Silvana D'Innocenzo

Validation of a food frequency questionnaire for children and adolescents aged 4 to 11 years living in Salvador, Bahia

OBJECTIVE To assess the validity of a food frequency questionnaire (FFQ) by applying it to children and adolescents living in Salvador, Bahia. METHODS The validity of this FFQ with 98 food items was investigated among 108 children and adolescents who were selected from a sample of 1445 that had been planned for a study on the risk factors for asthma and other allergic diseases. The adults responsible for these children and adolescents gave responses for a 24-hour recall (R24h) and an FFQ. The average energy and nutrient values from the FFQ were compared with those from the R24h by means of the paired t test and Pearson correlation coefficients. The concordance was evaluated using the Bland-Altman method and kappa statistics. RESULTS The energy and nutrient intake estimated using the FFQ was significantly higher than what was obtained using the R24h. The correlation coefficients adjusted for energy were statistically significant for protein, fat, vitamin C and zinc. The weighted kappa values ranged from 0.06 for vitamin A (p = 0.24) to 0.34 for energy (p < 0.00). The results from the Bland-Altman plots for lipid, protein and zinc showed the most significant validity parameters, and zinc was found to show the best concordance. CONCLUSION The results suggest that the FFQ showed satisfactory validity for use in studies involving children and adolescents.

Condições socioeconômicas e padrões alimentares de crianças de 4 a 11 anos: estudo SCAALA - Salvador/ Bahia

OBJECTIVE: to identify the patterns of food intake in children and the association between these and the socio-economic conditions of their families. METHODS: a cross-sectional study was carried out with 1260 children aged between 4 and 11 years, resident in the city of Salvador, in the Brazilian State of Bahia, including application of a semi-quantitative Food Intake Frequency questionnaire. The pattern of food intake of the children was assessed using factorial analysis by principal components. socio-economic level was assessed using a compound socio-economic indicator. Multivariate logistic regression was employed. RESULTS: four food groups were identified that explained 45.9% of the variability in food intake frequency data. Children from a more privileged socio-economic background were found to be 1.6 times more likely (p<0.001) to have a higher frequency of intake of food from group 1 (fruit, vegetables, pulses, cereals and sea food) and 3.09 times more likely (p<0.001) to have a higher frequency of consumption of food from group 2 (milk and dairy products, ketchup/mustard/mayonnaise and chicken), compared with children from a less privileged background. The opposite was found for group 4 (processed meat products, eggs, and red meat); with the children from more privileged backgrounds less likely to consume food from this group. A similar tendency was found for food from group 3 (fried food, sweets, snacks, soda/artificial fruit juice). CONCLUSION: patterns of food intake in children depend on the socio-economic conditions of their families and the choice of healthier food is associated with a more privileged socio-economic background.

Overweight, asthma symptoms, atopy and pulmonary function in children of 4-12 years of age: findings from the SCAALA cohort in Salvador, Bahia, Brazil.

OBJECTIVE To evaluate the association between overweight and the occurrence of asthma and atopy in a cohort of children of 4-12 years of age living in the city of Salvador in 2005. DESIGN Cross-sectional study nested in a cohort. SETTING The metropolitan region of Salvador, Bahia, Brazil. SUBJECTS The study included 1129 children of 4-12 years age who presented complete information on the variables used here. Skin tests for allergy, spirometry, faecal parasitology, serum IgE and anthropometric surveys were conducted. Poissons multivariate regression was adopted. RESULTS Wheezing was found in 29·1% and asthma in 22·8% of children, both conditions being more common in those under 6 years of age and 34% more common in overweight children (prevalence ratio (PR) = 1·34; 95% CI 1·07, 1·67) following adjustment. The ratio between forced expiratory volume in 1s and forced vital capacity was associated with overweight (PR = 1·35; 95% CI 1·11, 1·61). No statistically significant association was found between overweight and allergen-specific IgE or with wheezing. CONCLUSIONS These results are in agreement with the hypothesis that overweight is associated with asthma and pulmonary function, even following adjustment for intervening variables known to be associated with the pathogeny of asthma.

Velocidade de ganho de peso nos primeiros anos de vida e excesso de peso entre 5-11 anos de idade, Salvador, Bahia, Brasil

Overweight children are more prone to become overweight or obese adults. The most effective prevention is intervention in early childhood. We analyzed the association between early weight gain and overweight/obesity in 1,056 children under 11 years of age. Data were collected on lifestyle, sanitation, socioeconomic status, birth weight, and breastfeeding. Weight gain from birth until different age brackets ( 12 to 18, > 18 to 24, and > 24 to 60 months) was considered a continuous variable in z-scores. Overweight was defined as body mass index (BMI) > +1 z-score, based on 2006 and 2007 World Health Organization (WHO) guidelines. Poisson regression and linear regression were used in the multivariate statistical analysis. Weight gain rate was associated with BMI, and overweight or obesity in the 5-11-year age bracket increased twofold for each unit increase in the weight gain standard deviation between 24 and 60 months of age (RR = 2.08; 95%CI: 1.87-2.32). For all early childhood age brackets, there was an association between rapid weight gain and subsequent overweight or obesity.

Padrões alimentares de crianças menores de cinco anos de idade residentes na capital e em municípios da Bahia, Brasil, 1996 e 1999/2000

This cross-sectional study included 3,817 preschool children, of whom 1,770 in Salvador, Bahia State, Brazil, and 2,047 in urban and rural areas from nine other municipalities (counties) in the same State. The study used 24-hour recall and principal components analysis to identify and compare dietary patterns. The sample was stratified by age and area. In the first six months of life, breast milk composed the second and third patterns, with positive loadings for children in all 10 municipalities. For children under 17 months of age, pattern 1 was characterized by cows milk, flour, and sugar, except in rural areas. Pattern 2 was similar for children aged 6-17 months and consisted of bread/cookies, rice, beans, and meat. For children 18-23 months of age in urban areas, pattern 1 showed negative loadings for sugar, cows milk, and flour. In children over 24 months of age, fruits were not part of the first pattern. The study showed low consumption of milk and low variety of fruits and vegetables. This food consumption profile indicates the need for early interventions to promote healthy eating habits.Estudo transversal com 3.817 pre-escolares, 1.770 residentes em Salvador, Bahia, Brasil, e 2.047 nas areas urbana e rural de 10 municipios baianos. Utilizou-se recordatorio de 24 horas (R24h) e empregou-se analise fatorial por componentes principais com objetivo de identificar e comparar os principais padroes alimentares dessas criancas. Estratificou-se a amostra por idade e area. Antes dos seis meses de vida o leite materno compos o 2o e 3o padroes com carga positiva para criancas dos dez municipios. Para menores de 17 meses, o padrao 1 foi caracterizado por leite de vaca, farinhas e acucares. Em areas urbanas, pao/biscoito, arroz, feijao e carne integraram o padrao 2 aos 6-17 meses. Aos 18-23 meses, o padrao 1 apresentou carga negativa para acucares, leite de vaca e farinhas, exceto na area rural. Frutas nao fizeram parte do padrao 1 no grupo de 24 meses e mais. Observou-se baixo consumo de leite materno e pouca variacao de frutas e legumes a partir dos seis meses. Tal perfil de consumo alimentar indica a necessidade de intervencoes cada vez mais precoces para promocao de habitos alimentares saudaveis.

Padrão alimentar, asma e sibilo atópico e não atópico em crianças e adolescentes: estudo SCAALA, Salvador, Bahia, Brasil

Avaliou-se, em estudo transversal, a influencia do padrao alimentar sobre a ocorrencia de sibilo e asma atopica e nao atopica em 1.168 criancas e adolescentes em Salvador, Bahia, Brasil. Sibilo e sintomas de asma nos ultimos 12 meses foram obtidos por meio do questionario ISAAC. Atopia foi definida pela presenca de IgE especifica a aerolergenos. Questionario de frequencia alimentar foi usado para definir padroes alimentares. Empregou-se regressoes logistica e logistica politomica multivariadas. O consumo de pescados reduziu a ocorrencia de sibilo em 27% (IC95%: 0,56-0,94) e asma em 37% (IC95%: 0,47-0,83); asma nao atopica em 51% (IC95%: 0,31-0,79) e sibilo nao atopico em 38% (IC95%: 0,46-0,83). O maior tercil do padrao alimentar reduziu o sibilo em 27% (IC95%: 0,57-0,95), sibilo atopico em 46% (IC95%: 0,30-0,98), asma em 36% (IC95%: 0,49-0,83) e asma atopica em 50% (IC95%: 0,28-0,89). O consumo de pescados pode conferir efeito protetor para sibilo e asma nao atopica e o padrao alimentar para sibilo e asma atopica.A cross-sectional study was conducted on dietary patterns and their influence on the occurrence of wheezing and atopic and non-atopic asthma in a sample of 1,168 children and adolescents in Salvador, Bahia State, Brazil. Wheezing and asthma symptoms in the previous 12 months were obtained using the ISAAC questionnaire. The presence of aeroallergen-specific IgE was identified. A food frequency questionnaire was used to define dietary patterns. The study applied logistic regression and multinomial polytomous logistic regression. Fish consumption was associated with a 27% reduction in wheezing (95%CI: 0.56-0.94), 37% in asthma (95%CI: 0.47-0.83), 51% in non-atopic asthma (95%CI: 0.31-0.79), and 38% in non-atopic wheezing (95%CI: 0.46-0.83). The highest tertile of dietary patterns reduced wheezing by 27% (95%CI: 0.57-0.95), atopic wheezing by 46% (95%CI: 0.30-0.98), asthma by 36% (95%CI: 0.49-0.83), and atopic asthma by 50% (95%CI: 0.28-0.89). Fish consumption may thus have a protective effect against wheezing and non-atopic asthma and dietary pattern against atopic asthma and wheezing.

Weight gain in the first two years of life, asthma and atopy: the SCAALA cohort study

OBJECTIVE To evaluate the association between weight gain in the first two years of life and the occurrence of wheezing, asthma, serum IgE, skin reactivity and pulmonary function. DESIGN Cohort study. SETTING The metropolitan region of Salvador, Bahia, Brazil. SUBJECTS The association was studied between 1997 and 2005 in 669 children up to 11 years of age. Data were collected on asthma and risk factors, both current factors and those present in the first years of life. Weight gain was considered fast when the Z-score was >0·67. Poisson regression was used in the multivariate statistical analysis. RESULTS Wheezing was reported in 25·6 % of the children. Weight gain was considered fast (Z-score >0·67) in 29·6 % of the children and slow (Z-score <-0·67) in 13·9 %. Children in the slow weight gain group had 36 % fewer symptoms of asthma (prevalence ratio = 0·65; 95 % CI 0·42, 0·99). CONCLUSIONS Slower weight gain in the early years of life may constitute a protective factor against symptoms of asthma. The relevance of this finding for public health is not yet certain, since it is known that children with slow and fast weight gain may be more likely to develop adverse health consequences related to both these situations.

Dietary pattern, asthma, and atopic and non-atopic wheezing in children and adolescents: SCAALA study, Salvador, Bahia State, Brazil

Avaliou-se, em estudo transversal, a influencia do padrao alimentar sobre a ocorrencia de sibilo e asma atopica e nao atopica em 1.168 criancas e adolescentes em Salvador, Bahia, Brasil. Sibilo e sintomas de asma nos ultimos 12 meses foram obtidos por meio do questionario ISAAC. Atopia foi definida pela presenca de IgE especifica a aerolergenos. Questionario de frequencia alimentar foi usado para definir padroes alimentares. Empregou-se regressoes logistica e logistica politomica multivariadas. O consumo de pescados reduziu a ocorrencia de sibilo em 27% (IC95%: 0,56-0,94) e asma em 37% (IC95%: 0,47-0,83); asma nao atopica em 51% (IC95%: 0,31-0,79) e sibilo nao atopico em 38% (IC95%: 0,46-0,83). O maior tercil do padrao alimentar reduziu o sibilo em 27% (IC95%: 0,57-0,95), sibilo atopico em 46% (IC95%: 0,30-0,98), asma em 36% (IC95%: 0,49-0,83) e asma atopica em 50% (IC95%: 0,28-0,89). O consumo de pescados pode conferir efeito protetor para sibilo e asma nao atopica e o padrao alimentar para sibilo e asma atopica.A cross-sectional study was conducted on dietary patterns and their influence on the occurrence of wheezing and atopic and non-atopic asthma in a sample of 1,168 children and adolescents in Salvador, Bahia State, Brazil. Wheezing and asthma symptoms in the previous 12 months were obtained using the ISAAC questionnaire. The presence of aeroallergen-specific IgE was identified. A food frequency questionnaire was used to define dietary patterns. The study applied logistic regression and multinomial polytomous logistic regression. Fish consumption was associated with a 27% reduction in wheezing (95%CI: 0.56-0.94), 37% in asthma (95%CI: 0.47-0.83), 51% in non-atopic asthma (95%CI: 0.31-0.79), and 38% in non-atopic wheezing (95%CI: 0.46-0.83). The highest tertile of dietary patterns reduced wheezing by 27% (95%CI: 0.57-0.95), atopic wheezing by 46% (95%CI: 0.30-0.98), asthma by 36% (95%CI: 0.49-0.83), and atopic asthma by 50% (95%CI: 0.28-0.89). Fish consumption may thus have a protective effect against wheezing and non-atopic asthma and dietary pattern against atopic asthma and wheezing.

Patrón dietético, asma y sibilancias atópicas y no atópicas en niños y adolescentes: estudio SCAALA, Salvador, Bahía, Brasil

Avaliou-se, em estudo transversal, a influencia do padrao alimentar sobre a ocorrencia de sibilo e asma atopica e nao atopica em 1.168 criancas e adolescentes em Salvador, Bahia, Brasil. Sibilo e sintomas de asma nos ultimos 12 meses foram obtidos por meio do questionario ISAAC. Atopia foi definida pela presenca de IgE especifica a aerolergenos. Questionario de frequencia alimentar foi usado para definir padroes alimentares. Empregou-se regressoes logistica e logistica politomica multivariadas. O consumo de pescados reduziu a ocorrencia de sibilo em 27% (IC95%: 0,56-0,94) e asma em 37% (IC95%: 0,47-0,83); asma nao atopica em 51% (IC95%: 0,31-0,79) e sibilo nao atopico em 38% (IC95%: 0,46-0,83). O maior tercil do padrao alimentar reduziu o sibilo em 27% (IC95%: 0,57-0,95), sibilo atopico em 46% (IC95%: 0,30-0,98), asma em 36% (IC95%: 0,49-0,83) e asma atopica em 50% (IC95%: 0,28-0,89). O consumo de pescados pode conferir efeito protetor para sibilo e asma nao atopica e o padrao alimentar para sibilo e asma atopica.A cross-sectional study was conducted on dietary patterns and their influence on the occurrence of wheezing and atopic and non-atopic asthma in a sample of 1,168 children and adolescents in Salvador, Bahia State, Brazil. Wheezing and asthma symptoms in the previous 12 months were obtained using the ISAAC questionnaire. The presence of aeroallergen-specific IgE was identified. A food frequency questionnaire was used to define dietary patterns. The study applied logistic regression and multinomial polytomous logistic regression. Fish consumption was associated with a 27% reduction in wheezing (95%CI: 0.56-0.94), 37% in asthma (95%CI: 0.47-0.83), 51% in non-atopic asthma (95%CI: 0.31-0.79), and 38% in non-atopic wheezing (95%CI: 0.46-0.83). The highest tertile of dietary patterns reduced wheezing by 27% (95%CI: 0.57-0.95), atopic wheezing by 46% (95%CI: 0.30-0.98), asthma by 36% (95%CI: 0.49-0.83), and atopic asthma by 50% (95%CI: 0.28-0.89). Fish consumption may thus have a protective effect against wheezing and non-atopic asthma and dietary pattern against atopic asthma and wheezing.