Soraya Sant'Ana de Castro Selem

Prevalência e fatores associados à anemia entre crianças atendidas em creches públicas de São Paulo

Um dos grandes desafios na saude publica e o combate a anemia ferropriva em criancas. Considerando a importância da cidade de Sao Paulo em relacao ao tamanho da sua populacao e a escassez de estudos representativos de criancas que frequentam creches, este estudo teve como objetivo analisar a prevalencia de anemia em uma amostra probabilistica de criancas frequentadoras de creches da rede municipal de Sao Paulo e identificar os fatores associados. Este e um estudo transversal com 330 pre-escolares sorteados entre 20 creches publicas. Anemia foi definida como hemoglobina menor de 11g/dL. Utilizou-se regressao logistica hierarquizada para analise multipla. A prevalencia de anemia foi de 68,8% (IC95% = 63,8%; 73,8%). Entre as criancas com anemia, o percentual de anemia grave (< 9,5g/dL) foi de 26,9%. Estiveram associados a anemia idade menor de 24 meses (Odds ratio (OR) = 2,7; IC95% = 1,4; 5,2) e idade do responsavel pela crianca menor de 25 anos (OR = 1,8; IC95% = 1,0; 3,2). A prevalencia de anemia foi alta quando comparada a outros estudos. O acompanhamento de programas de combate a esta doenca deve ser realizado e modificado, quando necessario, especialmente entre criancas frequentadoras de creches publicas menores de dois anos que possuem responsaveis mais jovens.

Validity of self-reported hypertension is inversely associated with the level of education in Brazilian individuals

BACKGROUND Self-reported hypertension is an important piece of information for public health that is available in epidemiological studies. For proper use of this information, such studies should be validated. OBJECTIVE To validate self-reported hypertension and associated factors in adults and elderly individuals in São Paulo, Brazil. METHODS Participants were selected from the sample of a population-based cross-sectional health survey carried out in São Paulo (ISA Capital-2008). Their age was 20 years or older, they were from both genders, and had their blood pressure measured (n = 535). Hypertension was defined as blood pressure > 140/90 mmHg and/or use of medication for hypertension. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Kappa coefficient were calculated. Poisson regression was used to identify factors associated with sensitivity of self-reported hypertension. RESULTS Sensitivity of self-reported hypertension was 71.1% (95%CI: 64.8 to 76.9), specificity 80.5% (95%CI: 75.6 to 84.8), PPV 73.7% (95%CI: 67.4 to 79.3), and NPV 78.5% (95%CI: 73.5 to 82.9). There was moderate agreement between self-reported hypertension and hypertension as diagnosed by blood pressure measurement (kappa = 0.52, 95%CI: 0.45 to 0.59). Body mass index and level of education were independently associated with sensitivity (body mass index > 25 kg/m²: PR = 1.42, 95% CI: 1.15 to 1.76; schooling > 9 years: PR = 0.71 95%CI: 0.54-0.94). CONCLUSION Self-reported hypertension was shown to be valid in adults and the elderly in the city of São Paulo, and is thus an appropriate indicator for the surveillance of hypertension prevalence in the absence of blood pressure measurement. Overweight was positively associated with validity of self-reported hypertension. Further studies are needed to elucidate the inverse association between the validity of self-reported hypertension and level of education.

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.

Validity and reproducibility of a food frequency questionnaire for adults of São Paulo, Brazil.

OBJECTIVES To assess the validity and reproducibility of a food frequency questionnaire developed for estimating the food consumption of adults in São Paulo, Brazil, based population study. METHODS A sample of individuals aged above 20 years, of both genders, living in São Paulo, was used for the validation study (n = 77) and reproducibility study (n = 74) of the food frequency questionnaire. To verify the validity and reproducibility of energy and 19 nutrients were applied two food frequency questionnaires (60 items) and three 24-hour dietary recalls (24HR - reference method). The validity was verified by Spearman correlation coefficient (crude and de-attenuated) and weighted Kappa, and reproducibility by intraclass correlation coefficients and weighted kappa. RESULTS In analyzes of validity de-attenuated correlation coefficients ranged from 0.21 (carbohydrate) to 0.74 (energy), and weighted kappa exceeded 0.40 for 30% of the nutrients. Polyunsaturated fat and folate did not show significant correlation and weighted kappa. In reproducibility correlation coefficients ranged from 0.36 (polyunsaturated fat) to 0.69 (calcium), and weighted kappa exceeded 0.40 for 80% of the nutrients. CONCLUSION The food frequency questionnaire analyzed has good validity and reproducibility for estimating the food consumption of adults in São Paulo compared to the reference method, so it is an appropriate instrument to be used in epidemiological studies on similar populations. Estimates of polyunsaturated fat and folate should be interpreted with caution.

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.

Excessive red and processed meat intake: relations with health and environment in Brazil

The aims of the present study were to verify the proportion of population that consumed more red and processed meat than the World Cancer Research Fund (WCRF) dietary recommendation, to estimate the environmental impact of beef intake and the possible reduction of greenhouse gas emissions if the dietary recommendation was followed. We used the largest, cross-sectional, population-based survey entitled the National Dietary Survey (34 003 participants aged 10-104 years). The usual meat intake was obtained by two food records completed on 2 non-consecutive days. The usual intake was estimated by the multiple source method. The environmental impact was analysed according to estimates of CO2 equivalent emissions from beef intake as a proxy for beef production in Brazil. The red and processed meat intake mean was 88 g/d. More than 80 % of the population consumed more red and processed meat than the WCRF recommendation. Beef was the type of meat most consumed, accounting to almost 50 %. Each person contributed 1005 kg of CO2 equivalents from beef intake in 2008, the same quantity of CO2 produced if a car travelled a distance between the extreme north and south of Brazil (5370 km). The entire Brazilian population contributed more than 191 million tons of CO2 equivalents, which could have been reduced to more than 131 million tons if the dietary recommendation was followed. The present study shows that the magnitude of the excessive red and processed meat intake in Brazil can impact on health and the environment, pointing to the urgency of promoting a sustainable diet.

Padrões alimentares empiricamente derivados: interpretabilidade e validade de construto segundo diferentes métodos de rotação fatorial

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.

Patrones alimentarios empíricamente derivados: interpretabilidad y validez de constructo, según diferentes métodos de rotación en un análisis factorial

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.

P1-248 Ultra-processed food contributes with high proportions of the caloric intake: results from a population based survey in SÃo paulo, Brazil

Introduction Ultra-processed foods (UPF), a new classification proposed recently, comprise those foods prepared by the food, drink and associated industries, like soft drinks, snacks, etc, that intentionally are added salt, fat, sugar, preservatives and flavours and colours. They are usually energy-dense, and contain considerable quantities of added sugar, sodium, saturated or trans fats and little dietary fibre. Some of them are already associated with the increasing of the risk of obesity. Objective To estimate the ultra-processed foods consumption among Brazilian individuals. Methods A population-based survey that participated 273 adolescents, 436 adults and 385 elderly from São Paulo, Brazil, held in 2008. Dietary intake was collected by the one 24 h recall. It was calculated the caloric share of this group in relation to total energy intake. Further, it was verified the foods with the greatest caloric share. The analyses were stratified by age group, sex, income and educational level. Results The mean caloric share from UPF were 58% (SD 21%), 49% (SD 24%), and 42% (22%) for adolescents, adults and elderly, respectively (p<0.001). The highest educational level was associated with higher caloric share from UPF for all age group and sexes. There were no differences among quartiles of income. The overall UPF with the greatest caloric share were bread (22%), sandwiches and pizza (13%), soft drink (7%), biscuits (5%), and sausage (4.5%). Conclusion The UPF consumption represents a large percentage of total caloric intakes, mainly in adolescents.

SP3-78 Validity and reproducibility of a food frequency questionnaire developed based on a representative sample of adolescents from SÃo Paulo, Brazil

Introduction The food frequency questionnaire (FFQ) has been one the most widely used method for assessment of food consumption, as well as being able to provide the usual intake, is considered easy to use and of low cost. Objective To assess the validity and reproducibility of a quantitative FFQ with 66 food items (QFFQ) developed based on a representative sample of adolescents from São Paulo, Brazil. Methods 250 adolescents filled two FFQ (1-year interval) and 5 24-h recalls (3-month interval) as part of a population-based survey conducted in São Paulo, Brazil, in 2007. To quantify the nutrient intake, the software Nutrition Data System for Research was used. The intake was adjusted for within-person variability by the method proposed by Iowa State University, using the software PC-SIDE, and energy-adjusted for the residual method. The validity for 23 nutrients was assessed by Spearman correlation coefficient and weighted κ. Intra-class correlation coefficient and weighted κ was used to reproducibility assessment. Results In the validation, the Spearman correlation coefficients ranged from 0.25 (riboflavin) to 0.57 (phosphorus) of which eight nutrients showed acceptable correlation (>0.4). In the reproducibility analysis, the intra-class correlation coefficients ranged from 0.18 (vitamin C) to 0.57 (niacin), of which five nutrients showed acceptable correlation. The weighted κ ranged from 0.18 (sodium) to 0.67 (riboflavin) to reproducibility and from 0.19 (polyunsatured fat) to 0.56 (calcium) to validation. Conclusion The results support the use of this instrument to assess food intake in epidemiological studies conducted in São Paulo, Brazil.