Tools developed in Brazil for the promotion and assessment of adequate and healthy eating habits: A scoping review. / Ferramentas para promoção e avaliação da alimentação adequada e saudável desenvolvidas no Brasil: uma revisão de escopo.

The objective of this study was to identify and discuss the tools for the promotion and evaluation of adequate and healthy eating based on the Food Guide for the Brazilian Population. The scoping review was conducted according to the JBI Manual for Evidence Synthesis via the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and by searching PubMed/MEDLINE, EMBASE, SciELO and LILACS. Sixteen studies on relevant tools, based on the food guide for individuals of all age groups, were thus included: two descriptive studies, two randomized clinical trial protocols, eleven methodological analyses, and one psychometric paper, aimed at either a focal population (n=12) or health professionals (n=4). Six studies addressed tools for promoting adequate and healthy eating, and ten developed tools for evaluating dietary practices or the knowledge and activities of health professionals. This review can therefore assist health professionals in choosing instruments for the implementation and/or dissemination of food guide recommendations, contributing to the promotion of adequate and healthy eating habits.

O objetivo deste estudo foi identificar e discutir as ferramentas de promoção e avaliação da alimentação adequada e saudável baseadas no Guia Alimentar para a População Brasileira. A revisão de escopo foi conduzida de acordo com o JBI Manual for Evidence Synthesis, utilizando para relatório de revisão de escopo o guia Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews, com busca nas bases de dados PubMed/MEDLINE, EMBASE, SciELO e LILACS. Dezesseis estudos sobre ferramentas baseadas no guia alimentar para indivíduos de todas as faixas etárias, foram incluídos: dois descritivos, dois de protocolo de estudo clínico randomizado, onze metodológicos e um psicométrico, direcionados à população (n=12) ou à profissionais de saúde (n=4). Seis estudos abordaram ferramentas para promoção da alimentação adequada e saudável e dez desenvolveram ferramentas para avaliação de práticas alimentares ou de conhecimento e atividades de profissionais da saúde. Esta revisão auxiliará os profissionais de saúde na escolha dos instrumentos para o processo de implementação e, ou, divulgação das recomendações do guia alimentar, contribuindo para a promoção da alimentação adequada e saudável.

Ferramentas para promoção e avaliação da alimentação adequada e saudável desenvolvidas no Brasil: uma revisão de escopo / Tools developed in Brazil for the promotion and assessment of adequate and healthy eating habits: A scoping review

Resumo O objetivo deste estudo foi identificar e discutir as ferramentas de promoção e avaliação da alimentação adequada e saudável baseadas no Guia Alimentar para a População Brasileira. A revisão de escopo foi conduzida de acordo com o JBI Manual for Evidence Synthesis, utilizando para relatório de revisão de escopo o guia Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews, com busca nas bases de dados PubMed/MEDLINE, EMBASE, SciELO e LILACS. Dezesseis estudos sobre ferramentas baseadas no guia alimentar para indivíduos de todas as faixas etárias, foram incluídos: dois descritivos, dois de protocolo de estudo clínico randomizado, onze metodológicos e um psicométrico, direcionados à população (n=12) ou à profissionais de saúde (n=4). Seis estudos abordaram ferramentas para promoção da alimentação adequada e saudável e dez desenvolveram ferramentas para avaliação de práticas alimentares ou de conhecimento e atividades de profissionais da saúde. Esta revisão auxiliará os profissionais de saúde na escolha dos instrumentos para o processo de implementação e, ou, divulgação das recomendações do guia alimentar, contribuindo para a promoção da alimentação adequada e saudável.

Abstract The objective of this study was to identify and discuss the tools for the promotion and evaluation of adequate and healthy eating based on the Food Guide for the Brazilian Population. The scoping review was conducted according to the JBI Manual for Evidence Synthesis via the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and by searching PubMed/MEDLINE, EMBASE, SciELO and LILACS. Sixteen studies on relevant tools, based on the food guide for individuals of all age groups, were thus included: two descriptive studies, two randomized clinical trial protocols, eleven methodological analyses, and one psychometric paper, aimed at either a focal population (n=12) or health professionals (n=4). Six studies addressed tools for promoting adequate and healthy eating, and ten developed tools for evaluating dietary practices or the knowledge and activities of health professionals. This review can therefore assist health professionals in choosing instruments for the implementation and/or dissemination of food guide recommendations, contributing to the promotion of adequate and healthy eating habits.

Consumption of yacon flour and energy-restricted diet increased the relative abundance of intestinal bacteria in obese adults.

Prebiotics can alter the gastrointestinal environment, favoring the growth of health-promoting bacteria. Although yacon is a functional food, with prebiotic properties (fructooligosaccharides), its effects on the intestinal microbiota have not been investigated yet. The objective of this study was to evaluate the effects of yacon flour consumption and energy-restricted diet in the intestinal microbiota in adults with excess body weight. Twenty-one adults with excess body weight were included in this randomized, parallel, double-blind, placebo-controlled, 6-week clinical trial. Subjects daily consumed at breakfast a drink containing 25 g of yacon flour (n = 11) or not containing yacon (n = 10) and received the prescription of energy-restricted diets. Fecal samples were collected on the first and on last day of the study. 16S rRNA sequencing was assessed to evaluate the effect of yacon fermentation on intestinal microbiota bacterial composition. There was an increase in the genera Bifidobacterium, Blautia, Subdoligranulum, and Streptococcus after the consumption of yacon and energy-restricted diet. In the yacon group, we also observed a positive correlation between the concentrations of short-chain fatty acids versus the genera Coprococcus and Howardella, besides a negative correlation between the concentrations of advanced glycation end products and early glycation products versus the genera Ruminococcus and Prevotella, respectively. Consumption of yacon flour and energy-restricted diet selectively changed the intestinal microbiota composition in adults with excess body weight. TRIAL REGISTRATION: Register number: RBR-6YH6BQ. Registered 23 January, 2018.

Effect of the consumption of yacon flour and energy-restricted diet on glycation markers, and association between these markers and factors linked to obesity in adults with excess body weight: A randomized, double-blind, placebo-controlled clinical trial.

OBJECTIVES: Regardless of the positive effect of yacon on metabolic markers, this food contains fructose molecules, which can originate advanced glycation end products (AGEs). High AGEs serum concentrations can contribute to excess body weight. We evaluated the effect of consuming an energy-restricted diet and yacon flour on glycation markers concentrations, and the associations between these markers and factors linked to obesity in adults with excess body weight. METHODS: Twenty-six adults with excess body weight were included in this randomized, parallel, double-blind, placebo-controlled, 6-week clinical trial. Subjects were randomly allocated to the control group (n = 13) or the yacon-flour group (n = 13), and daily consumed a breakfast drink either not containing or containing 25 g of yacon flour (8.7 g of fructooligosaccharides). Energy-restricted diets were prescribed for both groups. Biochemical markers, anthropometric variables, and body composition were evaluated at baseline and the end of the study. RESULTS: AGEs and early glycation products did not increase in the yacon flour group. Soluble receptor for AGEs (sRAGE) decreased regardless of group. Besides, changes in AGEs were positively associated with changes in body fat (ß = 0.04, P = 0.038) and in sRAGE, with insulin (ß = 0.02, P = 0.035) and homeostasis model assessment index of insulin resistance (ß = 0.01, P = 0.049). CONCLUSIONS: The consumption of 25 g of yacon flour associated with an energy-restricted diet did not increase concentrations of glycation markers. Changes in glycation markers were positively associated with changes in consolidated anthropometric and biochemical markers related to being overweight. Assessing glycation markers may be a useful strategy for monitoring responses to dietary interventions in subjects with excess body weight.

Increased consumption of calcium from fat-free milk, energy-restricted diet and educational activities improves metabolic control in overweight type 2 diabetic patients.

We assessed the effects of increased Ca consumption from fat-free milk in an energy-restricted diet and educational activities in the metabolic control of overweight type 2 diabetes mellitus (T2DM) patients. Fourteen subjects with T2DM (BMI 29·4 (sd 4·5) kg/m2, low habitual Ca consumption (<600 mg/d)) were included in this randomised, crossover clinical trial. Subjects were randomly allocated to one of the two interventions: drink containing 700 mg of Ca (DAIR) or drink containing 0 mg of Ca (CONT) for ninety consecutive days each. Energy-restricted diets (-500 kcal/d; -2092 kJ/d), containing 800 mg of Ca from dietary sources/d, were prescribed for both groups. Questionnaires were applied at baseline and at the end of the study to assess the subjects' knowledge on the disease and on self-care, biochemical variables and physical activity. Blood pressure, food intake, body composition and anthropometry were assessed at baseline, days 45 and 90. There was a higher reduction of body fat %, waist circumference, hip circumference, neck circumference, waist:hip ratio, sagittal abdominal diameter, diastolic/systolic blood pressure and an increase in fat-free mass % in DAIR than in CONT. Uric acid, fasting glucose, Hb1Ac, parathyroid hormone and alanine aminotransferase concentrations reduced and vitamin D concentration increased after 90 d in DAIR compared with CONT. The consumption of energy-restricted diet containing 1200 mg Ca/d seems to favour metabolic control in subjects with T2DM. The educational activities increased the knowledge on the disease care.

Processed and ultra-processed food consumption are related to metabolic markers in hemodialysis subjects / Consumo de alimentos processados e ultraprocessados está relacionado a marcadores metabólicos em indivíduos em hemodiálise

ABSTRACT Objective To investigate the consumption of processed and ultra-processed foods and evaluate its relationship with the nutritional and metabolic status of hemodialysis patients in a single center in Brazil. Methods This cross-sectional study enrolled 73 individuals in hemodialysis (50 men and 23 women, 21-87 years-old). Clinical and lifestyle variables were assessed by a semi-structured questionnaire and dietary data by food frequency questionnaire. Anthropometric and metabolic data are collected from medical records. Results Processed and ultra-processed foods represented 11.0% of daily caloric intake, 53.0% of trans fatty acid, and 12.5% of salt consumed in the study sample. Individuals who had high intake of this food group (≥128.4g/day, median intake) had higher serum phosphorus and pre-dialysis urea values (p=0.038; p=0.013, respectively). Also, individual with higher consumption of processed meat, sausages and ready prepared food had higher pre-dialysis serum urea (p=0.021), while serum potassium was higher among the subjects who consumed more sauces and salt-based seasonings (p=0.002). Conclusion Higher consumption of processed and ultra-processed foods was associated with important biomarkers of metabolic control for hemodialysis subjects, probably due to non-health dietary composition. Nutritional guidelines and intervention strategies must be promoted to reduce consumption of these food-group in thisspecific population.

RESUMO Objetivo Investigar o consumo de alimentos processados e ultraprocessados e avaliar sua relação com o estado nutricional e metabólico de pacientes em hemodiálise em um único centro brasileiro. Métodos Este é um estudo transversal com 73 indivíduos em hemodiálise (50 homens e 23 mulheres, 21-87 anos de idade). As variáveis clínicas e de estilo de vida foram avaliados por um questionário semi-estruturado, bem como dados dietéticos por questionário de frequência alimentar. Dados antropométricos e metabólicos foram coletados de registros médicos. Resultados Os alimentos processados e ultraprocessados representaram 11,0% das calorias diárias, 53,0% dos ácidos graxos trans e 12,5% de sódio consumido na amostra estudada. Os indivíduos que tiveram alta ingestão deste grupo alimentar (≥128,4 g/dia, ingestão mediana) apresentaram maiores valores de fósforo sérico e uréia pré-diálise (p=0,038; p=0,013, respectivamente). Também, indivíduos com maior consumo de carne processada, embutidos e refeições prontas apresentaram maior ureia sérica pré-diálise (p=0,021), enquanto o potássio sérico foi maior entre os indivíduos que consumiram mais molhos e temperos á base de sal (p=0,002). Conclusão O maior consumo de alimentos processados e ultraprocessados foi associado a importantes biomarcadores de controle metabólico para indivíduos em hemodiálise, provavelmente devido à composição dietética não saudável. Orientações nutricionais e estratégias de intervenção devem ser promovidas para reduzir o consumo desses alimentos nessa população específica.

Processed and ultra-processed food consumption are related to metabolic markers in hemodialysis subjects / Consumo de alimentos processados e ultraprocessados está relacionado a marcadores metabólicos em indivíduos em hemodiálise

ABSTRACT Objective To investigate the consumption of processed and ultra-processed foods and evaluate its relationship with the nutritional and metabolic status of hemodialysis patients in a single center in Brazil. Methods This cross-sectional study enrolled 73 individuals in hemodialysis (50 men and 23 women, 21-87 years-old). Clinical and lifestyle variables were assessed by a semi-structured questionnaire and dietary data by food frequency questionnaire. Anthropometric and metabolic data are collected from medical records. Results Processed and ultra-processed foods represented 11.0% of daily caloric intake, 53.0% of trans fatty acid, and 12.5% of salt consumed in the study sample. Individuals who had high intake of this food group (≥128.4g/day, median intake) had higher serum phosphorus and pre-dialysis urea values (p=0.038; p=0.013, respectively). Also, individual with higher consumption of processed meat, sausages and ready prepared food had higher pre-dialysis serum urea (p=0.021), while serum potassium was higher among the subjects who consumed more sauces and salt-based seasonings (p=0.002). Conclusion Higher consumption of processed and ultra-processed foods was associated with important biomarkers of metabolic control for hemodialysis subjects, probably due to non-health dietary composition. Nutritional guidelines and intervention strategies must be promoted to reduce consumption of these food-group in thisspecific population.

RESUMO Objetivo Investigar o consumo de alimentos processados e ultraprocessados e avaliar sua relação com o estado nutricional e metabólico de pacientes em hemodiálise em um único centro brasileiro. Métodos Este é um estudo transversal com 73 indivíduos em hemodiálise (50 homens e 23 mulheres, 21-87 anos de idade). As variáveis clínicas e de estilo de vida foram avaliados por um questionário semi-estruturado, bem como dados dietéticos por questionário de frequência alimentar. Dados antropométricos e metabólicos foram coletados de registros médicos. Resultados Os alimentos processados e ultraprocessados representaram 11,0% das calorias diárias, 53,0% dos ácidos graxos trans e 12,5% de sódio consumido na amostra estudada. Os indivíduos que tiveram alta ingestão deste grupo alimentar (≥128,4 g/dia, ingestão mediana) apresentaram maiores valores de fósforo sérico e uréia pré-diálise (p=0,038; p=0,013, respectivamente). Também, indivíduos com maior consumo de carne processada, embutidos e refeições prontas apresentaram maior ureia sérica pré-diálise (p=0,021), enquanto o potássio sérico foi maior entre os indivíduos que consumiram mais molhos e temperos á base de sal (p=0,002). Conclusão O maior consumo de alimentos processados e ultraprocessados foi associado a importantes biomarcadores de controle metabólico para indivíduos em hemodiálise, provavelmente devido à composição dietética não saudável. Orientações nutricionais e estratégias de intervenção devem ser promovidas para reduzir o consumo desses alimentos nessa população específica.

High calcium intake from fat-free milk, body composition and glycaemic control in adults with type 2 diabetes: a randomised crossover clinical trial.

We evaluated the effects of high-Ca fat-free milk v. low-Ca control diet on adiposity and on glycaemic control. Fourteen subjects with type 2 diabetes (aged 49·5 (sd 8·6) years, BMI 29·4 (sd 4·5) kg/m2, low habitual Ca consumption (<600 mg/d)) were included in this randomised, crossover clinical trial. Subjects participated in two 12-week experimental sessions (high-Ca fat-free milk (HC) or low-Ca control (LC)) separated by 8-week washout. Subjects daily consumed in the laboratory a breakfast shake containing 700 mg (HC) or 6·4 mg (LC) of Ca. Energy-restricted diets containing 800 mg of dietary Ca/d were prescribed. Dietary records data indicated the consumption of 1200 mg of Ca/d during HC and of 525 mg of Ca/d during LC. There was a greater reduction in body weight, body fat mass, waist circumference and waist:hip ratio after HC. Serum 25-hydoxyvitamin D and homeostatic model assessment-2 ß-cell function (HOMA2-%B) increased, and serum uric acid, parathormone (PTH) and glycated Hb (HbA1c) concentrations reduced after HC. In addition, changes from baseline in terms of serum uric acid, glucose, HbA1c and PTH concentrations were lower, and those of HOMA2-%B, serum Ca and 25-hydoxyvitamin D were higher after the HC than after LC. The consumption of approximately three servings of fat-free milk and 1200 mg of dietary Ca/d enhanced weight loss, improved body composition and promoted glycaemic control in subjects with type 2 diabetes and low habitual Ca consumption (<600 mg/d).

Dietary non-nutrients in the prevention of non-communicable diseases: Potentially related mechanisms.

Among the 10 leading causes of death in developed countries are chronic non-communicable diseases (NCDs). The effect of these multifactorial diseases on public health has stimulated considerable research aimed at investigating their primary risk factors (genetic factors, stress, food intake, and amount of physical exercise). Thus, healthful foods (e.g., fruits, vegetables, oils, grains, and seeds) are sources of bioactive compounds that promote good health and disease prevention. Among their components are non-caloric substances identified as non-nutrients (polyphenols, phytosterols, saponins, and phytates), which have been found to have a role in modulating metabolic pathways, maintaining health, and preventing NCDs. The aim of this study is to demonstrate and review the performance of some non-nutrients, such as their antioxidant and anti-inflammatory action, modulation of the antiatherogenic lipid profile (higher high-density lipoprotein cholesterol, lower oxidized low-density lipoprotein, and triacylglycerols), reduction of glucose and fat intestinal absorption, increase in insulin sensitivity, and stimulation of nitic oxide synthesis.

Nutritional status variation and intestinal and extra intestinal symptomatology in patients with celiac disease and non-celiac gluten sensitivity given specialized dietary advice / Evolução do estado nutricional e sintomatologia intestinal e extra intestinal em pacientes com doença celíaca e sensibilidade ao glúten não celíaca submetidos à orientação dietética especializada

ABSTRACT Objective: To investigate the nutritional status variation and symptomatology of patients with celiac disease and non-celiac gluten sensitivity after specialized dietary advice Methods: This prospective study included 80 patients with celiac disease and non-celiac gluten sensitivity. Clinical, metabolic, and nutritional variables were collected from medical records, and the symptomatology was investigated by the Metabolic Screening Questionnaire. The variables were assessed on two occasions (T1 - before dietary advice and T2 - after dietary advice) with an interval of three months between T1 and T2 Results: The median age was 42 years. The prevalences of celiac disease and non-celiac gluten sensitivity were 66.2% and 33.8%, respectively. Normal weight prevailed at T1 (58.8%) and T2 (56.3%), but 30.0% of the patients at T1 and 34.9% of the patients at T2 had excess weight. The two conditions had similar symptomatology. The most frequent signs and symptoms on both occasions involved the gastrointestinal tract, followed by energy/activity and emotions. All symptoms decreased significantly after the introduction of a proper diet Conclusion: The patients were normal weight on both study occasions (T1 and T2), and the symptoms improved after dietary advice. Thus, we reinforce the importance of proper dietary management in both clinical conditions to make dietary adjustments that improve these individuals' symptomatology.

RESUMO Objetivo: Investigar a evolução do estado nutricional e a sintomatologia de pacientes com doença celíaca e sensibilidade ao glúten não celíaca após orientação dietética especializada Métodos: O estudo prospectivo foi realizado com 80 pacientes portadores da doença celíaca e de sensibilidade ao glúten não celíaca. A coleta das variáveis clínicas, metabólicas e nutricionais foi feita por análise dos prontuários, enquanto a sintomatologia foi investigada por meio de Questionário de Rastreamento Metabólico. As variáveis foram avaliadas em dois momentos (T1 - antes da orientação dietética e T2 - após orientação dietética), com intervalo de 3 meses entre T1 e T2 Resultados: A mediana de idade foi de 42 anos. A prevalência de doença celíaca e de sensibilidade ao glúten não celíaca foi de 66,2% e 33,8%, respectivamente. A eutrofia prevaleceu como estado nutricional de T1 (58,8%) e T2 (56,3%), porém 30,0% dos pacientes em T1 e 34,9% em T2 apresentaram excesso de peso. A sintomatologia foi similar entre as duas enfermidades. Os sinais e sintomas mais frequentes nos dois tempos foram os do trato digestório, seguido pelos relacionados à energia/atividade e às emoções. Todos os sintomas diminuíram significativamente após a introdução da dieta Conclusão: Os pacientes apresentaram estado nutricional de eutrofia nos dois momentos avaliados (T1 e T2) e houve redução dos sintomas após as orientações nutricionais. Dessa forma, reitera-se a importância do manejo dietético adequado para ambas as enfermidades clínicas a fim de adequar a dieta que favoreça a melhora da sintomatologia apresentada por esses indivíduos.