Estimation of underreporting of energy intake using different methods in a subsample of the ELSA-Brasil study / Estimativa da subnotificação de ingestão energética através de diferentes métodos em uma subamostra do estudo ELSA-Brasil / Estimación de la infradeclaración de la ingesta de energía utilizando diferentes métodos en una submuestra del estudio del ELSA-Brasil

Existing methods for assessing food consumption are subject to measurement errors, especially the underreporting of energy intake, characterized by reporting energy intake below the minimum necessary to maintain body weight. This study aimed to compare the identification of energy intake underreporters using different predictive equations and instruments to collect dietary data. The study was conducted with 101 selected participants in the third wave of the Longitudinal Study of Adult Health (ELSA-Brasil) at the University Hospital of the University of São Paulo. For the dietary assessment, we applied a food frequency questionnaire (FFQ), two 24-hour diet recall (24hR) using the GloboDiet software, and two 24hR using the Brasil-Nutri software. The energy intake underreport obtained from the FFQ was 13%, 16%, and 1% using the equations proposed by Goldberg et al. (1991), Black (2000), and McCrory et al. (2002), respectively. With these same equations, the 24hR described an underreport of 9.9%, 14.9%, and 0.9% respectively with the GloboDiet software and 14.7%, 15.8%, and 1.1% respectively with the Brasil-Nutri software. We verified a low prevalence of underreported energy intake among the three self-report-based dietary data collection methods (FFQ, 24hR with GloboDiet, and Brasil-Nutri). Though no statistically significant differences were found among three methods, the equations for each method differed among them. The agreement of energy intake between the methods was very similar, but the best was between GloboDiet and Brasil-Nutri.

Os métodos existentes para avaliar consumo alimentar estão sujeitos a erros de medição, especialmente à subnotificação de ingestão calórica, que descreve a ingestão calórica abaixo do mínimo necessário para manter o peso corporal. Este estudo buscou comparar a identificação de subnotificações de ingestão calórica através de diferentes equações preditivas e instrumentos para coletar dados dietéticos. Este estudo foi realizado com 101 participantes selecionados na terceira onda do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) do Hospital Universitário da Universidade de São Paulo. A partir da avaliação dietética, aplicamos um questionário de frequência alimentar (QFA), dois recordatórios de 24 horas (24hR) pelo software GloboDiet e dois 24hR utilizando o software Brasil-Nutri. A subnotificação de ingestão calórica obtida pelo QFA foi de 13%, 16% e 1%, utilizando-se as equações propostas por Goldberg et al. (1991), Black (2000) e McCrory et al. (2002), respectivamente. Com essas mesmas equações, o 24hR achou uma subnotificação de 9,9%, 14,9% e 0,9%, respectivamente, com o software GloboDiet e de 14,7%, 15,8% e 1,1%, respectivamente, com o software Brasil-Nutri. Verificou-se baixa prevalência de ingestão calórica subnotificada entre os três métodos de captação de dados dietéticos por autorrelato (FFQ e 24hR com GloboDiet e Brasil-Nutri). As equações para cada método diferem entre si embora não tenhamos encontrado diferenças estatisticamente significativas entre os três métodos. A concordância de ingestão calórica entre os métodos foi muito semelhante, mas a melhor foi entre a GloboDiet e a Brasil-Nutri.

Los métodos existentes para evaluar el consumo de alimentos están sujetos a errores de medición, especialmente la infradeclaración de la ingesta de energía, caracterizada por la notificación de la ingesta de energía por debajo del mínimo necesario para mantener el peso corporal. El objetivo de este estudio era comparar la identificación de las infradeclaraciones de ingesta energética utilizando diferentes ecuaciones de predicción e instrumentos de recogida de datos dietéticos. El estudio se realizó con 101 participantes seleccionados en la tercera ola del Estudio Longitudinal de Salud del Adulto (ELSA-Brasil) en el Hospital Universitario de la Universidad de São Paulo. Para la evaluación de la dieta, se aplicó un cuestionario de frecuencia de alimentos (QFA), dos recordatorios de dieta de 24 horas (24hR) utilizando el software GloboDiet, y dos 24hR utilizando el software Brasil-Nutri. La infradeclaración de la ingesta energética obtenida del QFA fue del 13%, el 16% y el 1,0% utilizando las ecuaciones propuestas por Goldberg et al. (1991), Black (2000) y McCrory et al. (2002), respectivamente. Con estas mismas ecuaciones, el 24hR describió una infradeclaración del 9,9%, el 14,9% y el 0,9% respectivamente con el software GloboDiet y del 14,7%, el 15,8% y el 1,1% respectivamente con el software Brasil-Nutri. Se verificó una baja prevalencia de ingesta de energía subdeclarada entre los tres métodos de recogida de datos dietéticos basados en el autoinforme (QFA, 24hR con GloboDiet y Brasil-Nutri). Aunque no se encontraron diferencias estadísticamente significativas entre los tres métodos, las ecuaciones de cada uno de ellos diferían entre sí. La concordancia de la ingesta de energía entre los métodos fue muy similar, pero la mejor fue entre GloboDiet y Brasil-Nutri.

Relative validity of a food frequency questionnaire for adolescents from a capital in the Northeastern region of Brazil

The present study was conducted to evaluate the validity of the Food Frequency Questionnaire (FFQ) used in the RPS Birth Cohort Consortium (Ribeirão Preto, Pelotas, and São Luís) to assess dietary intake of adolescents from São Luís, Maranhão. The research was developed with 152 adolescents aged 18 and 19 years. For the validation of the FFQ, the average of three 24-hour recalls (24HRs) was used as the reference method. The mean and standard deviation of energy and nutrient intake extracted from the surveys were estimated. The paired Student's t-test was used to verify the differences between the instruments. Pearson correlation coefficient, intraclass correlation coefficient (ICC), weighted Kappa, and the Bland-Altman plot were calculated in order to measure the agreement. The study adopted a level of significance <5%. Compared with the three 24HRs, the FFQ overestimated the consumption of most nutrients. Energy-adjusted and de-attenuated concordance Pearson correlation coefficients ranged from 0.06 to 0.43, and correlations were significant for iron, calcium, riboflavin, sodium, saturated fat, niacin, and vitamin C. The energy-adjusted and de-attenuated ICCs ranged from 0.01 to 0.31, and the weighted Kappa ranged from 0.01 to 0.46. The analyses of agreement were significant for vitamin C, fiber, calcium, riboflavin, niacin, sodium, lipids, and iron. In conclusion, the FFQ presented acceptable relative validity for lipids, saturated fatty acids, fiber, calcium, iron, riboflavin, niacin, vitamin C, and sodium. This instrument will be useful in studies about food consumption of adolescents in São Luís, Maranhão.

Relationship between the diet quality index in nursing mothers and the fatty acid profile of mature breast milk / Relação entre o índice de qualidade da dieta de nutrizes e o perfil de ácidos graxos do leite materno maduro

ABSTRACT Objective: To evaluate the relationship between the maternal diet quality and the fatty acid composition of breast milk in the first trimester of lactation. Methods: This is an observational cross-sectional epidemiological study of nursing mothers. The data collection instruments were a semi-structured questionnaire for sample characterization and a recall of usual intake. Diet quality was assessed based on the healthy eating index (HEI). Samples of mature breast milk were obtained by hand milking. Milk fat was extracted using the Bligh-Dyer method and methylated with 0.25 mol/L sodium methoxide in methanol diethyl ether. A gas chromatograph equipped with a flame ionization detector determined the milk fatty acid profile. Pearson's and Spearman's correlation tests evaluated association between the variables. Subsequently, a multiple linear regression model was built and multivariate regression analysis was applied. Results: Our findings revealed an inverse relationship between the consumption of total fruits and the polyunsaturated fatty acid profile and a direct association of the intake of total fruits and total grains with monounsaturated and saturated fatty acids. Conclusions: The results of this study suggest that maternal diet quality affects the fatty acid composition of breast milk.

RESUMO Objetivo: Avaliar a relação entre a qualidade da dieta materna e a composição do leite humano em ácidos graxos no primeiro trimestre de lactação. Métodos: Trata-se de um estudo epidemiológico observacional e transversal com nutrizes. Os instrumentos de coleta dos dados foram questionário semiestruturado para caracterização da amostra e o recordatório de ingestão habitual. A qualidade da dieta foi avaliada por meio do índice de alimentação saudável (IAS). Amostras de leite materno maduro foram obtidas por meio de ordenha manual. A extração da gordura do leite ocorreu mediante o método de Bligh-Dyer, e essa gordura foi metilada com metóxido de sódio 0,25 mol/L em metanol dietil éter. O perfil de ácidos graxos do leite foi determinado por um cromatógrafo a gás equipado com detector por ionização de chamas. Realizaram-se teste de correlação de Pearson e teste de Spearman para verificar associação entre as variáveis. Posteriormente se aplicaram o modelo de regressão linear múltiplo e a análise de regressão multivariada. Resultados: Foi possível observar relação inversa entre o consumo de frutas totais e o perfil de ácidos graxos poli-insaturados e relação direta entre o consumo de frutas totais e cereais totais e os ácidos monoinsaturados e saturados. Conclusões: Sugere-se que a qualidade da dieta reflete na composição de ácidos graxos do leite materno.

Consumo del desayuno escolar y su asociación con la ganancia de peso en niñas de San Luis Potosí / School breakfast consumption and its association with weight gain in girls of San Luis Potosí, Mexico

Resumen: Objetivo: Evaluar el consumo del Desayuno Escolar Frío (DEF) y su asociación con la ganancia de peso en población preescolar y escolar beneficiaria en San Luis Potosí, México. Material y métodos: Se realizó un estudio longitudinal en 255 niñas y niños de 3 a 8 años. Se midió la ganancia de peso durante un año, y la ingesta energética total se estimó por medio de un cuestionario de frecuencia de consumo. La energía proveniente del DEF se dividió en terciles y su asociación con la ganancia de peso fue estimada a través de regresión lineal múltiple. Resultados: En los escolares, la interacción entre los terciles de energía del DEF y sexo mostró que las niñas del segundo y tercer tercil ganaban 500g (p=0.063) y 800g (p=0.015) más, respectivamente. Conclusión: Un mayor consumo de energía proveniente del desayuno escolar se asocia con un incremento en la ganancia de peso en niñas de edad escolar.

Abstract: Objective: To evaluate the consumption of cold school breakfast (CSB) and its association with weight gain in the preschool and school beneficiary population in San Luis Potosí. Materials and methods: A longitudinal study was conducted on 255 girls and boys from 3 to 8 years old. The weight gain was measured during one year and the total energy intake was estimated by means of a frequency of consumption questionnaire. The energy from CSB was divided into terciles and its association with weight gain was estimated through multiple linear regression. Results: In schoolchildren, the interaction between the energy tercile of CSB and sex showed that the girls of the second and third tercile gained 500g (p=0. 063) and 800g (p=0. 015) more, respectively. Conclusion: Higher energy consumption from school breakfast is associated with an increase in weight gain in school-age girls.

Relative validation of a food frequency questionnaire to assess dietary fatty acid intake / Validación relativa de un cuestionario de frecuencia de alimentos para evaluar la ingesta dietaria de ácido graso

OBJECTIVES: This study aimed to develop and validate a Food Frequency Questionnaire (FFQ) for assessing consumption of fatty acids among pregnant women. METHODS: Two lists of foods were created according to percent contribution of each nutrient estimated by three 24-hour recalls: a long and short version FFQ to estimate long-chain polyunsaturated fatty acids (LCPUFAs). Student paired t-test and Pearson correlation coefficients were used to verify the differences in mean consumption of nutrients from the FFQ and 24-hour recall. The concordance between the consumption values of the two methods was assessed using the Bland-Altman method and quartiles concordance. RESULTS: For the FFQ - long version, correlation values ranged from 0.33 (<0.05) to 0.62 (<0.01) for docosahexaenoic acid (DHA) and linoleic acid (LA), respectively. Eicosapentaenoic acid (EPA) and docosapentaenoic acid (DPA) were not correlated. Exact concordance ranged from 49.0% (energy) to 22.4% (EPA), and discordance ranged from 14.3% (DPA) to 2.0% (Saturated). The FFQ - short version had high correlations for LCPUFAs. Exact concordance ranged from 36.7% (n-3 LCPUFA) to 16.3% (DHA); and discordance from 12.2% (DPA) to 2.0% (arachidonic acid). Bland-Altman analysis showed good concordance for both versions. CONCLUSION: This nutrient-specific FFQ is a valid instrument to be used to estimate the level of consumption of fatty acids among pregnant women.

OBJETIVO: Este estudio tuvo como objetivo desarrollar y validar un cuestionario de frecuencia de consumo de alimentos para evaluar el consumo de ácidos grasos en gestantes. MÉTODOS: Dos listas de alimentos fueron creadas de acuerdo con la contribución porcentual de cada nutriente estimado por 3 recordatorios de 24 horas: CFC - versión larga y CFC - versión corta para estimar ácidos grasos poliinsaturados de cadena larga (AGPICL). La prueba de t pareada de Student y el coeficiente de correlación de Pearson se utilizaron para verificar las diferencias entre el consumo medio de nutrientes de del CFC y el recordatorio de 24 horas. La concordancia entre los valores de consumo de los dos métodos se evaluó mediante el método de Bland-Altman y la concordancia de cuartiles. RESULTADOS: En CFC - versión larga, los valores de correlación oscilaron entre 0.33 (<0.05) y 0.62 (<0.01) para ácido docosahexaenoico (DHA) y ácido linoleico (LA), respectivamente. Ácido eicosapentaenoico (EPA) y ácido docosapentaenoico (DPA) no presentaron correlación. La concordancia exacta varió de 49,0% (energía) a 22,4% (EPA), y la discordancia varió de 14,3% (DPA) a 2,0% (saturado). CFC: la versión corta mostró los mejores valores de correlaciones para los AGPICL. La concordancia exacta varió de 36,7 (n-3 LCPUFA) a 16,3% (DHA); y discordancia de 12,2% (DPA) a 2,0% (ácido araquidónico). El análisis de Bland-Altman mostró una buena concordancia para ambas versiones. CONCLUSIÓN: Este método CFC específico de nutrientes es un instrumento válido que se utiliza para estimar el nivel de consumo de ácidos grasos en mujeres gestantes.

Prevalence of insulin resistance and association with metabolic risk factors and food consumption in adolescents - recife/brazil / Prevalência de resistência à insulina e associação com fatores de risco metabólicos e consumo alimentar de adolescentes - recife/brasil

ABSTRACT Objective: To identify the prevalence of insulin resistance in adolescents and its associations with metabolic factors and food intake. Methods: Cross-sectional study conducted with a stratified, complex, school-based sample. The subjects were adolescents (n=1,081) who participated in the Study of Cardiovascular Risk in Adolescents in the city of Recife (Pernambuco, Brazil). We analyzed demographic, socioeconomic, behavioral, anthropometric, biochemical, and dietary variables. Insulin resistance was defined as HOMA-IR>75th percentile. A Poisson multivariate regression model with robust variance adjustment was used, and variables with p≤0.05 in the final model were considered statistically associated with insulin resistance. Results: Median age was 14 years (interquartile range: 13-16 years), and 25.3% of the sample showed insulin resistance. The variables associated with insulin resistance in the final model were age, body mass index-for-age (BMI/A), biochemical markers (triglycerides and high-density lipoprotein cholesterol) and saturated fat intake, with insulin resistance being more prevalent in individuals whose consumption of this type of fat was below the median of the sample distribution. Conclusions: Insulin resistance was prevalent in the adolescents analyzed and was significantly associated with metabolic variables and saturated fat intake.

RESUMO Objetivo: Identificar a prevalência de resistência à insulina em adolescentes e verificar sua associação com variáveis metabólicas e com o consumo alimentar. Métodos: Estudo transversal, de base escolar, com amostra do tipo estratificada e complexa. Os indivíduos analisados foram adolescentes (n=1.081) participantes do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA) na cidade de Recife (Pernambuco, Brasil). Foram coletadas variáveis demográficas, socioeconômicas, comportamentais, antropométricas, bioquímicas e do consumo alimentar. A resistência à insulina foi definida como HOMA-IR>percentil 75. Análises de regressão de Poisson com ajuste robusto da variância foram empregadas, sendo identificadas associações estatisticamente significativas quando p≤0,05. Resultados: A idade mediana foi de 14 anos (intervalo interquartílico=13-16) e a resistência à insulina foi evidenciada em 25,3% da amostra. As variáveis que se associaram significativamente com a resistência à insulina no modelo final foram a faixa etária, o índice de massa corpórea por idade (IMC/I), marcadores bioquímicos (triglicerídeos e HDL-colesterol) e o consumo alimentar de gordura saturada, observando-se maior prevalência da resistência à insulina naqueles indivíduos que apresentaram a ingestão deste tipo de gordura abaixo da mediana da própria distribuição. Conclusões: A resistência à insulina foi prevalente nos adolescentes avaliados e se associou significativamente com variáveis metabólicas e com o consumo alimentar de gordura do tipo saturada.

Tecnologia em Saúde: versão brasileira do software GloboDiet para avaliação do consumo alimentar em estudos epidemiológicos / Technology in Health: Brazilian version of the GloboDiet program for dietary intake assessment in epidemiological studies

RESUMO: O Recordatório Alimentar de 24 horas (R24h) tem sido o método de escolha para a avaliação da dieta em inquéritos populacionais. Os avanços tecnológicos permitiram o desenvolvimento de softwares para a coleta de dados de R24h. A International Agency for Research on Cancer-World Health Organization (IARC-WHO) desenvolveu metodologia para avaliação do consumo alimentar de forma padronizada e personalizada, o GloboDiet, com o objetivo de utilizá-la em pesquisas e em estudos de vigilância alimentar e nutricional. O Brasil, inserido em um projeto para expansão global dessa metodologia, desenvolveu e adaptou uma versão para uso nacional. A adaptação considerou a tradução e adequação de aproximadamente 70 bases de dados. Para a elaboração da lista de alimentos, foram consultados bancos de dados nacionais de estudos de consumo alimentar, obtendo-se um rol de 2.113 alimentos e receitas. O software GloboDiet orienta uma entrevista que se desenvolve em cinco etapas: informações gerais do participante; lista rápida de alimentos e receitas; detalhamento dos alimentos/das receitas e das quantidades consumidas por meio, principalmente, do manual fotográfico; controle da quantidade de alimentos e nutrientes; e informações sobre o uso de suplementos dietéticos. A versão brasileira do software proporcionará uma avaliação mais acurada do consumo alimentar com base em uma metodologia padronizada para fins de vigilância alimentar e nutricional e de investigação da relação da dieta com desfechos em saúde, além de permitir a comparabilidade dos dados de consumo alimentar em estudos no âmbito nacional e internacional.

ABSTRACT: The 24-hour recall (R24h) has been the method for dietary assessment in surveys. Technological advances have allowed the development of a program for the collection of R24h data. International Agency for Research on Cancer-World Health Organization (IARC-WHO) developed a standardized interview and computer-based 24-hour dietary recall program called GloboDiet, aimed at using it in research and nutrition surveillance. Brazil was included in a project for the global expansion of this methodology for developing and adapting a version for national use. The adaptation followed the procedures established by the IARC-WHO that considered the translation and adaptation of approximately 70 databases. For the development of the food list, national databases of food consumption from national surveys were consulted obtaining a final list of 2113 foods and recipes. GloboDiet program guides an interview in five steps: general information of the participant; quick list of foods and recipes; details of food / recipes and quantities consumed using mainly a picture book; control of the amount of food and nutrients; and information on dietary supplements. The Brazilian version of the GloboDiet program will provide a more accurate assessment of food intake based on a standardized method for nutrition surveillance and investigation of the relationship between diet and health outcomes, as well as comparisons of dietary intakes within and between countries.

Excess weight and gastrointestinal symptoms in a group of autistic children / Excesso de peso e sintomas gastrintestinais em um grupo de crianças autistas

ABSTRACT Objective: To evaluate the nutritional status and gastrointestinal changes in children with autism spectrum disorder (ASD). Methods: Cross-sectional, descriptive analysis of 39 children with ASD aged between three and ten years old, registered in the participating association. Nutritional status was evaluated by body mass index/age and weight/age, according to the guidelines from the World Health Organization. In order to investigate whether gastrointestinal alterations occurred, the interviewees answered a questionnaire about the presence of these symptoms within the last 30 days. In order to evaluate food consumption, a 24-hour recall questionnaire was applied and the food reported were grouped as: gluten sources, casein and ultra-processed sources. For the statistical analysis, Epi-Info software version 7.2 was used. Multivariate logistic regression analysis was performed to evaluate the variables associated with gastrointestinal alterations. Results: There was a high prevalence of overweight children with autism spectrum disorder (64.1%). No child was underweight. Thirty-four children (84.2%) had gastrointestinal symptoms. Consumption of gluten was associated with gastrointestinal symptoms (β=0.38; 95%CI 0.07-0.75; p=0.02). Conclusions: The high prevalence of being overweight should be considered during the follow-up visits of children with ASD. The influence of gluten consumption on the presence of gastrointestinal symptoms was observed in this study, and the causes involved in these alterations need to be further investigated.

RESUMO Objetivo: Avaliar o estado nutricional e a presença de alterações gastrintestinais em crianças com transtorno do espectro autista. Métodos: Estudo transversal, descritivo, composto por 39 crianças autistas com idades entre três e dez anos, cadastradas na associação participante. O estado nutricional foi analisado a partir do índice de massa corporal/idade e do peso/idade, tendo como referências as curvas da Organização Mundial da Saúde. Para investigação das alterações gastrintestinais, o entrevistado respondeu sobre a presença de alterações nos últimos 30 dias. Na avaliação do consumo alimentar foi aplicado um recordatório de 24 horas e os alimentos listados foram categorizados em: fontes de glúten, fontes de caseína e ultraprocessados. A análise estatística utilizou o software Epi-Info, versão 7.2. Foi realizada a análise de regressão logística multivariada para avaliar os fatores associados às alterações gastrintestinais. Resultados: Observou-se alta prevalência de excesso de peso nas crianças com transtorno do espectro autista (64,1%), não sendo registrada nenhuma criança com déficit de peso. Um total de 34 crianças (84,2%) apresentava alterações gastrintestinais. O consumo de glúten esteve associado às manifestações gastrintestinais (β=0,38; IC95% 0,07-0,75; p=0,02). Conclusões: A elevada prevalência do excesso de peso deve ser tratada com maior atenção em crianças com transtorno do espectro autista. Foi observada a influência do consumo de glúten no aparecimento das alterações gastrintestinais, sendo necessário que as causas envolvidas nessas alterações sejam mais bem investigadas.

The relationship of flavonoid intake during pregnancy with excess body weight and gestational diabetes mellitus

ABSTRACT Objective: To investigate the relationship of flavonoid intake during pregnancy with maternal excessive body weight and gestational diabetes mellitus (GDM). Subjects and methods: A cross-sectional study was conducted among 785 adult women in singleton pregnancies, and data were collected at the time of the oral glucose tolerance test. For the body mass index (BMI) classification according to the gestational age, the criteria of Atalah was used, and the diagnosis of GDM was based on the World Health Organization of 2014. Two 24-hour dietary recalls were obtained, and the usual intake was determined by the Multiple Source Method. Adjusted multinomial logistic regression was used to investigate the relationship of the flavonoids with overweight and obesity, and adjusted non-conditional logistic regression for the relationship of the flavonoids with GDM. Results: The mean (SD) age of the women was 28 (5) years, 32.1% were overweight, 24.6% were obese and 17.7% were diagnosed with GDM. The median (P25, P75) of total flavonoid intake was 50 (31,75) mg/day. Considering the eutrophic women as the reference, the pregnant women with a higher total flavonoid intake [OR 0.62 (95% CI 0.38; 0.96)] and anthocyanidin intake [OR 0.62 (95% CI 0.40; 0.99)] were less likely to be obese when compared to the women with lower intakes. No association of the flavonoids intake with overweight or GDM was found. Conclusion: A very low intake of flavonoids was observed. The data suggest that the intake of foods naturally rich in total flavonoids and anthocyanidin has a beneficial role regarding obesity among pregnant women.

Association between ultra-processed food consumption and the nutrient profile of the Colombian diet in 2005 / Asociación entre el consumo de alimentos ultraprocesados y el perfil nutricional de la dieta de los colombianos en 2005

Abstract: Objective: To evaluate the consumption of ultra-processed food and drink products and its association with the nutrient profile of the Colombian diet in 2005. Materials and methods: Food consumption based on 24-hour dietary records from 38 643 men and women was classified into four NOVA groups according to the extent and purpose of food processing. Results: Ultra-processed food and drink products represented 15.9% of the total energy daily intake, compared to 63.3% from minimally processed food, 15.8% from processed culinary ingredients, and 4.9% from processed food. Non-ultra-processed food items had a healthier nutritional profile compared to ultra-processed items in terms of contribution to total calories from protein, carbohydrates, total fat, saturated fat, free sugar, fiber and energy density. Conclusions: Ultra-processed food products have a less healthy nutrient profile than non-ultra-processed ones. An increase in the consumption of these foods must be prevented within Colombia.

Resumen: Objetivo: Evaluar el consumo de alimentos y bebidas ultraprocesadas y su asociación con el perfil nutricional dentro de la Encuesta Nacional de Nutrición de 2005 en Colombia. Material y métodos: El consumo de alimentos basados en registros alimentarios de 24 horas de 38 643 individuos se clasificó en cuatro grupos de NOVA. Resultados: Los productos de alimentos y bebidas ultraprocesados representaron 15.9% de la ingesta diaria total de energía, en comparación con 63.3% de los alimentos mínimamente procesados, 15.8% de los ingredientes culinarios procesados y 4.9% de los procesados. Los alimentos mínimamente procesados tenían un perfil nutricional más saludable en comparación con los artículos ultraprocesados en términos de contribución a las calorías totales, de proteínas, carbohidratos, grasa total, grasa saturada, azúcar libre, densidad de fibra y densidad de energía. Conclusiones: Los alimentos ultraprocesados tienen un perfil nutricional menos saludable que los alimentos no procesados.

Principal Component Analysis and Factor Analysis: differences and similarities in Nutritional Epidemiology application / Análise de Componentes Principais e Análise Fatorial: diferenças e similaridades na aplicação em Epidemiologia Nutricional

ABSTRACT: Introduction: Statistical methods such as Principal Component Analysis (PCA) and Factor Analysis (FA) are increasingly popular in Nutritional Epidemiology studies. However, misunderstandings regarding the choice and application of these methods have been observed. Objectives: This study aims to compare and present the main differences and similarities between FA and PCA, focusing on their applicability to nutritional studies. Methods: PCA and FA were applied on a matrix of 34 variables expressing the mean food intake of 1,102 individuals from a population-based study. Results: Two factors were extracted and, together, they explained 57.66% of the common variance of food group variables, while five components were extracted, explaining 26.25% of the total variance of food group variables. Among the main differences of these two methods are: normality assumption, matrices of variance-covariance/correlation and its explained variance, factorial scores, and associated error. The similarities are: both analyses are used for data reduction, the sample size usually needs to be big, correlated data, and they are based on matrices of variance-covariance. Conclusion: PCA and FA should not be treated as equal statistical methods, given that the theoretical rationale and assumptions for using these methods as well as the interpretation of results are different.

RESUMO: Introdução: Métodos estatísticos de análise multivariada, tais como Análise de Componentes Principais e Análise Fatorial, têm sido cada vez mais utilizados nos estudos em Epidemiologia Nutricional, no entanto equívocos quanto à escolha e aplicação dos métodos são observados. Objetivos: Os objetivos deste estudo são comparar e apresentar as principais diferenças e similaridades conceituais e metodológicas entre Análise de Componentes Principais e Análise Fatorial visando à aplicabilidade nos estudos em nutrição. Métodos: Análise de Componentes Principais e Análise Fatorial foram aplicadas em uma matriz de 34 grupos de alimentos que expressaram o consumo alimentar médio de 1.102 indivíduos de um estudo populacional. Resultados: Um total de dois fatores foi extraído e juntos explicaram 57,66% da variância comum entre as variáveis dos grupos alimentares, enquanto um total de cinco componentes foi extraído e juntos explicaram 26,25% da variância total. Entre as principais diferenças envolvendo os dois métodos estão: pressuposto de normalidade; as matrizes de variância-covariância/correlação, com consequente quantidade de variância explicada; a carga fatorial/componente e o erro associado. Entre as similaridades estão: ambas as técnicas são usadas para redução de dados; necessitam de um grande tamanho de amostra; os dados precisam ser correlacionados e são baseadas nas matrizes de variância-covariância/correlação. Conclusão: Análise de Componentes Principais e Análise Fatorial não devem ser tratadas como métodos estatísticos iguais e intercambiáveis, uma vez que o racional teórico e os pressupostos para o uso dos métodos, assim como a interpretação dos resultados, são diferentes.

Food Frequency Questionnaire for Chinese Children Aged 12-17 Years: Validity and Reliability / 生物医学与环境科学（英文）

OBJECTIVE@#The primary objective of this study was to examine the validity and reliability of a semi-quantitative food frequency questionnaire (FFQ) among Chinese children aged 12-17 years.@*METHODS@#A semi-quantitative 72-food item FFQ was developed for children aged 12-17 years. The reliability and validity of this FFQ were evaluated against 24-h dietary recalls (24 h DRs) to measure the consumption of foods and nutrients. We administered two FFQs and three DRs to children (N = 160) over a period of 1 month to evaluate the reliability and validity. Reliability was examined by quartile agreement and intraclass correlation coefficients (ICCs), and validity was examined by quartile agreement, Bland-Altman plots and correlation with DRs.@*RESULTS@#For reliability, the ICCs between the two FFQs ranged from 0.21 to 0.76 for foods and nutrients, and the quartile agreement ranged from 70.0% to 95.0% in the same or adjacent quartiles. Spearman's correlation coefficients of foods and nutrients between the second FFQ and the 24 h DRs ranged from -0.04 to 0.59. The Bland-Altman plots demonstrated good agreement across the range of intakes among nutrients. The quartile agreement ranged from 50.0% to 100.0%, with infrequent misclassification.@*CONCLUSION@#The FFQ assessment of dietary intakes demonstrated acceptable relative validity and high reproducibility for Chinese children aged 12-17 years.

Utilização do diário alimentar no diagnóstico do consumo de sacarose em odontopediatria: revisão de literatura / Use of the food diary for diagnosing sucrose intake in pediatric dentistry: literature review

Objetivo: o presente trabalho tem por objetivo a realizaçãode uma revisão de literatura sobre a utilizaçãodo diário alimentar para diagnóstico do uso de sacarosee para o controle da cárie. Revisão de literatura:a cárie dentária está intimamente relacionada à dietaalimentar, principalmente à ingestão de carboidratos.Uma dieta rica em sacarose, além de promover umdescontrole no biofilme, descontrola as funções fisiológicasda saliva, a microbiota bacteriana, bem comoa saúde bucal por completo. Os hábitos presentes nadieta infantil constituem um fator importante para a determinaçãoda etiologia e o desenvolvimento da cáriedentária, por isso é fundamental a orientação quanto àsaúde bucal e, principalmente, ao consumo racional deaçúcar. Considerações finais: diante disso, os cuidadoscom os elementos dentários e a prevenção da cárie deveminiciar desde a infância. Para este fim, são de sumaimportância, além de uma boa higiene oral, uma dietaadequada às crianças e mudanças de atitudes dos paissobre a alimentação infantil. (AU)

Objective: the present study aims to perform a literature review on the use of the food diary to diagnose the use of sucrose and to control caries. Literature review: dental caries is closely related to diet, especially to carbohydrate intake. A diet rich in sucrose promotes the lack of control of biofilm and the physiological functions of saliva, bacterial microbiota, and the entire oral health. The habits present in the infant diet are important factors to determine the etiology and development of dental caries, so it is essential to instruct children about oral health and especially about the rational consumption of sugar. Final considerations: therefore, the care for dental elements and caries prevention should start at childhood. Hence, proper oral hygiene, as well as an adequate diet for children and changes in the attitudes of parents regarding infant diet habits is of utmost importance. (AU)

A higher number of school meals is associated with a less-processed diet / Maior número de refeições nas escolas está associado a uma alimentação menos processada

Abstract Objective: To compare the participation of food groups - fresh and minimally processed, processed, and ultra-processed - in the diet of students (n = 1357) from Belo Horizonte, MG, Brazil, in accordance with the number of school meals consumed daily. Methods: Four groups were defined: children that did not consume school meals and children that consumed one, two, or three school meals daily. Food groups participation, in g/1000 kcal, was obtained using two 24-hour recalls. Three linear regression models were analyzed, in which the consumption of each of the food groups was the dependent variable, the number of school meals was the independent variable, and sociodemographic data (gender, age, health vulnerability) and overweight condition were the control variables. Results: Children that consumed 2 or 3 school meals daily showed, respectively, 7.3% and 10.5% higher ingestion of fresh and minimally processed food in comparison to children that did not consume school meals. Moreover, ultra-processed food participation was 18.0% lower among students that consumed two school meals and 26.0% lower among children that consumed three meals daily, in comparison to students that did not consume school meals. Conclusion: The study showed a possible dose-response effect in children's daily diets with two or three school meals and highlighted the relevance of the prolonged stay at school for healthy eating promotion in children.

Resumo Objetivo: Comparar a participação dos alimentos in natura e minimamente processados, processados e ultraprocessados na alimentação de 1.357 escolares de Belo Horizonte (MG) de acordo com o número de refeições escolares consumidas diariamente. Métodos: Foram definidos quatro grupos de estudo: crianças que não consumiam a alimentação escolar e crianças que consumiam uma, duas ou três refeições escolares diariamente. A participação na dieta dos grupos de alimentos, em g/1.000 kcal, foi obtida a partir de dois recordatórios alimentares de 24 horas. Foram analisados três modelos de regressão linear, nos quais o consumo de cada um dos três grupos de alimentos constituiu a variável dependente, o número de refeições escolares consumidas diariamente constituiu a variável independente e os dados sociodemográficos (sexo, idade, índice de vulnerabilidade à saúde) e de excesso de peso constituíram-se as variáveis de ajuste. Resultados: Verificou-se que as crianças que consumiam duas e três refeições escolares diariamente apresentaram, respectivamente, 7,3% e 10,5% maior ingestão de alimentos in natura e minimamente processados quando comparadas com as crianças que não consumiam a alimentação escolar. Além disso, a participação de ultraprocessados foi 18,0% menor na alimentação das crianças que consumiam duas refeições escolares e 26,0% menor entre as que consumiam três refeições escolares diariamente, em comparação com aquelas que não consumiam a alimentação escolar. Conclusão: O estudo apontou possível efeito dose-resposta na proteção da alimentação dos estudantes a partir do consumo de duas refeições escolares diárias, destacando a relevância da permanência da criança em período integral na escola para a promoção da alimentação saudável.

Dietary intake of non-dialysis chronic kidney disease patients: the PROGREDIR study. A cross-sectional study

ABSTRACT BACKGROUND: Despite evidence that diet is very important in relation to chronic kidney disease (CKD) progression, studies in this field are scarce and have focused only on some specific nutrients. We evaluated the energy, macronutrient and micronutrient intakes and dietary patterns of non-dialysis CKD participants in the PROGREDIR study. DESIGN AND SETTING: Cross-sectional study; CKD cohort, São Paulo, Brazil. METHODS: Baseline data on 454 participants in the PROGREDIR study were analyzed. Dietary intake was evaluated through a food frequency questionnaire. Dietary patterns were derived through principal component analysis. Energy and protein intakes were compared with National Kidney Foundation recommendations. Linear regression analysis was performed between energy and nutrient intakes and estimated glomerular filtration rate (eGFR), and between sociodemographic and clinical variables and dietary patterns. RESULTS: Median energy and protein intakes were 25.0 kcal/kg and 1.1 g/kg, respectively. In linear regression, protein intake (β = -3.67; P = 0.07) was related to eGFR. Three dietary patterns (snack, mixed and traditional) were retained. The snack pattern was directly associated with male gender (β = 0.27; P = 0.006) and inversely with diabetes (β = -0.23; P = 0.02). The traditional pattern was directly associated with male gender (β = 0.27; P = 0.007) and schooling (β = 0.40; P < 0.001) and inversely with age (β = -0.01; P = 0.001) and hypertension (β = -0.34; P = 0.05). CONCLUSIONS: We identified low energy and high protein intake in this population. Protein intake was inversely related to eGFR. Dietary patterns were associated with age, gender, schooling level, hypertension and diabetes.

Development of Nutrition Quotient for Korean adults: item selection and validation of factor structure / 한국영양학회지

PURPOSE: This study was conducted to develop a nutrition quotient (NQ) to assess overall dietary quality and food behaviors of Korean adults. METHODS: The NQ was developed in three steps: item generation, item reduction, and validation. Candidate items of the NQ checklist were derived from a systematic literature review, expert in-depth interviews, statistical analyses of the Korea National Health and Nutrition Examination Survey (2010 ~ 2013) data, and national nutrition policies and recommendations. A total of 368 adults (19 ~ 64 years) participated in a one-day dietary record survey and responded to 43 items in the food behavior checklist. Pearson's correlation coefficients between responses to the checklist items and nutritional intake status of the adults were calculated. Item reduction was performed, and 24 items were selected for a nationwide survey. A total of 1,053 nationwide adult subjects completed the checklist questionnaires. Exploratory and confirmatory factor analyses were performed to develop a final NQ model. RESULTS: The 21 checklist items were used as final items for NQ. Checklist items were composed of four factors: nutrition balance (seven items), food diversity (three items), moderation for the amount of food intake (six items), and dietary behavior (five items). The four-factor structure accounted for 41.8% of the total variance. Indicator tests of the NQ model suggested an adequate model fit (GRI = 0.9693, adjusted GFI = 0.9617, RMR = 0.0054, SRMR = 0.0897, p < 0.05), and item loadings were significant for all subscales. Standardized path coefficients were used as weights of the items. The NQ and four-factor scores were calculated according to the obtained weights of the questionnaire items. CONCLUSION: NQ for adults would be a useful tool for assessing adult dietary quality and food behavior. Further investigations of adult NQ are needed to reflect changes in their food behavior, environment, and prevalence of chronic diseases.

Development and relative validity of semi-quantitative food frequency questionnaire for Korean adults / 한국영양학회지

PURPOSE: This study was implemented to develop and validate the semi-quantitative food frequency questionnaire (SQ-FFQ) to assess energy, carbohydrates, fat, protein, minerals, and vitamins as well as fatty acids and alcohol in Korean adults. METHODS: The SQ-FFQ consisted of 88 food items, and 12 food groups were selected based on information of frequently consumed foods from the Korean Health and Nutrition Examination survey. Each portion size was categorized as one of three amounts: small (0.5 times), medium (1 time), and large (1.5 times). A total of 111 subjects finished 3-day diet records and the SQ-FFQ. The relative validity of SQ-FFQ was assessed by comparison with the 3-day diet records. RESULTS: The mean nutrient intakes obtained from the SQ-FFQ were estimated to be greater than those of the two 3-day dietary records. Spearman's correlation coefficient between the two methods was the highest for energy (r = 0.583; p < 0.001) and lowest for saturated fatty acid (r = 0.121). Correlation coefficients were energy (r = 0.583; p < 0.001), carbohydrates (r = 0.500; p < 0.001), protein (r = 0.466; p < 0.001), fat (r = 0.411; p < 0.001), dietary fiber (r = 0.467; p < 0.001), alcohol (r = 0.527; p < 0.001), calcium (r = 0.409; p < 0.001), phosphorus (r = 0.499; p < 0.001), potassium (r = 0.418; p < 0.001), magnesium (r = 0.427; p < 0.001), and zinc (r = 0.464; p < 0.001), respectively, for all subjects. CONCLUSION: The developed SQ-FFQ in this study seems to be useful for estimating nutritional status, particularly energy, carbohydrates, protein, fat, dietary fiber, alcohol, calcium, phosphorus, potassium, magnesium, and zinc of Korean adults.

Effects of Maternal Iodine Status during Pregnancy and Lactation on Maternal Thyroid Function and Offspring Growth and Development: A Prospective Study Protocol for the Ideal Breast Milk Cohort

BACKGROUND: Iodine is an intrinsic element of thyroid hormone, which is essential for childhood growth and development. The Ideal Breast Milk (IBM) cohort study aims to evaluate the effects of maternal iodine status during pregnancy and lactation on maternal thyroid function, offspring growth and development, and offspring thyroid function. METHODS: The IBM cohort study recruited pregnant women from Seoul National University Hospital between June 2016 and August 2017, followed by enrollment of their offspring after delivery. For the maternal participants, iodine status is evaluated by urinary iodine concentration (UIC) and dietary records in the third trimester and at 3 to 4 weeks and 12 to 15 months postpartum. For the child participants, cord blood sampling and UIC measurements are performed at birth. At 3 to 4 weeks of age, UIC and breastmilk iodine concentrations are measured. At 12 to 15 months of age, growth and development are assessed and measurements of UIC, a thyroid function test, and ultrasonography are performed. RESULTS: A total of 198 pregnant women in their third trimester were recruited. Their mean age was 35.1±3.5 years, and 78 (39.4%) of them were pregnant with twins. Thirty-three (16.7%) of them had a previous history of thyroid disease. CONCLUSION: Korea is an iodine-replete area. In particular, lactating women in Korea are commonly exposed to excess iodine due to the traditional practice of consuming brown seaweed soup postpartum. The study of the IBM cohort is expected to contribute to developing guidelines for optimal iodine nutrition in pregnant or lactating women.

Evaluación de la densidad mineral ósea en niños con infección vertical por VIH / Evaluation of bone mineral density in children with vertical infection by HIV

Resumen Los cambios en la densidad mineral ósea (DMO) son comunes en adultos infectados con virus de la inmunodeficiencia humana (VIH). Existen pocos estudios que evalúen el compromiso óseo en niños. Objetivo: Evaluar la DMO en niños infectados verticalmente por VIH. Métodos: Se estudiaron 53 niños infectados (8-18) de cinco hospitales. Se registró severidad de enfermedad, evaluación nutricional, vitamina D (25-OHD) y estado inmunológico. La DMO se midió mediante densitometría. Se utilizó análisis descriptivo, comparación de medias y regresión lineal simple y múltiple. Resultados: El 88,7% estaban en estadio B y C, 57% eran eutróficos y 18,9% tenían talla baja. El 33,3% presentaba niveles de 25-OHD < 20 ng/ml. El 11%, 6% y 4% de los niños tenían DMO < 2DE en cadera, columna y cuerpo entero, respectivamente. La DMO se correlacionó con IMC, talla, severidad de enfermedad y años de tratamiento. Sólo inhibidores de las proteasas (IP) mantuvieron su significancia al ajustar por otras variables. Conclusión: Los niños infectados con VIH tuvieron DMO más baja por edad comparados con datos de NHANES III. La severidad de la enfermedad, talla, zIMC, los años de tratamiento con anti-retrovirales, principalmente IP, están relacionados con la reducción de la masa ósea.

Changes in bone mineral density (BMD) are common in adults infected with human immunodeficiency virus (HIV). There are few studies evaluating bone involvement in children infected. Objective: To evaluate BMD in vertically HIV-infected children. Methods: We studied 53 infected children (8-18 years) from five hospitals. Disease status, nutritional assessment, vitamin D (25-OHD) levels and immunological status were recorded. BMD was measured by densitometry. Descriptive analysis, comparison of means and simple and multiple linear regression were used. Results: 88.7% children were in stage B and C, 57% were eutrophic and 18.9% had short stature. 33.3% had 25-OHD levels < 20 ng / ml. 11%, 6% and 4% of the children had BMD <-2DE in hip, spine and whole body respectively. BMD was correlated with BMI, height, disease stage and years of treatment. Only protease inhibitors (PIs) maintained their significance when adjusted for other variables. Conclusion: children infected with HIV had lower BMD by age compared to NHANES III data. The severity of the disease, height, zBMI, years of treatment with antiretrovirals, mainly IP, are related to the reduction of bone mass.