Rosely Sichieri

Disponibilidade domiciliar de alimentos no Brasil: distribuição e evolução (1974-2003)

OBJETIVO: Descrever a distribuicao da disponibilidade domiciliar de alimentos no Brasil em 2002-2003 e avaliar sua evolucao nas areas metropolitanas do Pais no periodo 1974-2003. METODOS: A principal base de dados do estudo e a Pesquisa de Orcamento Familiar de 2002-2003 realizada pelo Instituto Brasileiro de Geografia e Estatistica em 48.470 domicilios brasileiros. Em cada domicilio, num periodo de sete dias consecutivos, foram registradas todas as aquisicoes, monetarias ou nao monetarias, de alimentos e bebidas para consumo familiar. As quantidades de alimentos adquiridas foram transformadas em calorias e macronutrientes, usando tabelas de composicao alimentar. RESULTADOS: Caracteristicas positivas do padrao alimentar, encontradas em todas as regioes e em todas as classes de rendimento, foram a adequacao do teor proteico das dietas e o elevado aporte relativo de proteinas de alto valor biologico. Caracteristicas negativas, tambem disseminadas no Pais, foram excesso de acucar e presenca insuficiente de frutas e hortalicas na dieta. Nas regioes economicamente mais desenvolvidas, no meio urbano e entre familias com maior rendimento houve tambem excesso de gorduras em geral e de gorduras saturadas. A evolucao nas areas metropolitanas do Pais evidenciou declinio no consumo de alimentos basicos, como arroz e feijao, aumentos de ate 400% no consumo de produtos industrializados, como biscoitos e refrigerantes, persistencia do consumo excessivo de acucar e insuficiente de frutas e hortalicas e aumento no teor da dieta em gorduras em geral e gorduras saturadas. CONCLUSOES: Padroes e tendencias da disponibilidade domiciliar de alimentos no Brasil sao consistentes com a importância crescente de doencas cronicas nao transmissiveis no perfil de morbi-mortalidade e com o aumento continuo da prevalencia da obesidade no Pais.

School randomised trial on prevention of excessive weight gain by discouraging students from drinking sodas

OBJECTIVE To determine whether an educational programme aimed at discouraging students from drinking sugar-sweetened beverages could prevent excessive weight gain. DESIGN Forty-seven classes in twenty-two schools were randomised as intervention or control. SUBJECTS Participants were 1140, 9-12-year-old fourth graders (435 in the intervention group and 608 in the control group). Sugar-sweetened beverages and juice intake were measured through one 24 h recall at baseline and another at the end of the trial. The main outcome was the change in BMI (BMI = weight (kg)/height (m2)), measured at the beginning and at the end of the school year. Intention-to-treat analysis was performed taking into account the cluster (classes) effect. RESULTS A statistically significant decrease in the daily consumption of carbonated drinks in the intervention compared to control (mean difference = -56 ml; 95 % CI -119, -7 ml) was followed by a non-significant overall reduction in BMI, P = 0.33. However, among those students overweight at baseline, the intervention group showed greater BMI reduction (-0.4 kg/m2 compared with -0.2 kg/m2 in the control group (P = 0.11)), and this difference was statistically significant among girls (P = 0.009). Fruit juice consumption was slightly increased in the intervention group (P = 0.08), but not among girls. CONCLUSION Decreasing sugar-sweetened beverages intake significantly reduced BMI among overweight children, and mainly among girls. Efforts to reduce energy intake through liquids need to emphasise overall sweetened beverages and addition of sugar on juices.

High temporal, geographic, and income variation in body mass index among adults in Brazil

OBJECTIVES Population-based data on body mass index for developing countries are scarce. Body mass index data from two Brazilian surveys were examined to determine regional and temporal variations in the prevalences of underweight, overweight, and obesity. METHODS Nationwide surveys in 1974/75 and 1989 collected anthropometric data in Brazil from 55,000 and 14,455 households, respectively. Trained interviewers used the same methods to measure weight and stature in both surveys, and survey designs were identical. Prevalences of underweight, overweight, and obesity were determined for persons 18 years of age and older. RESULTS In the 1989 survey, body mass index varied greatly according to region of the country, urbanization, and income. In the wealthier South, the prevalence of overweight/obesity was the highest and the prevalence of underweight was the lowest; in the poorer rural Northeast, these patterns were reversed. For both surveys, overweight/obesity was more common among women than among men and peaked at age 45 to 64 years in both sexes. Over the 15 years between surveys, the prevalence of both overweight and obesity increased strikingly. CONCLUSIONS In contrast to findings in developed countries, obesity in Brazil was positively associated with income and was much more prevalent among women than among men. For Brazilian women, the overall prevalence of overweight was nearly as high as that among women in the United States.

Trends in Overweight Among Adolescents Living in the Poorest and Richest Regions of Brazil

OBJECTIVES We assessed changes in body mass index (BMI) among Brazilian adolescents. METHODS In 1975, 1989, and 1997, we conducted household surveys of the weights and statures of a probabilistic sample of about 50,000 Brazilian adolescents aged 10 to 19 years. Weighted prevalences were calculated and an analysis was performed with the sample design taken into account. RESULTS Adolescents of rich (southeast) and poor (northeast) regions showed a substantial increase in BMI. In the southeast, the prevalence of overweight, defined by international age- and gender-specific BMI cutoffs, for both genders reached 17% in 1997, whereas in the northeast, the prevalence tripled, reaching 5% among boys and 12% among girls. Older girls living in urban areas in the southeast showed a decrease in prevalence from 16% to 13% in the latter 2 surveys. For all boys and for young girls, the BMI values for the 85th percentile in 1997 were much higher than the 95th percentile values in 1975. CONCLUSIONS BMI increased dramatically in Brazilian adolescents, mainly among boys; among older girls from the richest region, the prevalence of overweight is decreasing.

Physical activity in a probabilistic sample in the city of Rio de Janeiro

This study evaluated physical activity in a probabilistic sample of 4,331 individuals 12 years of age and older residing in the city of Rio de Janeiro, who participated in a household survey in 1996. Occupation and leisure activity were grouped according to categories of energy expenditure. The study also evaluated number of hours watching TV, using the computer, or playing video-games. Only 3.6% of males and 0.3% of females reported heavy occupational work. A full 59.8% of males and 77.8% of females reported never performing recreational physical activity, and there was an increase in this prevalence with age, especially for men. Womens leisure activities involved less energy expenditure and had a lower median duration than those of men. Mean daily TV/video/computer time was greater for women than for men. The greater the level of schooling, the higher the frequency of physical activity for both sexes. Analyzed jointly, these data show the low energy expenditure through physical activity by the population of the city of Rio de Janeiro. Women, the middle-aged, the elderly, and low-income individuals were at greatest risk of not performing recreational physical activity.

Índice de massa corporal e indicadores antropométricos de adiposidade em idosos

OBJETIVO: Avaliar o estado nutricional dos idosos e comparar o Indice de Massa Corporal (IMC=kg/m²) com varios indicadores de adiposidade e de localizacao de gordura em idosos e adultos de meia idade. METODOS: Idosos (N=699; 60 anos e mais) e adultos (N=1.306; 40-59,9 anos) participantes de inquerito realizado em 1996, no municipio do Rio de Janeiro foram avaliados quanto ao indice de massa corporal, perimetro braquial, perimetro da cintura, perimetro do quadril, espessuras das dobras cutâneas triciptal e subescapular, area de gordura e area muscular do braco obtidas a partir de procedimentos padronizados. Foram utilizados os pontos de corte propostos pela Organizacao Mundial de Saude para relacao cintura quadril, perimetro da cintura e indice de massa corporal. As comparacoes utilizaram o coeficiente de correlacao de Spearman e a regressao linear, ajustada para idade. RESULTADOS: Cerca de 50% dos idosos apresentaram sobrepeso. A prevalencia de inadequacao do perimetro da cintura e da relacao cintura quadril foi superior a 50% entre as mulheres e cerca de 40% para o perimetro da cintura e de 20% para a relacao cintura quadril entre os homens. As medidas relacionadas com adiposidade (perimetro da cintura, dobra cutânea triciptal, dobra cutânea subescapular e area de gordura do braco) apresentaram, em idosos, correlacoes parciais (ajustadas pela idade) com o indice de massa corporal entre 0,45 e 0,85 nos homens e de 0,54 a 0,86 nas mulheres. Tanto em adultos, quanto em idosos, a massa corporal seguida do perimetro da cintura foram as variaveis que mais explicaram o indice de massa corporal. CONCLUSOES: A prevalencia de sobrepeso em idosos foi alta tanto em homens quanto em mulheres e o indice de massa corporal guarda relacao similar com a adiposidade independente do envelhecimento.

Factors associated with dietary patterns in the urban Brazilian population

This study evaluated factors associated with dietary patterns in the Brazilian population based on the Living Standards Survey conducted in the Northeast and Southeast regions of the country. Multi-stage probability sampling was employed to select the households, and for the present analysis 5,121 adults aged 20 to 50 years were included. Pregnant women and individuals reporting chronic health conditions were excluded. Through principal component analysis, two major family dietary patterns were identified: a mixed pattern, in which all groups and foods have approximately the same factor loading, and a second pattern based main1y on rice and beans, which was called a traditional diet. Weight and height were measured in the households, and food intake was based on a 21-item semi-quantitative family questionnaire. The Northeast (as compared to the Southeast) was negatively associated with the mixed pattern. Body mass index was positively associated with the mixed pattern, whereas leisure physical activity and Black skin color were negatively associated with the mixed pattern. Schooling and income levels explained most of the dietary variance, but after adjusting for education and income, region of residence remained significantly associated and was the third most important explanatory variable.

Association between eating out of home and body weight.

Eating outside of the home environment on a frequent basis has been associated with weight gain. Food choices when eating out are usually high in energy content, which contributes to excessive energy intake; however, the available data on out-of-home eating and obesity are far from conclusive. This systematic review assesses the association between out-of-home eating and body weight in adults over 18 years of age. The literature databases searched included Medline, Embase, Lilacs, The Cochrane Library, and the ISI Web of Knowledge. The review includes a comprehensive quality assessment of all included observational studies, 20 cross-sectional studies, and 8 prospective cohort studies. All but one of the prospective cohort studies and about half of the cross-sectional analyses found a positive association between out-of-home eating and body weight. However, many methodological differences among the studies were found, such as the definition of out-of-home eating and its assessment, which limits comparisons. The results of the present analysis suggest that in future studies fast-food restaurants and other out-of-home dining venues should be analyzed separately, assessments based on a single 24-h recall should be avoided, and controls for at-home choices (which were not included in any of the studies reviewed) are necessary to evaluate this association.

Weight Loss Associated With a Daily Intake of Three Apples or Three Pears Among Overweight Women

OBJECTIVE We investigated the effect of fruit intake on body weight change. METHODS Hypercholesterolemic, overweight (body mass index > 25 kg/m2), and non-smoking women, 30 to 50 y of age, were randomized to receive, free of charge, one of three dietary supplements: apples, pears, or oat cookies. Women were instructed to eat one supplement three times a day in a total of six meals a day. Participants (411 women) were recruited at a primary care center of the State University of Rio de Janeiro, Brazil. Fifty-one women had fasting blood cholesterol levels greater than 6.2 mM/L (240 mg/dL) and 49 were randomized. Subjects were instructed by a dietitian to eat a diet (55% of energy from carbohydrate, 15% from protein, and 30% from fat) to encourage weight reduction at the rate of 1 kg/mo. RESULTS After 12 wk of follow-up, the fruit group lost 1.22 kg (95% confidence interval = 0.44-1.85), whereas the oat group had a non-significant weight loss of 0.88 kg (0.37-2.13). The difference between the two groups was statistically significant (P = 0.004). To explore further the body weight loss associated with fruit intake, we measured the ratio of glucose to insulin. A significantly greater decrease of blood glucose was observed among those who had eaten fruits compared with those who had eaten oat cookies, but the glucose:insulin ratio was not statistically different from baseline to follow-up. Adherence to the diet was high, as indicated by changes in serum triacylglycerols, total cholesterol, and reported fruit intake. Fruit intake in the oat group throughout treatment was minimal. CONCLUSIONS Intake of fruits may contribute to weight loss.

Eating out of home and obesity: a Brazilian nationwide survey

OBJECTIVE The aim of the present study was to investigate the relationship between out-of-home (OH) eating and overweight and obesity among adults in Brazil. DESIGN Data were based on the 2002-2003 Household Budget Survey (48,470 households) conducted by The Brazilian Census Bureau. Foods and drinks purchased for OH eating during a one-week period were recorded by each participant. We considered OH eating as the purchase of at least one food or drink item for OH consumption during this period. We classified items as: soft drinks, deep-fried snacks, fast foods, sweets and sit-down meals. SETTING Urban areas in Brazil. SUBJECTS 56,178 participants (26,225 men and 29,953 women), aged 25-65 years. RESULTS The weighted prevalence of OH eating was 40.3 %. Overall, OH eating was positively associated with overweight (OR = 1.21; 95 % CI 1.10, 1.33) and obesity (OR = 1.35; 95 % CI 1.16, 1.57) among men, but not among women. Sit-down meals and soft drinks were the most frequently reported food groups. Both were positively associated with overweight (OR = 1.34 for meals; OR = 1.17 for soft drinks, P < 0.05) and obesity (OR = 1.51 for meals; OR = 1.39 for soft drinks, P < 0.05) among men, but negatively associated with overweight and obesity among women. CONCLUSIONS OH eating was associated with overweight and obesity only among men, whereas, among women, eating sit-down meals out of home was protective for obesity, suggesting that women make healthier food choices when they eat out of home.