Flávia dos Santos Barbosa

Incidência e mortalidade por câncer de tireóide no Brasil

In this study we evaluated the incidence and mortality due to thyroid cancer (TC) in Brazil using incidence data provided by seven Brazilian cancer registries and mortality data from the Brazilian Mortality Information System. Five-year age-adjusted mortality rates were calculated over a 20-year period (1980-1999) for the country as a whole. We have calculated a 3-year age-adjusted incidence rate using data available since 1993. Age-adjusted mortality rates decreased from 0.22/100,000 to 0.28/100,000 (-21%) among males, and from 0.42/100,000 to 0.51/100,000 (-17%) among females. Among males, age-adjusted incidence rates varied from 0.7/100,000 in Belém to 3.0/100,000 in São Paulo. These cities also presented the lowest (0.8/100,000) and the highest (10.9/100,000) age-adjusted incidence rates among females. The downward tendency of mortality is probably explained by an improvement in diagnosis and treatment of TC over the study period, whereas geographical variations in incidence are probably related to availability of medical care resources in the different regions and the quality of cancer registers 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.

Inadequação do consumo de nutrientes entre adolescentes brasileiros

OBJETIVO: Estimar o consumo de energia e nutrientes e a prevalencia de inadequacao da ingestao de micronutrientes entre adolescentes brasileiros. METODOS: Amostra probabilistica composta por 6.797 adolescentes (49,7% do sexo feminino) entre dez e 18 anos de idade foi avaliada no Inquerito Nacional de Alimentacao, 2008-2009. Os fatores de expansao, a complexidade do desenho da amostra e a correcao da variabilidade intrapessoal do consumo foram considerados. A prevalencia de inadequacao de consumo de micronutrientes foi estimada pela proporcao de adolescentes com ingestao abaixo da necessidade media estimada. Para o sodio, estimou-se a prevalencia de consumo acima do valor de ingestao maxima toleravel. RESULTADOS: A media de consumo de energia variou de 1.869 kcal, observada nas adolescentes de 10 a 13 anos, a 2.198 kcal, estimada para os adolescentes de 14 a 18 anos. Os carboidratos forneceram 57% da energia total, os lipidios, 27% e as proteinas, 16%. As maiores prevalencias de inadequacao foram observadas para calcio (> 95%), fosforo (entre 54% e 69%) e vitaminas A (entre 66% e 85%), E (100%) e C (entre 27% e 49%). Mais de 70% dos adolescentes apresentaram consumo de sodio superior a ingestao maxima toleravel. CONCLUSOES: As medias de consumo energetico e a distribuicao de macronutrientes eram adequadas, mas foram observadas elevadas prevalencias de inadequacao no consumo de vitaminas e minerais, destacando-se consumo de sodio muito acima do recomendado, consumo de calcio reduzido e nas adolescentes de 14 a 18 anos foi observada importante inadequacao na ingestao de ferro.

Dietary availability patterns of the brazilian macro-regions

IntroductionEpidemiological studies have raised concerns about the role of dietary patterns on the risk of chronic diseases and also in the formulation of better informed nutrition policies.ObjectiveThe development of a dietary availability patterns according to geographic regions in Brazil.MethodologyThe 2002-2003 Brazilian Household Budget Survey was conducted in 48,470 households. Dietary availability patterns were identified by Principal Component Analysis using as a unit of analysis the surveys Primary Sampling Units (PSUs) and purchased amounts for 21 food groups. Each of the extracted dietary availability patterns was regressed on socioeconomics categories.ResultsThere were no differences in dietary availability patterns between urban and rural areas. In all regions, a rice and beans pattern was identified. This pattern explained 15% to 28% of the variance dependent on the region of the country. In South, Southeast and Midwest regions, a mixed pattern including at least 10 food groups explaining 8% to 16% of the variance. In the North region (Amazon forest included) the first pattern was based on fish and nuts and then it was designed as regional pattern. In multiple linear regression the rice and beans pattern was associated with the presence of adolescents in the households, except for North region, whereas the presence of adolescents was associated with the Regional pattern. A mixed patterns were associated with a higher income and education (p < 0.05), except in the South region.ConclusionThe rice and beans and regional dietary availability patterns, both considered healthy eating patterns are still important in the country. Brazil has taken many actions to improve nutrition as part of their public health policies, the data of the Household Budget Survey could help to recognize the different food choices in the large regions of the country.

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.

Inadequate nutrient intake in Brazilian adolescents

OBJECTIVE To assess energy and nutrient consumption and the prevalence of inadequate micronutrient intake among Brazilian adolescents. METHODS A random sample composed of 6,797 adolescents (49.7% girls), between 10 and 18 years old, was evaluated in the first National Dietary Survey, part of the Household Budget Survey carried out in 2008-2009. Expansion factors, sample complexity design and correction of intraindividual variability were considered. The prevalence of inadequate micronutrient intake was based on the proportion of adolescents with intake below the Estimated Average Requirement (EAR). The prevalence of intake above the Tolerable Upper Intake Level (UL) was estimated for sodium. RESULTS The mean energy intake ranged between 1,869 kcal (10 to 13 year old females) and 2,198 kcal (14 to 18 year old males). Of the total energy intake, 57% came from carbohydrates, 27% from lipids and about 16% from proteins. Inadequacies were higher for calcium (> 95%), phosphorous (54% to 69%) and vitamins A (66% to 85%), E (100%) and C (27% to 49%). More than 70% of adolescents reported sodium intake above the UL. CONCLUSIONS Mean energy consumption and distribution of macro-nutrients were adequate, but prevalence of inadequate vitamin and mineral intake were high and notable consumption of sodium above the recommended levels, low levels of calcium consumption and, in 14 to 18 year old females, important inadequacies in iron intake were found.

Assessing usual dietary intake in complex sample design surveys: the National Dietary Survey

The National Cancer Institute (NCI) method allows the distributions of usual intake of nutrients and foods to be estimated. This method can be used in complex surveys. However, the user must perform additional calculations, such as balanced repeated replication (BRR), in order to obtain standard errors and confidence intervals for the percentiles and mean from the distribution of usual intake. The objective is to highlight adaptations of the NCI method using data from the National Dietary Survey. The application of the NCI method was exemplified analyzing the total energy (kcal) and fruit (g) intake, comparing estimations of mean and standard deviation that were based on the complex design of the Brazilian survey with those assuming simple random sample. Although means point estimates were similar, estimates of standard error using the complex design increased by up to 60% compared to simple random sample. Thus, for valid estimates of food and energy intake for the population, all of the sampling characteristics of the surveys should be taken into account because when these characteristics are neglected, statistical analysis may produce underestimated standard errors that would compromise the results and the conclusions of the survey.

Evaluación del consumo alimentario usual en investigaciones con muestras complejas: pesquisa nacional de alimentación

The National Cancer Institute (NCI) method allows the distributions of usual intake of nutrients and foods to be estimated. This method can be used in complex surveys. However, the user must perform additional calculations, such as balanced repeated replication (BRR), in order to obtain standard errors and confidence intervals for the percentiles and mean from the distribution of usual intake. The objective is to highlight adaptations of the NCI method using data from the National Dietary Survey. The application of the NCI method was exemplified analyzing the total energy (kcal) and fruit (g) intake, comparing estimations of mean and standard deviation that were based on the complex design of the Brazilian survey with those assuming simple random sample. Although means point estimates were similar, estimates of standard error using the complex design increased by up to 60% compared to simple random sample. Thus, for valid estimates of food and energy intake for the population, all of the sampling characteristics of the surveys should be taken into account because when these characteristics are neglected, statistical analysis may produce underestimated standard errors that would compromise the results and the conclusions of the survey.

Estimates of thyroid cancer incidence in Brazil: an approach using polynomial models

This study aimed to estimate thyroid cancer incidence in Brazil in 2006 using polynomial models that take age and birth cohort effects into account in the estimation process. Estimates were based on new cases of thyroid cancer in nine Brazilian cities (Manaus, Palmas, Natal, Recife, Cuiabá, Belo Horizonte, São Paulo, Porto Alegre, and Curitiba) and the Federal District from 1997 to 2001. We estimated 6,066 new cases, of which 1,065 in men and 5,001 in women. The incidence rates were, respectively, 1.16 and 5.27 per 100,000 inhabitants. Rates increased with age in both genders, especially after 30 years. The size and profile of rates according to age and gender indicate that the method yields plausible estimates.

Estimativas de parâmetros no linkage entre os bancos de mortalidade e de hospitalização, segundo a qualidade do registro da causa básica do óbito

The purpose of the study was to compare the linkage parameter estimates between hospitalization and mortality databases, calculated separately for the subsets of deaths from ill-defined causes and deaths from known causes. The databases for deaths from known causes and ill-defined causes were linked to a hospital admissions database. Parameters were estimated using two strategies: (1) first name, last name, and day, month, and year of birth, (2) full name and date of birth. In the first strategy, the estimates for the first and last name were at least 97% in both sets. However, the items day, month, and year of birth produced low values in both sets. In the second strategy there was an important difference between the two groups, with much lower values for full name and especially for date of birth in the group of deaths from ill-defined causes. Our results emphasize the need for pilot studies to evaluate possible internal heterogeneity of databases during the planning stage of linkage projects.