CONTEXTO: Comportamentos de risco para transtornos alimentares envolvem atitudes e praticas inadequadas para com o alimento e o peso e podem ser avaliados com base em instrumentos validados. OBJETIVOS: Avaliar comportamento de risco para transtornos alimentares em universitarias brasileiras das cinco regioes do pais. METODOS: 2.483 universitarias responderam ao Teste de Atitudes Alimentares (EAT-26) nas cinco regioes. A pontuacao no teste foi comparada entre as regioes por meio do teste qui-quadrado. Possiveis associacoes ou correlacoes com curso de graduacao, idade, estado nutricional, renda individual e escolaridade do chefe da familia foram avaliadas pelos coeficientes de Pearson e Spearman. Uma analise de covariância comparou o escore do EAT entre as regioes. RESULTADOS: A frequencia de comportamento de risco para transtornos alimentares variou de 23,7% a 30,1% nas cinco regioes e nao houve diferenca na pontuacao media do EAT e na proporcao de escores positivos para comportamento de risco entre as regioes. Nao houve forte correlacao do escore do EAT com nenhuma das variaveis. CONCLUSAO: Universitarias brasileiras apresentam alta frequencia de comportamentos de risco para TA em todas as regioes do pais. Medidas de prevencao devem ser planejadas para a populacao jovem feminina do Brasil.

Development and Validity of the Disordered Eating Attitude Scale (Deas)

The aim of this study was to develop and validate the Disordered Eating Attitude Scale to measure disordered eating attitudes, defined as abnormal beliefs, thoughts, feelings, behaviors, and relationship regarding food. Exploratory factor analysis was performed and internal consistency assessed in a sample of female university students (N = 196). Convergent validity was acceptable based on statistically significant correlations with the Eating Attitude Test–26 and Restraint Scale. Known-groups validity was determined by comparing the student samples mean scores against scores of an eating disorder group (N = 51). The Disordered Eating Attitude Scale comprises 25 questions and five subscales explaining 54.3% of total variance. The total scores differentiated student, bulimia, and anorexia groups. The scale should prove useful for evaluating eating attitudes in various population groups and eating disordered patients.

Psychometric evaluation of the Disordered Eating Attitude Scale (DEAS). English version

UNLABELLEDnEating attitudes are defined as beliefs, thoughts, feelings, behaviors and relationship with food. They could influence peoples food choices and their health status.nnnOBJECTIVEnThis study aimed to adapt from Portuguese to English the Disordered Eating Attitude Scale (DEAS) and evaluate its validity and reliability. The original scale in Portuguese was translated and adapted into English and was applied to female university students of University of Minnesota-USA (n=224). Internal consistency was determined (Cronbachs Alpha). Convergent validity was assessed by correlations between Eating Attitude Test-26 (EAT-26) and Restrain Scale (RS). Reliability was evaluated applying twice the scale to a sub-sample (n=30). The scale was back translated into Portuguese and compared with the original version and discrepancies were not found. The internal consistency was .76. The DEAS total score was significantly associated with EAT-26 (r=0.65) and RS (r=0.69) scores. The correlation between test-retest was r=0.9. The English version of DEAS showed appropriate internal consistency, convergent validity and test-retest reliability and will be useful to assess eating attitudes in different population groups in English spoken countries.

Under-reporting of food intake is frequent among Brazilian free-living older persons: a doubly labelled water study†

The assessment of food intake is essential for the development of dietetic interventions. Accuracy is low when intake is assessed by questionnaires, the under-reporting of food intake being frequent. Most such studies, however, were performed in developed countries and there is little data about the older population of developing nations. This study aimed to verify the total energy expenditure (TEE) of independent older Brazilians living in an urban area, through the doubly labelled water (DLW) method and to compare it with the reported energy intake obtained through the application of a food frequency questionnaire (FFQ). Initially, 100 volunteers aged from 60 to 75 years had their body composition determined by dual-energy X-ray absorptiometry (DEXA). Five volunteers of each quartile of body fat percentage had their energy expenditure determined by DLW. The mean age of the subjects included in this phase of the study was 66.4 +/- 3.5 years, and ten of the subjects were men. The mean TEE was 2565 +/- 614 and 2154 +/- 339 kcal.day(-1) for men and women, respectively. The Physical Activity Level (PAL) was 1.58 +/- 0.31 and 1.52 +/- 0.22, respectively. Under-reporting of food intake was highly prevalent, with a mean percentage of reported intake in relation to measured TEE of -17.7%. Thus, under-reporting of food intake is highly prevalent among Brazilian independent older persons. The DLW method is an important tool in nutritional studies and its use is to be recommended in developing countries.

Validation of an Adapted Version of the Nutrition Environment Measurement Tool for Stores (NEMS-S) in an Urban Area of Brazil

OBJECTIVEnTo validate an adapted instrument that assesses the nutritional environment of food stores in Brazilian urban areas.nnnMETHODSnThe instrument measured aspects of food environment such as availability, prices, and quality. The Harvard Healthy Eating Pyramid and the degree of processing were used to define healthy foods. The sample included 44 food stores in 3 census tracts in the city of Santos. Inter-rater reliability and stability coefficient were obtained with measurements performed by different individuals at different times. Internal consistency and construct validity were assessed by Cronbach α and the known-groups comparison method, respectively.nnnRESULTSnInter-rater reliability was high. The mean intra-class correlation coefficient was 0.98 and the mean kappa was 0.77. Cronbach α values ranged from .68 to .93.nnnCONCLUSIONS AND IMPLICATIONSnThe instrument can be useful in the development of interventions to promote healthy eating through actions focused on healthy food availability in Brazilian communities.

Disordered eating among Brazilian female college students

O estudo investigou fatores socioeconomicos e nutricionais associados ao comer transtornado em universitarias brasileiras (n = 2.489). Modelos de regressao de Poisson com variância robusta estimaram razoes de prevalencia de fatores associados ao comer transtornado - avaliado por questoes do Teste de Atitudes Alimentares e da Disordered Eating Attitude Scale. Encontrou-se que 40,7% faziam regime para emagrecer; 35,6% usavam dieta ou metodos compensatorios; 23,9% pulavam refeicoes e 12,6% ficavam a base de liquidos ou sem comer para emagrecer; e 3,3% vomitavam. Ajustado por idade e regiao, ficar sem comer ou so com liquidos e pular refeicoes associaram-se positivamente ao estado nutricional. Compensacao e regimes associaram-se positivamente a escolaridade do chefe de familia. O comer transtornado foi frequente, sendo que ficar sem comer e pular refeicoes foram mais prevalentes naquelas com sobrepeso/obesidade; e compensacao e regimes menos prevalentes naquelas com chefes de familia com menor escolaridade. Estrategias de prevencao e educacao alimentar sao necessarias para diminuir a frequencia destes comportamentos.This study aimed to investigate the socioeconomic and nutritional factors associated with disordered eating among Brazilian female college students (n = 2,489). Prevalence ratios of risk factors were calculated using Poisson regression models with robust variance based on responses to selected questions from the Eating Attitude Test and Disordered Eating Attitude Scale. It was found that 40.7% of students were dieting, 35.6% were using diet or compensatory methods, 23.9% skipping meals, 12.6% not eating or just drinking liquids, and 3.3%, vomiting to lose weight. A positive association was found between not eating or just drinking liquids and skipping meals and nutritional status after adjustment for age and region. A positive association was found between compensatory methods and dieting and education level of the head of the family. Disordered eating behaviors were frequent, and not eating and skipping meals were more prevalent among overweight/obese students; compensatory methods and dieting were less prevalent among students from families whose head had up to only four years of education. Prevention strategies and food education are necessary in order to decrease the prevalence of these behaviors.O objetivo do presente estudo foi avaliar o impacto do Programa Agua para Todos (PAT), implantado no Estado da Bahia, Brasil, por ampliar a cobertura do saneamento basico em areas de maior vulnerabilidade. Foram selecionados 224 municipios com informacoes vitais adequadas. Foi utilizado um desenho de estudo antes-e-depois controlado, efetuando uma analise de regressao multivariada para dados em painel com resposta binomial negativa a efeitos fixos do ano 2005 ate 2008. A cobertura do PAT, como variavel continua, esteve associada negativamente (p < 0,01) com a taxa de mortalidade em menores de cinco anos. Os municipios com uma cobertura ≥ 10% tiveram uma reducao de 39% (p < 0,05) na mortalidade por diarreia, de 14% (p < 0,01) na taxa de mortalidade em menores de cinco anos e de 6% (p < 0,05) nas internacoes hospitalares, em comparacao com municipios sem cobertura ou com cobertura menor, ajustando-se pelas covariaveis. Nao teve efeito na mortalidade por causas externas, utilizada como controle. Programas de saneamento basico, focalizados em areas de maior vulnerabilidade, podem ter um grande impacto na reducao das desigualdades em saude.

Factors associated with overweight in children living in the neighbourhoods of an urban area of Brazil

OBJECTIVEnThe present study aimed to investigate the individual and family determinants of being overweight among children younger than 10 years of age.nnnDESIGNnCross-sectional survey. Direct data on childrens age, food intake, physical activity, type of transportation used and anthropometric measurements, as well as the education level of the mothers, were collected by trained interviewers.nnnSETTINGnPopulation-based study in the city of Santos, Brazil.nnnSUBJECTSnA total of 531 children under 10 years of age (302 aged <6 years, 229 aged ≥6 years), living in the city of Santos.nnnRESULTSnThe overall prevalence of overweight and obesity (BMI-for-age Z-score >1) was 35·4 % for children under 6 years and 38·9 % for children aged 6-10 years. The socio-economic status of the family was associated with being overweight for both age groups. Logistic regression analysis showed that the lower the socio-economic status, the higher the likelihood of being overweight, among both younger children (OR = 7·73; P = 0·02) and older children (OR = 1·98; P = 0·04). The use of active transportation was associated with a lower likelihood of being overweight, but only among younger children (OR = 1·70; P = 0·05).nnnCONCLUSIONSnSocio-economic status seems to be an important individual-level determinant of overweight in children. Public policies should consider promoting the use of active transportation, as the results showed it to have a positive effect on reducing overweight issues. The high prevalence of overweight in younger children suggests that this age group should be a priority in health-promoting interventions.

Ortorexia nervosa: reflexões sobre um novo conceito

Orthorexia nervosa is a new term described as an obsessive pathological behavior characterized by fixation on healthy eating. It has not yet been officially recognized as an eating disorder, but its concept, characteristics, interactions and symptoms have been discussed. This work presents a review of the articles published on the theme since 1997, when orthorexic behavior was first described. Similarities and differences between orthorexic behavior and the more common eating disorders, such as anorexia nervosa and bulimia nervosa, are discussed. To date, one instrument was developed and validated to detect orthorexic behavior. Studies indicate that some groups are more vulnerable to orthorexia nervosa: medical students, physicians, dietitians, individuals with anxiety symptoms, obsessive-compulsive individuals and those who overvalue a perfect body. The discussion on orthorexia nervosa is based on analyzing the concepts of eating attitude and healthy eating, and seeks a biopsychosocial focus for proper eating in addition to a physiological focus. To date, there are no studies about orthorexia nervosa in Brazil. Nevertheless, this subject is worthy of discussion since health professionals should be made aware of the existence of this deviant behavior and its possible consequences, not only for someones physical and emotional health, but also for the understanding of healthy eating.Orthorexia nervosa is a new term described as an obsessive pathological behavior characterized by fixation on healthy eating. It has not yet been officially recognized as an eating disorder, but its concept, characteristics, interactions and symptoms have been discussed. This work presents a review of the articles published on the theme since 1997, when orthorexic behavior was first described. Similarities and differences between orthorexic behavior and the more common eating disorders, such as anorexia nervosa and bulimia nervosa, are discussed. To date, one instrument was developed and validated to detect orthorexic behavior. Studies indicate that some groups are more vulnerable to orthorexia nervosa: medical students, physicians, dietitians, individuals with anxiety symptoms, obsessive-compulsive individuals and those who overvalue a perfect body. The discussion on orthorexia nervosa is based on analyzing the concepts of eating attitude and healthy eating, and seeks a biopsychosocial focus for proper eating in addition to a physiological focus. To date, there are no studies about orthorexia nervosa in Brazil. Nevertheless, this subject is worthy of discussion since health professionals should be made aware of the existence of this deviant behavior and its possible consequences, not only for someones physical and emotional health, but also for the understanding of healthy eating.

Relative validity of a food-frequency questionnaire developed to assess food intake of schoolchildren living in the Brazilian Western Amazon

This study aimed to assess the relative validity of a food frequency questionnaire (FFQ) developed to assess food intake of schoolchildren from the Brazilian Western Amazon. The dietary intakes of 61 schoolchildren, aged between six and nine 9 years, were measured using two 24-hour dietary recalls and one FFQ, conducted with the childrens, mother or guardians. Validity of the FFQ compared to the mean of the two dietary recalls was assessed using Pearsons correlation coefficient adjusted for attenuation and energy intake, Bland & Altman plots and evaluation of agreement levels between the two assessment methods. Energy-adjusted and deattenuated correlation coefficients ranged from -0.03 for vitamin C, to 0.93 for calcium. The mean coefficient was 0.46. The mean proportion of subjects classified within one quintile by the two methods was 66%. The Bland & Altman plots indicated good agreement for almost all nutrients, with a mean limit of agreement of 108%. These results indicate that, although there was a lack of accuracy for certain nutrients, such as vitamins A and C, the FFQ ensures reliable estimates of intake of most nutrients.