Marina Campos Araujo

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.

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.

Inadequate nutrient intake among the Brazilian elderly: National Dietary Survey 2008-2009

OBJETIVO: Estimar la prevalencia de ingestion inadecuada de nutrientes en la poblacion anciana brasilena. METODOS: Se analizaron datos de la Pesquisa Nacional de Alimentacion como parte de la Investigacion de Presupuestos Familiares, en 2008-2009. Datos de consumo alimentario individual de 4.322 individuos con 60 anos o mas se obtuvieron por medio de registro alimentario de dos dias no consecutivos. La ingestion habitual para cada nutriente fue estimada por el metodo del National Cancer Institute, cuyos modelos tuvieron como co-variables sexo y region. Las prevalencias de inadecuacion de ingestion de micronutrientes se estimaron segun sexo y region utilizando el metodo de la EAR como punto de corte. RESULTADOS: Elevadas prevalencias de inadecuacion (>50%) se observaron para las vitaminas E, D, A, calcio, magnesio y piridoxina en ambos sexos. En todas las regiones, se observo 100% de inadecuacion de vitamina E. Vitamina D obtuvo porcentajes de inadecuacion proximos a 100% en todas las regiones, excepto para la region Norte. Las prevalencias de inadecuacion de vitamina A fueron superiores a 70% en las regiones Norte, Noreste y Centro-oeste. Calcio y magnesio fueron los minerales con mayor prevalencia de ingestion inadecuada (>80%) en todas las regiones. CONCLUSIONES: Ancianos brasilenos presentaban elevada inadecuacion de ingestion de nutrientes, reconocidos como protectores contra enfermedades cronicas.

Ingestão inadequada de nutrientes na população de idosos do Brasil: Inquérito Nacional de Alimentação 2008-2009

OBJETIVO: Estimar a prevalencia de ingestao inadequada de nutrientes na populacao idosa brasileira. METODOS: Foram analisados dados do Inquerito Nacional de Alimentacao como parte da Pesquisa de Orcamentos Familiares, em 2008-2009. Dados de consumo alimentar individual de 4.322 individuos com 60 anos ou mais foram obtidos por meio do registro alimentar de dois dias nao consecutivos. A ingestao habitual para cada nutriente foi estimada pelo metodo do National Cancer Institute, cujos modelos tiveram como covariaveis sexo e regiao. As prevalencias de inadequacao de ingestao de micronutrientes foram estimadas segundo sexo e regiao utilizando o metodo da EAR como ponte de corte. RESULTADOS: Elevadas prevalencias de inadequacao (> 50%) foram observadas para as vitaminas E, D, A, calcio, magnesio e piridoxina em ambos os sexos. Em todas as regioes, observou-se 100% de inadequacao de vitamina E. Vitamina D obteve percentuais de inadequacao proximos de 100% em todas as regioes, exceto para a regiao Norte. As prevalencias de inadequacao de vitamina A foram superiores a 70% nas regioes Norte, Nordeste e Centro-Oeste. Calcio e magnesio foram os minerais com maior prevalencia de ingestao inadequada (> 80%) em todas as regioes. CONCLUSOES: Idosos brasileiros apresentam elevada inadequacao da ingestao de nutrientes, reconhecidos como protetores contra doencas cronicas.

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.

Independent associations of income and education with nutrient intakes in Brazilian adults: 2008–2009 National Dietary Survey

OBJECTIVE To verify associations of income and education with nutrient intakes in Brazilian adults. DESIGN Data from the population-based National Dietary Survey conducted in 2008-2009. Family per capita income and education levels were categorized into quartiles. Prevalences of inadequate nutrient intakes and excessive intakes of saturated fat and Na were calculated by using the method prescribed by the National Cancer Institute. The Estimated Average Requirement was used as a reference for micronutrient intake. Linear regression models for both the independent and the mutually adjusted associations of education and income with nutrient intakes were tested. Interaction between education and income was tested. SETTING Households (n 13 569) selected using a two-stage cluster sampling design. SUBJECTS Food records for two non-consecutive days were obtained for 21 003 Brazilian adults (aged 20-59 years). RESULTS For most of eleven nutrients, the prevalence of inadequate intake declined with increasing income and education levels; however, it remained high across all income and education quartiles. Excessive intake of saturated fat and low fibre intake increased with both variables. Most nutrients were independently associated with income and education in both sexes. Fe, vitamin B12 and Na intakes among women were associated only with education. There was an interaction between income and education for Na intake in men, P intake in women and Ca intake in both sexes. CONCLUSIONS Education is one important step to improve nutrient intakes in Brazil. Emphasis should be laid on enhancing dietary knowledge and formulating economic strategies that would allow lower-income individuals to adopt a healthy diet.

Adapting the standardised computer- and interview-based 24 h dietary recall method (GloboDiet) for dietary monitoring in Latin America

OBJECTIVE The present study describes the procedure and approaches needed to adapt and harmonise the GloboDiet methodology, a computer- and interview-based 24 h dietary recall, for use in two Latin American pilot countries, Brazil and Mexico. DESIGN About seventy common and country-specific databases on foods, recipes, dietary supplements, quantification methods and coefficients were customised and translated following standardised guidelines, starting from existing Spanish and Portuguese versions. SETTING Brazil and Mexico. SUBJECTS Not applicable. RESULTS New subgroups were added into the existing common food classification together with new descriptors required to better classify and describe specific Brazilian and Mexican foods. Quantification methods were critically evaluated and adapted considering types and quantities of food consumed in these two countries, using data available from previous surveys. Furthermore, the photos to be used for quantification purposes were identified for compilation in country-specific but standardised picture booklets. CONCLUSIONS The completion of the customisation of the GloboDiet Latin America versions in these two pilot countries provides new insights into the adaptability of this dietary international tool to the Latin American context. The ultimate purpose is to enable dietary intake comparisons within and between Latin American countries, support building capacities and foster regional and international collaborations. The development of the GloboDiet methodology could represent a major benefit for Latin America in terms of standardised dietary methodologies for multiple surveillance, research and prevention purposes.

Design of a school randomized trial for nudging students towards healthy diet and physical activity to prevent obesity: PAAPAS Nudge study protocol

Objective: To evaluate the effectiveness of nudge activities at school on the students’ body mass index (BMI). Design: School-based factorial randomized community trial. Setting: Eighteen public schools in the municipality of Duque de Caxias, metropolitan area of Rio de Janeiro, Brazil. Participants and intervention: The 18 schools will be randomized into 4 group arms: group 1—control (without any activity); group 2—will receive educational activities in the classroom; group 3—will receive changes in the school environment (nudge strategies); group 4—will receive educational activities and changes in the school environment. Activities will occur during the 2018 school-year. Main outcome measure(s): The primary (BMI) and secondary (body fat percentage) outcomes will be assessed at baseline and after the study using a portable electronic scale with a segmental body composition monitor. The height will be measured by a portable stadiometer. Analysis: Statistical analyses for each outcome will be conducted through linear mixed models that took into account the missing data and cluster effect of the schools.