Regina Mara Fisberg

Validation of a semi-quantitative adolescent food frequency questionnaire applied at a public school in São Paulo, Brazil

Objective: To develop a food frequency questionnaire for adolescents (AFFQ) and demonstrate its relative validity.Design: The final version of the AFFQ was composed of 76 food items previously identified according to their contribution in nutrients and overall importance within the eating habits of this population group. The validation study, which was undertaken during a 6 month period (June to November 1999), was administered to a sample of 79 who answered at least three 24 h dietary recalls (R24 h) applied at intervals of 45 days and one AFFQ at the end of the study. Applying the paired t-test and calculating Pearson correlation coefficients on nutrient data, differences in the mean of nutrients were obtained. Correlation coefficients between the mean energy-adjusted nutrients computed by the two methods were calculated, and correction was made for within-person variability. Agreement was evaluated by distribution of the adolescents according to quartiles of consumption.Locus: A public school within the metropolitan region of São Paulo city.Results: A high variability in the dietary intake of adolescents was observed, with high rates of variability for cholesterol, retinal and vitamin C. The Pearson correlation coefficients, after being adjusted and corrected for variability, ranged from 0.10 to 0.72 among females and from 0.16 and 0.91 among males. The mean correlation coefficient for the entire group was 0.52.Conclusions: These results indicate that the AFFQ provides a potentially reliable scale for categorizing individuals by level of past intake of most nutrients, excluding retinol and iron.

Avaliação do consumo alimentar e da ingestão de nutrientes na prática clínica

The assessment of food consumption in clinical practice is often carried out to develop and implement nutritional advice. Factors as the patient health conditions, the evolution of his/her clinical condition as well as the reasons that motivated the search for advice will guide the selection of the best method of assessment of food consumption or nutrient intake to employ. The chosen method might drive the professional to offer a food plan that aims to promote health, to prevent illness, and to alter the nutritional state of the patient. Despite the easily available national literature on methods and techniques to estimate food consumption, it is not uncommon that professionals still have doubts about what methods are the most appropriated in daily practice. This study aimed to present a critical analysis, taking into account the clinical applicability, of the food assessment methods and its characteristics.

Health, agricultural, and economic effects of adoption of healthy diet recommendations

Transition to diets that are high in saturated fat and sugar has caused a global public health concern, as the pattern of food consumption is a major modifiable risk factor for chronic non-communicable diseases. Although agri-food systems are intimately associated with this transition, agriculture and health sectors are largely disconnected in their priorities, policy, and analysis, with neither side considering the complex inter-relation between agri-trade, patterns of food consumption, health, and development. We show the importance of connection of these perspectives through estimation of the eff ect of adopting a healthy diet on population health, agricultural production, trade, the economy, and livelihoods,with a computable general equilibrium approach. On the basis of case-studies from the UK and Brazil, we suggest that benefits of a healthy diet policy will vary substantially between different populations, not only because of population dietary intake but also because of agricultural production, trade, and other economic factors.

Estimando a prevalência da ingestão inadequada de nutrientes

In assessing food intake patterns in groups of individuals, it is usually important to know how many of these individuals present nutrient intakes above or below a determined criterion. This information is relevant for planning healthcare actions, both in monitoring and in assessing such interventions, and also for the purposes of regulating commercial activities. This paper discusses a new methodology for estimating the prevalence of inadequate nutrient intake, with the Dietary Reference Intakes as the reference values. The utilization of diet surveys that allow the most accurate quantitative estimate possible is dealt with. These should use repeated measurements of food intake, on non-consecutive days. The food intake should be adjusted for between-person and within-person variance, so as to obtain a corrected distribution for the nutrient intake values. After constructing this distribution curve based on the corrected estimated parameters (average and standard deviation), the EAR method (Estimated Average Requirement) can be used as a cutoff point for verifying the proportion of individuals that has inadequate nutrient intake. This corresponds to the area of the curve below this reference value. It is concluded that this new approach minimizes the error in the calculation of the prevalence of inadequate nutrient intake, since it takes into consideration the random characteristics of the diet.

Questionário de freqüência alimentar para adultos com base em estudo populacional

The objective of the study was to develop a food frequency questionnaire for each of the following groups: female adults, male adults and male and female adults, based on dietary data obtained in a population-based study comprising individuals from different income levels. Dietary data was obtained from a 24-hour Dietary Recall applied to a probabilistic sample of 1,477 subjects in the city of Sao Paulo (Southeastern Brazil) in 2003. Food items accounting for at least 90% of total daily calorie intake and nutrients were selected. The reference time frame was the year preceding the interview and subjects had the choice of four serving sizes.

Validaçäo de questionários de freqüência alimentar - QFA: consideraçöes metodológicas

O Questionario de Frequencia Alimentar (QFA) tornou-se o metodo dominante nos estudos epidemiologicos para avaliacao do consumo dietetico, em especial para avaliar a relacao da dieta com a ocorrencia de doencas cronicas nao transmissiveis. O QFA e um instrumento que tem como objetivo a avaliacao da dieta habitual de grupos populacionais e apresenta como vantagens a rapidez na aplicacao e a eficiencia na pratica epidemiologica para identificar o consumo habitual de alimentos, alem do baixo custo. Comparado a outros instrumentos, substitui a medicao da ingestao alimentar de um ou varios dias pela informacao global da ingestao de um periodo amplo de tempo. Constitui ferramenta util nos estudos sempre que seu desenvolvimento tenha sido precedido por procedimentos metodologicos cuidadosamente planejados que garantirao confiabilidade e precisao dos dados. Para tanto, sao necessarios estudos de validacao que permitam estimar os erros de medicao proprios do metodo. Sem o reconhecimento destes erros, a relacao dieta-doenca podera estar prejudicada. Este artigo pretende abordar de forma sistematica consideracoes metodologicas para a realizacao de estudos de validacao de QFA.

Ácidos graxos e doenças cardiovasculares: uma revisão

During the last decades the prevalence of cardiovascular diseases has increased progressively, becoming a serious public health problem. Some studies have shown a positive association between saturated fatty acid intake and the prevalence of cardiovascular diseases, and a negative association with unsaturated fatty acids intake. These studies indicate a need to evaluate the different kinds of fatty acids (saturated, monounsaturated and polyunsaturated) and their effects, aiming at a better utilization and maintaining a suitable proportion in the diet in order to diminish the incidence of cardiovascular diseases. The objective of this paper is to accomplish a review of the medical literature regarding fatty acids and their effects on cardiovascular diseases, as well as the evolution of their requirements through time, consumption trends and future perspectives.

Índice de Qualidade da Dieta Revisado para população brasileira

The revised version of the Brazilian Healthy Eating Index is an indicator of dietary quality developed according to current nutritional recommendations. Dietary data were obtained from a population-based survey, the 2003 Inquérito de Saúde e Alimentação (ISA - Health and Diet Survey)-Capital. The Revised Index consists of 12 components: nine food groups included in the 2006 Brazilian Dietary Guidelines, in which daily portions are expressed in terms of energy density; two nutrients (sodium and saturated fats), and SoFAAS (calories from solid fat, alcohol and added sugar). The Revised Brazilian Healthy Eating Index allows for the measurement of dietary risk factors for chronic diseases, evaluating and monitoring the diet at both individual and population levels.

Dietary quality index and associated factors among adolescents of the state of Sao Paulo, Brazil.

OBJECTIVE To assess dietary quality and associated factors in adolescents. STUDY DESIGN We conducted a population-based cross-sectional study in a sample of 1584 adolescents living in areas of the state of São Paulo, Brazil. Dietary intake was measured with the 24-hour recall method, and dietary quality was assessed by means of the Health Eating Index (HEI), adapted to fit to the local requirements. Linear regression analyses were performed to assess the association between the HEI and demographic, socioeconomic, and lifestyle variables. RESULTS A total of 97.1% of the adolescents studied had an inadequate diet or a diet that needed improvement. The mean overall HEI score was 59.7. Lower mean HEI scores were found for fruits, dairy products, and vegetables. Male adolescents who were physically active and lived in a house or apartment had higher HEI scores. The multiple regression analyses showed that the quality of the diet improved as age decreased. Adolescents who lived in houses or apartments had higher HEI scores than adolescents living in shacks or slums, regardless of age and energy intake. CONCLUSIONS Dietary quality is associated with income and age. A better understanding of the factors associated can provide input to the formulation of policies and development of nutritional actions.

Estado nutricional e fatores associados ao déficit de crescimento de crianças freqüentadoras de creches públicas do Município de São Paulo, Brasil

This study reports the nutritional status of children attending daycare centers in the Municipality of Sao Paulo, Brazil. A representative sample of 827 children under 84 months of age was evaluated. Anthropometric measurements and information on socioeconomic characteristics and morbidity were collected. The most prevalent nutritional deficit was stunting (7.0%; 95%CI: 3.60-10.40). Univariate analysis showed a significant association between stunting and age ( 7), OR = 3.02(95%CI: 1.46-6.22); and number of siblings (> 2) OR = 4.81 (95%CI: 1.72-13.44). In the multivariate analysis, only diarrhea one month prior to the data collection, OR = 2.54 (95%CI: 1.20-5.38) and > 2 siblings, OR = 7.40 (95%CI: 2.20-24.93), remained associated with stunting.