Patricia Constante Jaime

Do school based food and nutrition policies improve diet and reduce obesity

OBJECTIVE To review the effectiveness of school food and nutrition policies world wide in improving the school food environment, students dietary intake, and decreasing overweight and obesity. METHODS Systematic review of published and unpublished literature up to November 2007 of three categories of nutrition policy; nutrition guidelines, regulation of food and/or beverage availability, and price interventions applied in preschools, primary and secondary schools. RESULTS 18 studies met the inclusion criteria. Most evidence of effectiveness was found for the impact of both nutrition guidelines and price interventions on intake and availability of food and drinks, with less conclusive research on product regulation. Despite the introduction of school food policies worldwide few large scale or national policies have been evaluated, and all included studies were from the USA and Europe. CONCLUSION Some current school policies have been effective in improving the food environment and dietary intake in schools, but there is little evaluation of their impact on BMI. As schools have been proposed worldwide as a major setting for tackling childhood obesity it is essential that future policy evaluations measure the long term effectiveness of a range of school food policies in tackling both dietary intake and overweight and obesity.

Monitoramento de fatores de risco para doenças crônicas por entrevistas telefônicas

OBJETIVO: Descrever metodos e resultados iniciais de sistema de monitoramento de fatores de risco para doencas cronicas nao transmissiveis por meio de entrevistas telefonicas. METODOS: Estudou-se amostra probabilistica (n=2.122) da populacao adulta do Municipio de Sao Paulo residente em domicilios conectados a rede de telefonia fixa, com amostragem realizada em duas etapas: sorteio de linhas telefonicas e sorteio do morador do domicilio a ser entrevistado. Foi aplicado questionario para investigar caracteristicas demograficas e socioeconomicas, padrao de alimentacao e de atividade fisica, consumo de cigarros e de bebidas alcoolicas, peso e altura recordados e auto-referencia a diagnostico medico de hipertensao arterial e diabetes, entre outros quesitos. Foram calculadas estimativas sobre a prevalencia de fatores de risco selecionados para doencas cronicas nao transmissiveis para a populacao adulta com telefone e para a populacao adulta total do municipio. Neste ultimo caso, populacao total, foram aplicados a amostra fatores de ponderacao que levaram em conta diferencas demograficas e socioeconomicas entre a populacao com telefone e a populacao total do municipio. RESULTADOS: Foram observadas diferencas substanciais entre os sexos quanto a frequencia da maioria dos fatores de risco estudados, sendo significativamente mais frequentes em homens o consumo insuficiente de frutas e hortalicas, o consumo excessivo de bebidas alcoolicas e o excesso de peso; e nas mulheres foram mais frequentes o sedentarismo e a hipertensao. Possibilidades adicionais de estratificacao da prevalencia de fatores de risco permitidas pelo sistema de monitoramento foram ilustradas a partir de exemplos abrangendo faixa etaria, nivel de escolaridade e area de residencia na cidade dos entrevistados. CONCLUSOES: O desempenho do sistema de monitoramento, avaliado a partir da representatividade e confiabilidade das estimativas obtidas e do custo por entrevista realizada, mostrou-se adequado e, de modo geral, superior a sistemas equivalentes existentes em paises desenvolvidos. O custo por entrevista realizada foi oito vezes inferior ao custo estimado por sistemas semelhantes existentes em paises desenvolvidos e quatro a oito vezes inferior ao custo de inqueritos domiciliares tradicionais realizados no Municipio de Sao Paulo.OBJECTIVE To describe methods and initial findings of a surveillance system of risk factors for chronic non-communicable diseases (CNCDs) based on telephone interviews. METHODS Interviews undertaken in a random sample of the adult population of the Municipality of Sao Paulo living in households with telephone. Sampling was done in two steps and included the random selection of households and the random selection of the household member to be interviewed. The systems questionnaire investigated demographic and socioeconomic characteristics, food consumption and physical activity patterns, smoking, consumption of alcoholic beverages, recalled weight and height and reported medical diagnoses of hypertension and diabetes, among other topics. Prevalence estimates of selected risk factors for CNCDs were calculated for the adult population with telephone and for the citys entire adult population. In this last case, we applied sample weighting factors that took into account demographic and socioeconomic differences between the adult population with telephone and the entire adult population of the municipality. RESULTS Strong differences between sexes were found for most risk factors: low consumption of fruit and vegetables, high consumption of alcohol and overweight were more frequent among men while sedentary lifestyle and hypertension were more frequent among women. Additional possibilities of stratification of risk factor prevalences allowed by the surveillance system are illustrated using age groups, schooling, and place of residence in the city. CONCLUSIONS System performance was considered as good and was better than the performance observed in similar systems operating in developed countries when evaluated with basis on the representativeness and reliability of the estimates and on costs. The cost per concluded interview was eight times lower than the cost usually seen in similar systems in developed countries and four to eight times lower than the cost of traditional household surveys undertaken in the city of Sao Paulo.

Fruit and vegetable intake by Brazilian adults, 2003.

This study estimated indicators of fruit and vegetable intake by Brazilian adults and examined the influence of demographic and socioeconomic variables on the consumption of these foods. We used the following indicators: daily fruit intake, daily vegetable intake, and daily consumption of five or more servings of fruits and vegetables per day. Only 41.0% of adults reported daily fruit intake, while 30.0% reported daily vegetable intake. Fruit and vegetable intake was more common in urban as compared to rural areas and increased in both genders with age, schooling, and number of household goods. We conclude that initiatives to promote fruit and vegetable consumption are necessary for the country as a whole, but special attention should be given to younger individuals, males, rural communities, and groups with less schooling and lower income.

Methodology to evaluation the habitual physical activity in men aged 50 years or more

OBJETIVO: Descrever a metodologia de avaliacao da atividade fisica habitual, utilizanda em uma pesquisa em populacao masculina, por meio de um questionario ja validado. METODOS: O questionario de atividade fisica habitual de Baecke, traduzido para a lingua portuguesa e, a seguir, foi realizado o back translation. Em sua versao final o questionario foi aplicado em estudo epidemiologico transversal, realizado com 326 homens com idade igual ou superior a 50 anos. A consistencia interna entre as questoes foi analisada pelo a de Cronbach e foram calculados os coeficientes de correlacao de Spearman entre os escores de atividade fisica habitual, bem como os coeficientes de correlacao parcial, ajustados por idade, indice de massa corporal e escolaridade. RESULTADOS: A consistencia interna mostrou-se satisfatoria nas magnitudes de atividade fisica ocupacional e exercicios fisicos no lazer. Foram obtidas correlacoes significativas entre todos os escores de atividades fisicas com o escore total de atividade fisica habitual, independente da idade, escolaridade e indice de massa corporal. CONCLUSOES: O questionario Baecke mostrou-se um instrumento pratico para avaliar a atividade fisica habitual, aliando rapidez na aplicabilidade e facilidade no entendimento para as respostas, sendo indicado para estudos epidemiologicos no Brasil.OBJECTIVE To describe the methodology for evaluating habitual physical activity that was adopted for a survey among the male population utilizing a questionnaire validated earlier. METHODS The Baecke questionnaire on habitual physical activity was translated into Portuguese and then back-translated into English by two anglophone teachers. The final version of the questionnaire was applied in a cross-sectional epidemiological study done on 326 men aged 50 years or over. The internal consistency among the questions was evaluated using the Cronbach a statistic. The Spearman correlation coefficients between the habitual physical activity scores were calculated. Partial correlation coefficients with adjustments for age, body mass index and schooling were also calculated. RESULTS There was satisfactory internal consistency in relation to the magnitudes of occupational physical activity and leisure-time physical exercises. Significant correlation was obtained between all the physical activity scores and the total habitual physical activity score, independent of age, body mass index and schooling. CONCLUSIONS The Baecke questionnaire was found to be a practical instrument for assessing habitual physical activity that is quickly applied and easily understood, and it is recommended for epidemiological studies in Brazil.

Fatores associados ao consumo de frutas e hortaliças no Brasil, 2006

OBJECTIVE To estimate the frequency of fruit and vegetable consumption and associated factors. METHODS A total of 54,369 individuals aged > or = 18 years living in Brazilian state capitals and the Federal District in 2006 were interviewed through the system Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL--telephone-based surveillance of risk and protective factors for chronic diseases). The food consumption indicators used were regular intake of fruits and vegetables (> or = 5 days/week) and adequate intake (> or = 5 times/day). The prevalence of the indicators and their confidence intervals, stratified according to sex, were calculated. To analyze associations between sociodemographic variables, crude odds ratios were calculated and then adjusted for sex, age, schooling level and marital status. RESULTS Less than half of the individuals said that they regularly consumed fruits (44.1%) or vegetables (43.8%), while 23.9% said they regularly consumed both fruits and vegetables. Adequate intake was reported by 7.3% of the interviewees. Fruit and vegetable consumption varied between the cities studied, was greater among women and increased with increasing age and schooling level. CONCLUSIONS Initiatives for promoting fruit and vegetable consumption need to address both the whole population and, especially, cities in the Northern and Northeastern regions of Brazil, young people, men and the population strata of low schooling level.OBJETIVO: Estimar a frequencia do consumo de frutas e hortalicas e fatores associados. METODOS: Foram estudados 54.369 individuos com idade >18 anos, entrevistados pelo sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas por Inquerito Telefonico (VIGITEL) nas capitais brasileiras e Distrito Federal, em 2006. Os indicadores do consumo alimentar foram: consumo regular (>5 dias/semana) de frutas e hortalicas e consumo adequado (>5 vezes/dia). Calculou-se a prevalencia dos indicadores e intervalos de confianca, estratificada por sexo. Para analisar a associacao das variaveis sociodemograficas foram calculados odds ratio bruta e ajustada por sexo, idade, escolaridade e estado civil. RESULTADOS: Menos da metade dos individuos referiu consumo regular de fruta (44,1%) ou hortalicas (43,8%), enquanto 23,9% referiram consumo regular de frutas e hortalicas em conjunto; o consumo adequado foi referido por 7,3% dos entrevistados. O consumo de frutas e hortalicas variou entre as cidades estudadas, foi maior entre as mulheres e aumentou com a idade e escolaridade. CONCLUSOES: Iniciativas de promocao do consumo de frutas e hortalicas devem atender a populacao como um todo, especialmente as cidades das regioes Norte e Nordeste, aos jovens, aos homens e aos estratos populacionais com baixa escolaridade.

Investigating Environmental Determinants of Diet, Physical Activity, and Overweight among Adults in Sao Paulo, Brazil

There is worldwide recognition that the burden of noncommunicable diseases (NCDs) and obesity-related health problems is rapidly increasing in low- and middle-income countries. Environmental determinants of obesity are likely to differ between countries, particularly in those undergoing rapid socioeconomic and nutrition transitions such as Brazil. This study aims to describe some built environment and local food environment variables and to explore their association with the overweight rate and diet and physical activity area-level aggregated indicators of adults living in the city of Sao Paulo, the largest city in Brazil. This formative study includes an ecological analysis of environmental factors associated with overweight across 31 submunicipalities of the city of Sao Paulo using statistical and spatial analyses. Average prevalence of overweight was 41.69% (95% confidence interval 38.74, 44.64), ranging from 27.14% to 60.75% across the submunicipalities. There was a wide geographical variation of both individual diet and physical activity, and indicators of food and built environments, favoring wealthier areas. After controlling for area socioeconomic status, there was a positive correlation between regular fruits and vegetables (FV) intake and density of FV specialized food markets (r = 0.497; p < 0.001), but no relationship between fast-food restaurant density and overweight prevalence was found. A negative association between overweight prevalence and density of parks and public sport facilities was seen (r = −0.527; p < 0.05). Understanding the relationship between local neighborhood environments and increasing rates of poor diet, physical activity, and obesity is essential in countries undergoing rapid economic and urban development, such as Brazil, in order to provide insights for policies to reduce increasing rates of NCDs and food access and health inequalities.

Neighborhood socioeconomic characteristics and differences in the availability of healthy food stores and restaurants in Sao Paulo, Brazil

Differential access to healthy foods has been hypothesized to contribute to health disparities, but evidence from low and middle-income countries is still scarce. This study examines whether the access of healthy foods varies across store types and neighborhoods of different socioeconomic statuses (SES) in a large Brazilian city. A cross-sectional study was conducted in 2010-2011 across 52 census tracts. Healthy food access was measured by a comprehensive in-store data collection, summarized into two indexes developed for retail food stores (HFSI) and restaurants (HMRI). Descriptive analyses and multilevel models were used to examine associations of store type and neighborhood SES with healthy food access. Fast food restaurants were more likely to be located in low SES neighborhoods whereas supermarkets and full service restaurants were more likely to be found in higher SES neighborhoods. Multilevel analyses showed that both store type and neighborhood SES were independently associated with in-store food measures. We found differences in the availability of healthy food stores and restaurants in Sao Paulo city favoring middle and high SES neighborhoods.

Prevalência de sobrepeso e obesidade abdominal em indivíduos portadores de HIV/AIDS, em uso de terapia anti-retroviral de alta potência

OBJECTIVE: To evaluate the nutritional status of HIV/AIDS patients treated with highly active antiretroviral therapy, according to gender and T CD4 + lymphocyte count. MATERIAL AND METHODS: This was a cross-sectional study, including 223 individuals (171 men and 52 women) treated with protease inhibitors, aged between 20 and 59 years. This study was developed at a HIV/AIDS reference treatment center in the city of Sao Paulo. Anthropometric data, including current weight, height, and waist circumference (WC) were collected. The body mass index (BMI) was calculated as the ratio between weight (kg) and the square of the height (m2), according to World Health Organization classification criteria. Patients were divided into three groups according to T CD4+ lymphocyte count: 350 (cel/mm3). RESULTS: The prevalence of overweight was 30.5% and of central obesity was 12.6%. Women presented a higher prevalence of overweight (36.5%) and of central obesity (32.7%) when compared to men (28.7% and 6.4% respectively). The prevalence of underweight was higher among women than in men, respectively 7.7% and 2.3%. Categories of T CD4 + lymphocyte counts were not associated with overweight and central obesity in this population. CONCLUSION: Women presented a higher prevalence of underweight, overweight and central obesity in relation to men. Obesity is the most important deviation of nutritional status, overcoming malnutrition, in these HIV/AIDS patients treated with highly active antiretroviral therapy.

Fatores associados ao consumo de frutas, legumes e verduras em adultos da cidade de São Paulo

OBJETIVO: Describir la frecuencia de consumo de frutas, legumbres y verduras por adultos y analisar los factores asociados a su consumo. METODOS: Se realizo estudio transversal entre octubre y diciembre de 2003 en el municipio de Sao Paulo (Sureste de Brasil). Se realizaron encuestas telefonicas en muestras probabilisticas de la poblacion adulta (³18 anos) residente en domicilios con servicio de lineas fijas de telefono, totalizando 1.267 mujeres y 855 hombres. La frecuencia del consumo de frutas, legumbres y verduras fue medida por medio de una guia con preguntas cortas y simples. En la evaluacion de los factores asociados al consumo, se realizo analisis de regresion linear multivariada y jerarquizada, con variables sociodemograficas en el primer nivel jerarquico, de comportamiento en el segundo y relacionadas con el patron de alimentacion en el tercer nivel. RESULTADOS: La frecuencia de consumo de frutas, legumbres y verduras fue mayor entre las mujeres. En los dos sexos se verifico que la frecuencia de consumo aumentaba con la edad y la escolaridad del individuo. Entre las mujeres que informaron haber realizado dieta el ano anterior hubo mayor consumo de frutas, legumbres y verduras. El consumo de alimentos que indican un patron de consumo no saludable como azucares y grasas se mostro inversamente asociado al consumo de frutas, legumbres y verduras en los dos sexos. CONCLUSIONES: El consumo de frutas, legumbres y verduras de la poblacion adulta residente en Sao Paulo fue mayor entre las mujeres, estando influenciado por la edad, la escolaridad y la dieta.OBJECTIVE To describe the frequency of fruit and vegetable intake by adults and to assess factors associated with this frequency. METHODS Cross-sectional study, carried out between October and December 2003 in the municipality of São Paulo, Southeastern Brazil. Telephone interviews were conducted on a probabilistic sample of the adult population (>18 years) living in the city of Sao Paulo and with access to land telephone lines, totaling 1,267 women and 855 men. Frequency of fruit and vegetable intake was obtained by means of a questionnaire containing short, simple questions. Association of different factors with fruit and vegetable intake was assessed by multivariate linear regression using a hierarchic model with sociodemographic variables in the first hierarchical level, behavioral variables in the second, and diet--related variables in the third. RESULTS Frequency of fruit and vegetable intake was higher among women. For both sexes, frequency of intake increased with age and schooling. Intake was also higher among women who reported having been on a diet during the last year. Consumption of foods indicative of an unhealthy diet such as sugars and fats was--inversely associated with fruit and vegetable intake among subjects of both sexes. CONCLUSIONS Fruit and vegetable intake in the adult population of Sao Paulo was higher among women, and was influenced by age, schooling, and diet.

Validade de indicadores do consumo de alimentos e bebidas obtidos por inquérito telefônico

OBJETIVO: Avaliar a reprodutibilidade e a validade de indicadores do consumo de alimentos e bebidas obtidos por sistema de vigilância baseado em inqueritos telefonicos. METODOS: Foram realizadas analises de reprodutibilidade e validade em duas subamostras aleatorias (n=112 e n=109, respectivamente) da amostra total (N=2.024) de adultos (>18 anos) estudada pelo sistema em 2005 no municipio de Sao Paulo. Os indicadores avaliados incluiram fatores de protecao (consumo diario ou quase diario de frutas e hortalicas) e de risco (consumo diario ou quase diario de refrigerantes, consumo habitual de alimentos fontes de gorduras saturadas de origem animal, e consumo abusivo de bebidas alcoolicas) para doencas cronicas. Para a analise de reprodutibilidade compararam-se resultados obtidos a partir da entrevista telefonica original do sistema e de outra entrevista identica repetida apos sete a 15 dias. Para a analise de validade compararam-se resultados obtidos a partir da entrevista telefonica original e de tres recordatorios de 24 horas (padrao-ouro) realizados ate 15 dias apos a entrevista original. RESULTADOS: A frequencia dos indicadores estudados mostrou-se relativamente constante entre a primeira e a segunda entrevistas telefonicas e os coeficientes kappa se situaram entre 0,57 e 0,80, indicando boa reprodutibilidade de todos os indicadores. Relativamente ao padrao-ouro, evidenciou-se tendencia de superestimacao na frequencia do consumo de alimentos protetores, mas nao na frequencia de alimentos associados a risco para doencas cronicas. Sensibilidade e especificidade foram elevadas para indicadores do consumo de alimentos associados a risco (proximas a 80%) e variaveis no caso de alimentos protetores (entre 42% e 80%). CONCLUSOES: A avaliacao indicou boa reprodutibilidade e adequada validade para a maioria dos indicadores empregados pelo sistema, o que indica que a manutencao da sua operacao nos proximos anos oferecera ao Brasil um util instrumento para avaliacao de politicas publicas de promocao da alimentacao saudavel e controle das doencas cronicas nao transmissiveis relacionadas a alimentacao.OBJECTIVE To evaluate the reproducibility and validity of data on food and beverage intake obtained by means of a telephone-based surveillance system. METHODS Reproducibility and validity analyses were carried out in two random subsamples (n=112 and n=119, respectively) of the total sample (N=2,024) of adults (> or =18 years) studied by the system in 2005 in the municipality of São Paulo, Southeastern Brazil. Indicators evaluated included protective factors (daily or almost daily intake of fruit and vegetables) and risk factors (daily or almost daily intake of soft drinks, frequent intake of foods containing saturated animal fat, and abusive intake of alcoholic beverages) for the development of chronic diseases. Reproducibility was studied by comparing the results of the original telephonic interview with those of another interview carried out 7-15 days later. Validity was analyzed by comparing the results of the telephone interview with those of three 24-hour recalls (our gold-standard) carried out up to 5 days following the original interview. RESULTS The frequency of the studied indicators remained relatively constant between the first and second telephone interviews, with kappa coefficients ranging from 0.57 to 0.80, indicating good reproducibility for all indicators. In relation to the gold standard, there was a trend towards overestimating the frequency of intake of protective foods, but of foods associated with increased risk of chronic diseases. Sensitivity and specificity were high for indicators of consumption of risk-associated foods (close to 80%), and variable in the case of protective foods (42% to 80%). CONCLUSIONS The evaluation showed evidence of good reproducibility and adequate validity for most indicators employed in the system, which indicates that maintaining this system operational in coming years will provide a useful instrument for evaluating public policies for the promotion of a healthy diet and for control of non-communicable chronic diseases with a dietary component in Brazil.