Michelle Alessandra de Castro

Determinantes do consumo de frutas e hortaliças em adolescentes por regressão quantílica

OBJECTIVE To analyze fruit and vegetable intake in adolescents and to identify associated factors. METHODS A population-based cross-sectional study was conducted with a representative sample of 812 adolescents of both sexes in the city of São Paulo, Southeastern Brazil, in 2003. Food consumption was measured with the 24-hour dietary recall. Fruit and vegetable intake was described in percentiles. Quantile regression models were used to investigate the association between this intake and explanatory variables. RESULTS Of all adolescents interviewed, 6.4% consumed the minimum recommendation of 400 g/day of fruits and vegetables and 22% did not consume any type of fruits and vegetables. According to quantile regression models, adjusted for energy intake, age group and sex, per capita household income and head of households level of education were positively associated with fruit and vegetable intake, whereas smoking habit showed a negative association. Income was significantly associated with lower intake percentiles (p20 to p55); smoking, with intermediate percentiles (p45 to p75); and head of households level of education, with higher percentiles (p70 to 95). CONCLUSIONS Fruit and vegetable intake among adolescents of São Paulo was below the Ministry of Healths recommendations and it is influenced by per capita household income, head of familys level of education and smoking habit.OBJETIVO: Analisar o consumo de frutas, legumes e verduras (FLV) de adolescentes e identificar fatores associados. METODOS: Estudo transversal de base populacional com amostra representativa de 812 adolescentes de ambos os sexos de Sao Paulo, SP, em 2003. O consumo alimentar foi medido pelo recordatorio alimentar de 24 horas. O consumo de FLV foi descrito em percentis e para investigar a associacao entre a ingestao de FLV e variaveis explanatorias; foram utilizados modelos de regressao quantilica. RESULTADOS: Dos adolescentes entrevistados, 6,4% consumiram a recomendacao minima de 400 g/dia de FLV e 22% nao consumiram nenhum tipo de FLV. Nos modelos de regressao quantilica, ajustados pelo consumo energetico, faixa etaria e sexo, a renda domiciliar per capita e a escolaridade do chefe de familia associaram-se positivamente ao consumo de FLV, enquanto o habito de fumar associou-se negativamente. Renda associou-se significativamente aos menores percentis de ingestao (p20 ao p55); tabagismo aos percentis intermediarios (p45 ao p75) e escolaridade do chefe de familia aos percentis finais de consumo de FLV (p70 ao p95). CONCLUSOES: O consumo de FLV por adolescentes paulistanos mostrou-se abaixo das recomendacoes do Ministerio da Saude e e influenciado pela renda domiciliar per capita, pela escolaridade do chefe de familia e pelo habito de fumar.

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.

Trans fatty acid intake among the population of the city of São Paulo, Brazil

OBJECTIVE To analyze the monounsaturated and polyunsaturated trans fatty acid intake among the general population. METHODS A cross-sectional study was conducted in São Paulo, Southeastern Brazil, in 2003, on a representative sample of 2,298 male and female subjects, including 803 adolescents (12 to 19 years), 713 adults (20 to 59 years) and 782 elderly people (60 years or over). Food intake was measured using 24-hour recall. Mean trans fatty acid intake was described according to gender and age group. RESULTS The mean trans fatty acid intake was 5.0 g/day (SE = 0.1), accounting for 2.4% (SE = 0.1) of total energy and 6.8% (SE = 0.1) of total lipids. The adolescents had the highest mean intake levels (7.4 g/day; 2.9% of energy) while the adults and the elderly had similar intake (2.2% of energy for both; 6.4% of lipids and 6.5% of lipids, respectively). The mean trans fatty acid intake among adult and elderly women (approximately 2.5% of energy and 7.0% of lipids) was higher than among men in the same age group. The food item with the highest contribution towards trans fatty acids was margarine, accounting for more than 30% of total intake, followed by filled cookies among adolescents and meat among adults and the elderly. CONCLUSIONS The trans fatty acid intake is above the level recommended by the World Health Organization. Replacement of the trans fatty acids in manufactured food items may be an effective measure for reducing trans fatty acid intake in Brazil.OBJETIVO: Analisar o consumo de acidos graxos monoinsaturados e poliinsaturados de configuracao trans na populacao geral. METODOS: Estudo transversal realizado em Sao Paulo, SP, 2003, com amostra representativa de 2.298 individuos, sendo 803 adolescentes (12 a 19 anos), 713 adultos (20 a 59 anos) e 782 idosos (60 anos ou mais), de ambos os sexos. O consumo alimentar foi medido por meio do recordatorio alimentar de 24 horas. Os valores medios de ingestao de acidos graxos trans foram descritos segundo sexo e faixa etaria. RESULTADOS: O consumo medio de acidos graxos trans foi de 5,0g/dia (EP=0,1), correspondendo a 2,4% (EP=0,1) do total calorico e 6,8% (EP=0,1) do total de lipidios. Os adolescentes apresentaram as maiores medias de ingestao (7,4g/dia e 2,9% energia), enquanto os adultos e idosos registraram ingestao semelhante (2,2% energia; 6,4% lipidios e 6,5% lipidios, respectivamente). As medias de consumo de acidos graxos trans entre mulheres adultas e idosas (aproximadamente 2,5% energia e 7,0% lipidios) foram maiores que as medias dos homens de mesma faixa etaria. O alimento de maior contribuicao para o consumo de acidos graxos trans foi a margarina, representando mais de 30% do total ingerido, seguido do biscoito recheado para os adolescentes e da carne bovina para os adultos e idosos. CONCLUSOES: O consumo de acidos graxos trans encontra-se acima do preconizado pela Organizacao Mundial da Saude. A substituicao dos acidos graxos trans dos alimentos industrializados pode ser uma medida eficaz para a reducao do consumo desse tipo de gordura no Brasil.

Precision of usual food intake estimates according to the percentage of individuals with a second dietary measurement.

BACKGROUND Statistical methods for estimating usual intake require at least two short-term dietary measurements in a subsample of the target population. However, the percentage of individuals with a second dietary measurement (replication rate) may influence the precision of estimates, such as percentiles and proportions of individuals below cut-offs of intake. OBJECTIVE To investigate the precision of the usual food intake estimates using different replication rates and different sample sizes. PARTICIPANTS/SETTING Adolescents participating in the continuous National Health and Nutrition Examination Survey 2007-2008 (n=1,304) who completed two 24-hour recalls. STATISTICAL ANALYSES PERFORMED The National Cancer Institute method was used to estimate the usual intake of dark green vegetables in the original sample comprising 1,304 adolescents with a replication rate of 100%. A bootstrap with 100 replications was performed to estimate CIs for percentiles and proportions of individuals below cut-offs of intake. Using the same bootstrap replications, four sets of data sets were sampled with different replication rates (80%, 60%, 40%, and 20%). For each data set created, the National Cancer Institute method was performed and percentiles, CI, and proportions of individuals below cut-offs were calculated. Precision estimates were checked by comparing each CI obtained from data sets with different replication rates with the CI obtained from original data set. Further, we sampled 1,000, 750, 500, and 250 individuals from the original data set, and performed the same analytical procedures. RESULTS Percentiles of intake and percentage of individuals below the cut-off points were similar throughout the replication rates and sample sizes, but the CI increased as the replication rate decreased. Wider CIs were observed at 40% and 20% of replication rate. CONCLUSIONS The precision of the usual intake estimates decreased when low replication rates were used. However, even with different sample sizes, replication rates >40% may not lead to an important loss of precision.

Determinants of fruit and vegetable intake in adolescents using quantile regression

OBJECTIVE To analyze fruit and vegetable intake in adolescents and to identify associated factors. METHODS A population-based cross-sectional study was conducted with a representative sample of 812 adolescents of both sexes in the city of São Paulo, Southeastern Brazil, in 2003. Food consumption was measured with the 24-hour dietary recall. Fruit and vegetable intake was described in percentiles. Quantile regression models were used to investigate the association between this intake and explanatory variables. RESULTS Of all adolescents interviewed, 6.4% consumed the minimum recommendation of 400 g/day of fruits and vegetables and 22% did not consume any type of fruits and vegetables. According to quantile regression models, adjusted for energy intake, age group and sex, per capita household income and head of households level of education were positively associated with fruit and vegetable intake, whereas smoking habit showed a negative association. Income was significantly associated with lower intake percentiles (p20 to p55); smoking, with intermediate percentiles (p45 to p75); and head of households level of education, with higher percentiles (p70 to 95). CONCLUSIONS Fruit and vegetable intake among adolescents of São Paulo was below the Ministry of Healths recommendations and it is influenced by per capita household income, head of familys level of education and smoking habit.OBJETIVO: Analisar o consumo de frutas, legumes e verduras (FLV) de adolescentes e identificar fatores associados. METODOS: Estudo transversal de base populacional com amostra representativa de 812 adolescentes de ambos os sexos de Sao Paulo, SP, em 2003. O consumo alimentar foi medido pelo recordatorio alimentar de 24 horas. O consumo de FLV foi descrito em percentis e para investigar a associacao entre a ingestao de FLV e variaveis explanatorias; foram utilizados modelos de regressao quantilica. RESULTADOS: Dos adolescentes entrevistados, 6,4% consumiram a recomendacao minima de 400 g/dia de FLV e 22% nao consumiram nenhum tipo de FLV. Nos modelos de regressao quantilica, ajustados pelo consumo energetico, faixa etaria e sexo, a renda domiciliar per capita e a escolaridade do chefe de familia associaram-se positivamente ao consumo de FLV, enquanto o habito de fumar associou-se negativamente. Renda associou-se significativamente aos menores percentis de ingestao (p20 ao p55); tabagismo aos percentis intermediarios (p45 ao p75) e escolaridade do chefe de familia aos percentis finais de consumo de FLV (p70 ao p95). CONCLUSOES: O consumo de FLV por adolescentes paulistanos mostrou-se abaixo das recomendacoes do Ministerio da Saude e e influenciado pela renda domiciliar per capita, pela escolaridade do chefe de familia e pelo habito de fumar.

Associations between Dietary Patterns and Self-Reported Hypertension among Brazilian Adults: A Cross-Sectional Population-Based Study

Hypertension is a prevalent cardiovascular disease, the important modifiable risk factor of which is diet. The aim of this study was to derive dietary patterns and to test associations with self-reported hypertension and other characteristics, namely demographic, socioeconomic, and lifestyle factors. Data were obtained from the population-based cross-sectional study titled Health Survey of the City of São Paulo, with a random sample of residents of the city of São Paulo, Brazil, aged older than 20 years of both sexes (n=1,102). In 2008, a structured questionnaire with information about socioeconomic, anthropometric, lifestyle, and dietary factors was applied. Dietary intake was estimated by two 24-hour dietary recalls, adjusted by Multiple Source Method. Dietary patterns were obtained through exploratory principal component factor analysis. Poisson regression was used to assess relationships. Three dietary patterns were identified: prudent (fruits, vegetables, whole-grain bread, white cheeses, juices, reduced-fat milk/nonfat milk), traditional (rice, beans, bread/toast/crackers, butter/margarine, whole milk, coffee/teas, sugar), and modern (sodas, pastries/sandwiches/pizzas, yellow cheeses, pastas, sauces, alcoholic beverages, sweets, processed meats). Hypertension and demographic, socioeconomic, and lifestyle factors, as well as the presence of health insurance, were associated with adherence to one or more identified dietary patterns. These results suggest the existence of a target audience for planning and executing public policies of food and nutrition to prevent and control hypertension.

Sub-relato da ingestão energética e fatores associados em estudo de base populacional

Objetivou-se identificar a prevalencia de sub-relato da ingestao energetica e os fatores associados em amostra de 331 individuos, proveniente do estudo de base populacional Inquerito de Saude no Municipio de Sao Paulo, Brasil. A ingestao energetica foi avaliada pela media de dois recordatorios de 24 horas coletados em dias nao consecutivos. O gasto energetico total foi calculado por equacao preditiva, considerando sub-relatores os individuos com ingestao energetica inferior a 2 desvios-padrao da razao ingestao energetica/gasto energetico total predito. A analise de regressao de Poisson foi utilizada para identificar os fatores associados a subnotificacao. A prevalencia de sub-relatores da ingestao energetica foi de 15,1%, sendo que os individuos com excesso de peso e insatisfeitos com o peso corporal apresentaram maior probabilidade de serem sub-relatores quando comparados aos sem excesso de peso e aos satisfeitos com peso corporal, respectivamente. Conclui-se que esses fatores deveriam ser considerados na elaboracao de tecnicas para melhorar a acuracia do inquerito dietetico.This study aimed to identify the prevalence of underreporting of energy intake and associated factors in a sample of 331 individuals from the population-based Health Survey in the City of São Paulo, Brazil. Energy intake was assessed by averaging two 24-hour recalls collected on nonconsecutive days. Total energy expenditure was calculated by the predictive equation, and under-reporters were defined as individuals with energy intake less than 2 standard deviations from the energy intake/predicted total energy expenditure ratio. Poisson regression was used to identify factors associated with underreporting. Prevalence of underreporting of energy intake was 15.1%, whereas individuals with overweight and dissatisfied with body weight were more likely to underreport when compared to individuals without excess weight and who were satisfied with body weight, respectively. We conclude that these factors should be considered when developing techniques to improve the accuracy of dietary assessment.

Sex differences in serum leptin and its relation to markers of cardiometabolic risk in middle-aged adults: Evidence from a population-based study

OBJECTIVE At elevated concentrations, circulating leptin has been associated with metabolic disturbances, namely insulin resistance, elevated blood pressure, inflammation, and endothelial dysfunction. Because women have higher leptin concentrations than men, it is possible that the effects of leptin on the metabolic profile are different between the sexes. The aim of this study was to investigate whether leptin is one of the key hormones to sex affect differences in the pathophysiology of cardiometabolic risk. METHODS Participants were 178 men and 284 women (average age: 53.9 y), evaluated in a cross-sectional, population-based study performed in Brazil. A structural equation model was used to test a theoretic pathway for the relationship between serum leptin, obesity indicators (body weight and waist circumference), and cardiometabolic risk factors (high-sensitivity C-reactive protein; blood pressure; atherogenic dyslipidemia-total cholesterol/high-density lipoprotein cholesterol (HDL-C) ratio and triacylglycerol /HDL-C ratio; and fasting plasma glucose) stratified by sex. RESULTS In men, increasing 1 SD in serum leptin predicted an increase in 0.731 SD in body weight and in 0.123 SD in C-reactive protein. Serum leptin had positive and significant indirect effects on mens ratios of total cholesterol to HDL-C (β = 0.215) and triacylglycerol to HDL-C (β = 0.209), as well as fasting glucose (β = 0.173). In women, serum leptin predicted an increase of 0.675 SD in body weight and had positive indirect effects on all cardiometabolic risk factors evaluated. CONCLUSIONS Serum leptin was indirectly related to cardiometabolic risk factors and its relation was modest and different between sexes. The effects of leptin through mediation of body weight and waist circumference highlight the importance of weight control to prevent cardiometabolic disorders in middle-aged adults.

Empirically derived dietary patterns: interpretability and construct validity according to different factor rotation methods

This study aimed to investigate the effects of factor rotation methods on interpretability and construct validity of dietary patterns derived in a representative sample of 1,102 Brazilian adults. Dietary patterns were derived from exploratory factor analysis. Orthogonal (varimax) and oblique rotations (promax, direct oblimin) were applied. Confirmatory factor analysis assessed construct validity of the dietary patterns derived according to two factor loading cut-offs (≥ |0.20| and ≥ |0.25|). Goodness-of-fit indexes assessed the model fit. Differences in composition and in interpretability of the first pattern were observed between varimax and promax/oblimin at cut-off ≥ |0.20|. At cut-off ≥ |0.25|, these differences were no longer observed. None of the patterns derived at cut-off ≥ |0.20| showed acceptable model fit. At cut-off ≥ |0.25|, the promax rotation produced the best model fit. The effects of factor rotation on dietary patterns differed according to the factor loading cut-off used in exploratory factor analysis.Objetivou-se investigar os efeitos dos metodos de rotacao fatorial na interpretabilidade e validade de construto de padroes alimentares em uma amostra representativa de 1.102 adultos brasileiros. Os padroes foram derivados por analise fatorial exploratoria. As rotacoes ortogonal (varimax) e obliqua (promax e oblimin direta) foram utilizadas. Avaliou-se a validade de construto dos padroes segundo os pontos de corte de cargas fatoriais: (≥ |0,20| e ≥ |0,25|) por meio de analise fatorial confirmatoria. Indices de qualidade de ajuste do modelo foram analisados. Observaram-se diferencas na composicao e interpretabilidade do primeiro padrao obtido pelas rotacoes varimax e promax/oblimin no ponto de corte ≥ |0,20|. No ponto de corte ≥ |0,25|, nao foram observadas diferencas. Nenhum dos padroes derivados no ponto de corte ≥ |0,20| apresentou qualidade de ajuste aceitavel. No ponto de corte ≥ |0,25|, a rotacao promax obteve o melhor ajuste. Os efeitos das rotacoes nos padroes alimentares diferiram segundo o ponto de corte de carga fatorial utilizado na analise fato-rial exploratoria.