Eating regularly and carefully, in appropriate environments and in company: An analysis between social representations and official stances on these recommendations of the Dietary Guidelines for the Brazilian Population

ABSTRACT The second edition of the Dietary Guidelines for the Brazilian Population (DGBP) advises "eating regularly and carefully", "eating in appropriate environments," and "eating in company". Individuals may interpret these guidelines differently. We analyzed social representations of these recommendations to ascertain how such representations relate to the official DGBP advice. This cross-sectional, exploratory study was conducted with a selected sample of teachers, administrative technicians, and students (N= 24) from the Federal University of Grande Dourados, Brazil. We carried out an exploratory content analysis of the responses to semi-structured interviews on the topic. We identified seven themes that encompassed the social representations of "eating regularly and carefully": 1) paying attention to what you eat; 2) having several meals; 3) eating slowly; 4) having time to eat; 5) eating without distractions; 6) eating adequate amounts; and 7) ensuring a nutritional balance. Four themes emerged from the analysis of the social representations of "eating in appropriate environments": 1) a pleasant environment; 2) at the table; 3) without interferences; and 4) a clean environment. The following themes encompassed the social representations of "eating in company": 1) eating in company is good; 2) I prefer to eat alone; and 3) eating in company is inconsequential. Although participant representations align with DGBP recommendations in the three orientations, in general, they extend beyond them. Professionals and government organizations in Brazil or abroad could take into consideration these results in order to optimize this tool's potential for research and policy in nutrition and public health.

RESUMEN La segunda edición de la Guía Alimentaria para la Población Brasileña (DGBP) aconseja "comer con regularidad y atención", "comer en ambientes adecuados" y "comer en compañía". Las personas pueden interpretar estas pautas de manera diferente. Analizamos las representaciones sociales de estas recomendaciones para determinar cómo se relacionan con la postura oficial de la DGBP. Este estudio transversal y exploratorio se realizó con una muestra seleccionada de profesores, técnicos administrativos y estudiantes (N= 24) de la Universidad Federal de Grande Dourados, Brasil. Realizamos un análisis exploratorio de contenido de las respuestas a entrevistas semiestructuradas sobre el tema. Identificamos siete temas que abarcan las representaciones sociales de "comer con regularidad y atención": 1) prestar atención a lo que come; 2) tener varias comidas; 3) comer despacio; 4) tener tiempo para comer; 5) comer sin distracciones; 6) comer cantidades adecuadas; y 7) asegurar un equilibrio nutricional. Cuatro temas surgieron del análisis de las representaciones sociales de "comer en ambientes adecuados": 1) ambiente agradable; 2) en la mesa; 3) sin interferencias; y 4) medio ambiente limpio. Los siguientes temas engloban las representaciones sociales de "comer en compañía": 1) comer en compañía es bueno; 2) prefiero comer solo; y 3) comer en compañía es intrascendente. Aunque las representaciones de los participantes se alinean con las recomendaciones de la DGBP en las tres orientaciones, en general, se extienden más allá de ellas. Investigadores y organizaciones gubernamentales en Brasil y en el extranjero podrían tener en cuenta estos resultados para optimizar el potencial de esta herramienta para la investigación y las políticas en nutrición y salud pública.

Health at Every Size®-Based Interventions May Improve Cardiometabolic Risk and Quality of Life Even in the Absence of Weight Loss: An Ancillary, Exploratory Analysis of the Health and Wellness in Obesity Study.

We examined whether weight loss following HAES®-based interventions associates with changes in cardiometabolic risk factors and quality of life of women with obesity. This was an exploratory, ancillary analysis of a 7-month, mixed-method, randomized controlled trial. Fifty-five women (age: 33.0 ± 7.2; BMI: 30-39.9 kg/m2) were included in this study. Body weight, cardiovascular risk factors, clustered cardiometabolic risk, and quality of life were assessed before (Pre) and after HAES®-based interventions (Post). Delta scores (Post-Pre) were calculated for each outcome and used in linear regression models. After adjusting by potential confounders, weight loss was associated with improvements in waist circumference (ß = 0.83, p <0.001), fasting glycemia (ß = 0.45, p = 0.036), total cholesterol (ß = 1.48, p = 0.024), LDL (ß = 1.33, p = 0.012), clustered cardiometabolic risk (ß = 0.18, p = 0.006), and quality of life (ß = -1.05, p = 0.007). All participants but one who reduced body weight (n = 11) improved clustered cardiometabolic risk and quality of life. Of relevance, 34% and 73% of the participants who maintained or gained weight improved clustered cardiometabolic risk and quality of life, respectively, although the magnitude of improvements was lower than that among those who lose weight. Improvements in cardiovascular risk factors and quality of life following HAES®-based interventions associated with weight loss as expected. However, most of the participants who maintained or even gained weight experienced benefits to some extent. This suggests that weight-neutral, lifestyle-modification interventions may improve wellness and health-related outcomes, even in the absence of weight loss.

It is over there, next to that fat lady: a qualitative study of fat womens own body perceptions and weight-related discriminations / É lá, perto da moça gorda: estudo qualitativo sobre as percepções de mulheres gordas acerca de seus corpos e discriminações relacionadas ao peso corporal

Abstract We investigated fat women's perceptions of their own bodies and their experiences with weight-related discriminations, and how these situations affected their well-being. Thirty-nine obese women were interviewed, and three axes of analysis were identified: (1) repercussions of being fat, (2) living with a fat body, and (3) am I a person or just a fat body? These axes were composed of eight themes which had similar meaning or complemented each other. The results showed our participants had mechanisms to diminish the magnitude of their stigmatized bodies (e.g., attempting to lose weight and changing their current food choices). Participants also reported being fat had physical and psychological consequences for them. Most notably, their larger bodies influenced their self-evaluation, making them feel devalued, unlovable, incapable, and incomplete. They reported stigmatizing experiences in familiar situations, at the workplace and in public spaces, and reported being stigmatized by both close and unknown individuals, including healthcare professionals. These professionals were reported to treat patients disrespectfully, which urges attention to health care inequalities for obese people. Our results stress stigmatizing attitudes towards fat people and their own considerations about themselves have negative consequences in their physical and mental well-being.

Resumo Investigamos a percepção de mulheres gordas sobre seu próprio corpo e suas experiências com discriminações relacionadas ao peso e como essas situações afetavam seu bem-estar. Trinta e nove mulheres obesas foram entrevistadas, sendo identificados três eixos de análise: (1) repercussões de ser gorda, (2) vivendo com um corpo gordo, e (3) eu sou uma pessoa ou apenas um corpo gordo? Esses eixos eram compostos por oito temas que se complementavam ou tinham significado semelhante. Os resultados mostraram que nossas participantes utilizavam mecanismos para diminuir a magnitude de seus corpos estigmatizados (por exemplo, tentando perder peso e modificando suas escolhas alimentares atuais). As participantes também relataram que ser gorda teve consequências físicas e psicológicas para elas. É importante ressaltar que seus corpos maiores influenciaram sua autoavaliação, fazendo com que se sentissem desvalorizadas, incapazes, incompletas e sem possibilidade de se sentirem amadas. Elas relataram experiências estigmatizadoras em situações familiares, no local de trabalho e em espaços públicos, e relataram serem estigmatizadas por pessoas próximas e desconhecidas, bem como por profissionais de saúde. Foi relatado que esses profissionais tratam os pacientes com desrespeito, o que exige atenção quanto às desigualdades na assistência à saúde de pessoas obesas. Nossos resultados enfatizam que atitudes estigmatizadoras em relação às pessoas gordas e suas próprias considerações sobre si mesmas têm consequências negativas para seu bem-estar físico e mental.

Eating Pleasure in a Sample of Obese Brazilian Women: A Qualitative Report of an Interdisciplinary Intervention Based on the Health at Every Size Approach.

INTRODUCTION: Health at Every Size (HAES) is a weight-neutral approach focused on promoting healthy behaviors in people with different body sizes and on enhancing pleasure derived from consuming food to achieve sustainable healthy eating outcomes. However, to the best of our knowledge, there are no studies in the literature assessing the effects of the HAES approach on perceptions of eating pleasure. OBJECTIVE: We qualitatively investigated the perceptions of obese women about eating pleasure before and after a new interdisciplinary, nonprescriptive intervention based on the HAES approach. DESIGN: The intervention was a randomized controlled clinical trial, designated as Health and Wellness in Obesity, conducted over 7 months at University of São Paulo (Brazil). We used a qualitative approach to data construction and analysis of perceptions about eating pleasure. Participants were randomized to either the intervention (I-HAES) group or the control (CTRL) group. The I-HAES group featured individual nutritional counseling, group practice of enjoyable physical activity, and philosophical workshops. The CTRL group was a traditional HAES intervention group (lecture-based model). Focus group discussions eliciting perceptions of pleasure around eating were conducted at baseline and post-study. Focus group transcripts were analyzed by exploratory content analysis. PARTICIPANTS: Forty-three women aged 25 to 50 years with body mass index (measured in kilograms per square meter) between 30 and 39. 9 completed the intervention and the focus groups, with 32 in the I-HAES group and 11 in the CTRL group. RESULTS: Lack of guilt about experiencing pleasure while eating and increased reflection on their own desires increased in participants of both groups after the study. The I-HAES group also displayed a greater sense of autonomy related to eating, increased pleasure in commensality, familiarity with the practice of cooking, and decreased automatic eating. CONCLUSION: HAES-based intervention featuring nutritional counseling, appreciation for physical activity, and philosophical engagement was shown to stimulate pleasure around eating without leading to indiscriminate eating.

The design and rationale of an interdisciplinary, non-prescriptive, and Health at Every Size®-based clinical trial: The "Health and Wellness in Obesity" study.

BACKGROUND: This manuscript describes the design and rationale of a clinical trial that aims to investigate the multiple physiological, attitudinal, nutritional, and behavioral effects of a new interdisciplinary intervention based on the Health at Every Size® (HAES®) approach in obese women. METHODS: This will be a prospective, 7-month, randomized (2:1), mixed-method clinical trial. Obese women will be recruited and randomly allocated into two groups. The intervention group (I-HAES®; proposed n = 40) will undertake a novel HAES®-based intervention. Participants will take part in an exercise program, nutrition counseling sessions, and philosophical workshops, all aligned with the principles of the HAES® approach. The control group (CTRL; proposed n = 20) will participate in a program using a traditional HAES®-based group format, characterized by bimonthly lectures about the same topics offered to the experimental group, encouraging the adoption of a healthy lifestyle. The following multiple quantitative outcomes will be assessed pre and post intervention: health-related quality of life, cardiovascular risk factors, anthropometric assessments, physical activity level, physical capacity and function, and psychological and behavioral assessments. Qualitative analysis will be used to evaluate the experiences of the participants throughout the intervention, as assessed by focus groups and semi-structured interviews. CONCLUSIONS: The interdisciplinary research team leading this study has varied and complementary expertise. The knowledge arising from this study will help to guide new interdisciplinary interventions with the potential to holistically improve the health of obese individuals. This trial is registered at Clinicaltrials.gov (NCT02102061).

Validation of the Disordered Eating Attitude Scale for adolescents / Validação da Escala de Atitudes Alimentares Transtornadas para adolescentes

ABSTRACT Objective To perform the psychometric evaluation of the Disordered Eating Attitude Scale (DEAS) for adolescents. Methods Sample consisted of 1,119 Brazilian adolescents (12-18 years old; 59.6% female) studying at technical schools in São Paulo state-Brazil, who answered an online survey with the DEAS, the Eating Attitude Test (EAT-26), and the Restraint Scale (RS). The internal consistency of the DEAS was assessed using Cronbach’s alpha. The convergent validity of DEAS was evaluated by means of Pearson’s coefficient correlation with EAT-26 and RS. The test-retest reliability was evaluated using a sub-sample of 61 adolescents. Known-groups validity was determined by comparing female student mean scores with scores of 33 female adolescents with eating disorders. Results The reliability of the DEAS was 0.79. EAT-26 and RS scores were positively correlated with DEAS scores (EAT: 0.78 for females and 0.59 for males, p < 0.001; RS: 0.63 for females and 0.48 for males, p < 0.001). The DEAS total and subscale scores differentiated students and patients with eating disorders (p < 0.001). The intra-class correlation coefficient for test-retest reliability was 0.87. Conclusion Results indicate that the DEAS adolescent version showed good internal consistency, convergent validity, known-groups validity, and test-retest reliability, suggesting its potential in identifying disordered eating attitudes among adolescents. It could also be helpful in identifying adolescents at risk from eating disorders, assisting in prevention programs.

RESUMO Objetivo Realizar a avaliação psicométrica da Escala de Atitudes Alimentares Transtornadas (EAAT) para adolescentes. Métodos A amostra foi composta por 1.119 adolescentes (12-18 anos; 59,6% do sexo feminino) estudantes de escolas técnicas do estado de São Paulo, que responderam online à EAAT, ao Teste de Atitudes Alimentares (EAT-26) e à Escala de Restrição (RS). A consistência interna da EAAT foi avaliada usando o alpha de Cronbach e a validade convergente por meio do coeficiente de correlação de Pearson com o EAT-26 e a RS. A confiabilidade teste-reteste foi avaliada usando uma subamostra de 61 adolescentes. A validade known-groups foi determinada pela comparação dos escores médios de estudantes do sexo feminino com os escores de 33 adolescentes do sexo feminino com transtornos alimentares. Resultados A consistência interna foi de 0,79, e as pontuações no EAT-26 e na RS estiveram positivamente correlacionadas com a pontuação da EAAT (EAT: 0,78 para o sexo feminino e 0,59 para o masculino, p < 0,001; RS: 0,63 para o sexo feminino e 0,48 para o masculino, p < 0,001). O escore da EAAT diferenciou estudantes e pacientes com transtornos alimentares (p < 0,001). O coeficiente de correlação intraclasse na confiabilidade teste-reteste foi de 0,87. Conclusão A versão da EAAT para adolescentes mostrou boa consistência interna, validade convergente, known-groups e confiabilidade teste-reteste, sugerindo o seu potencial na identificação de atitudes alimentares transtornadas entre adolescentes. Ela pode, portanto, ser útil na identificação de adolescentes com risco de transtornos alimentares, auxiliando em programas de prevenção.

The Effects of a "Health at Every Size(®)"-Based Approach in Obese Women: A Pilot-Trial of the "Health and Wellness in Obesity" Study.

This study explored the effects of Health at Every Size(®)-based intervention on obese women by qualitatively evaluating participants' perception toward the program and quantitatively evaluating changes related to psychological, behavioral, and body composition assessments. A prospective 1-year quasi-experimental mixed-method trial was conducted. The mixed-method design was characterized by a spiral method, and quantitative and qualitative findings were combined during the interpretation phase. The qualitative data involved three focus groups; and quantitative data comprised physiological, psychological, and behavioral assessments. Initially, 30 participants were recruited; 14 concluded the intervention. From the focus groups, the following interpretative axes were constructed: the intervention as a period of discoveries; shifting parameters: psychological, physical, and behavioral changes; eating changes, and; redefining success. Body weight, body mass index, total body fat mass, and body fat percentage were significantly decreased after the intervention (-3.6, -3.2, -13.0, and -11.1%, respectively; p ≤ 0.05, within-time effect). Participants reported to be more physically active and perceiving better their bodies. Eating-wise, participants reported that the hunger and satiety cues and the consumption of more frequent meals facilitated their eating changes. Finally, participants reported that they could identify feelings with eating choices and refrain from the restrained behavior. These qualitative improvements were accompanied by modest but significant improvements in quantitative assessments. Clinicaltrials.gov registration: NCT02102061.

"Now I Can Do Better": A Study of Obese Women's Experiences Following a Nonprescriptive Nutritional Intervention.

The present study analyzed obese women's experiences following a nonprescriptive nutritional intervention, implemented through a 1-year program based on the Health at Every Size(®) philosophy. We employed an action research method and conducted three focus groups during the intervention. We identified five interpretative axes across the focus groups, as follows: conflicts and perceptions; gaining motivation, perspective, and positioning; becoming autonomous eaters; acquiring tools; and the meetings between the nutritional therapist and participant. Our findings revealed varying levels of readiness among participants in adapting to the intervention and varying valuations of achievements related to eating and health, independent of body-weight changes. Participants reported benefiting from and expressed approval of the intervention. Participants reported positive behavioral and attitudinal changes to their diet and improvements to diet quality, diet structure, and consumption. Finally, participants seemed to show increased autonomy concerning diet and indicated increased confidence, comfort, flexibility, and positivity of attitude regarding eating.

Validation of an adapted version of the nutrition environment measurement tool for stores (NEMS-S) in an urban area of Brazil.

OBJECTIVE: To validate an adapted instrument that assesses the nutritional environment of food stores in Brazilian urban areas. METHODS: The instrument measured aspects of food environment such as availability, prices, and quality. The Harvard Healthy Eating Pyramid and the degree of processing were used to define healthy foods. The sample included 44 food stores in 3 census tracts in the city of Santos. Inter-rater reliability and stability coefficient were obtained with measurements performed by different individuals at different times. Internal consistency and construct validity were assessed by Cronbach α and the known-groups comparison method, respectively. RESULTS: Inter-rater reliability was high. The mean intra-class correlation coefficient was 0.98 and the mean kappa was 0.77. Cronbach α values ranged from .68 to .93. CONCLUSIONS AND IMPLICATIONS: The instrument can be useful in the development of interventions to promote healthy eating through actions focused on healthy food availability in Brazilian communities.

Propriedades psicométricas da Escala de Atitudes Alimentares Transtornadas para adultos do sexo masculino / Psychometric properties of the Disordered Eating Attitude Scale for adult men

OBJETIVO: Avaliar as propriedades psicométricas da Escala de Atitudes Alimentares Transtornadas (EAAT) para o sexo masculino. MÉTODOS: Duzentos e vinte e oito universitários (18-39 anos) responderam à EAAT, originalmente desenvolvida e validada para o sexo feminino. A consistência interna foi avaliada pelo Alpha de Cronbach e a validade convergente, por meio do coeficiente de correlação de Pearson comparando os escores da EAAT, do Teste de Atitudes Alimentares (EAT) e da Escala de Restrição (RS). A reprodutibilidade foi avaliada aplicando a escala numa subamostra (n = 38) com um mês de intervalo utilizando o coeficiente de correlação intraclasse (CCI). A validade known-groups foi obtida comparando o escore dos universitários na EAAT com o escore de homens com diagnóstico de transtornos alimentares (TA) (n = 28). RESULTADOS: A consistência interna da escala foi de 0,63. O escore da EAAT foi correlacionado com a EAT (r = 0,65) e RS (r = 0,51), e o CCI entre o teste e o reteste foi de 0,948. A análise known-groups diferenciou pacientes com TA de estudantes universitários (p < 0,001). CONCLUSÕES: A escala apresentou propriedades psicométricas adequadas e pode ser utilizada em estudos com homens adultos - uma vez que o constructo é pouco explorado em homens. Recomenda-se, de qualquer forma, uma revisão da escala e desenvolvimento de instrumentos específicos para o público masculino.

OBJECTIVE: To evaluate psychometric properties of the Disordered Eating Attitude Scale (DEAS) for men. METHODS: Two hundred and twenty-eight undergraduate male students (18-39 years old) answered the DEAS, originally developed and validated for women. Internal consistency was evaluated by Cronbach's Alpha; convergent validity by comparing DEAS and the Eating Attitude (EAT) and Restraint Scale (RS) scores using Pearson's coefficient. Test-retest reliability was evaluated with a subsample (n = 38) in a month interval by means of intraclass correlation coefficient (ICC). Known-groups validity was obtained comparing scores in DEAS among undergraduate students and men with eating disorders (ED) (n = 28). RESULTS: Internal consistency of scale was 0.63. DEAS score correlated with EAT (r = 0.65) and RS (r = 0.51); ICC between test and retest was 0.948. Known-groups analysis differentiated ED patients and undergraduate students (p < 0.001). CONCLUSIONS: The scale presented adequate psychometric properties and could be used in studies with adult men, since the construct is not explored among males. Nevertheless, it is recommended to revise the scale and to develop specific instruments for male public.

Under-reporting of food intake is frequent among Brazilian free-living older persons: a doubly labelled water study.

The assessment of food intake is essential for the development of dietetic interventions. Accuracy is low when intake is assessed by questionnaires, the under-reporting of food intake being frequent. Most such studies, however, were performed in developed countries and there is little data about the older population of developing nations. This study aimed to verify the total energy expenditure (TEE) of independent older Brazilians living in an urban area, through the doubly labelled water (DLW) method and to compare it with the reported energy intake obtained through the application of a food frequency questionnaire (FFQ). Initially, 100 volunteers aged from 60 to 75 years had their body composition determined by dual-energy X-ray absorptiometry (DEXA). Five volunteers of each quartile of body fat percentage had their energy expenditure determined by DLW. The mean age of the subjects included in this phase of the study was 66.4 +/- 3.5 years, and ten of the subjects were men. The mean TEE was 2565 +/- 614 and 2154 +/- 339 kcal.day(-1) for men and women, respectively. The Physical Activity Level (PAL) was 1.58 +/- 0.31 and 1.52 +/- 0.22, respectively. Under-reporting of food intake was highly prevalent, with a mean percentage of reported intake in relation to measured TEE of -17.7%. Thus, under-reporting of food intake is highly prevalent among Brazilian independent older persons. The DLW method is an important tool in nutritional studies and its use is to be recommended in developing countries.

Underreporting of energy intake in Brazilian women varies according to dietary assessment: a cross-sectional study using doubly labeled water.

OBJECTIVE: Underreporting of energy intake is prevalent in food surveys, but there is controversy about which dietary assessment method provides greater underreporting rates. Our objective is to compare validity of self-reported energy intake obtained by three dietary assessment methods with total energy expenditure (TEE) obtained by doubly labeled water (DLW) among Brazilian women. DESIGN: We used a cross-sectional study. SUBJECTS/SETTING: Sixty-five females aged 18 to 57 years (28 normal-weight, 10 overweight, and 27 obese) were recruited from two universities to participate. MAIN OUTCOME MEASURES: TEE determined by DLW, energy intake estimated by three 24-hour recalls, 3-day food record, and a food frequency questionnaire (FFQ). STATISTICAL ANALYSES PERFORMED: Regression and analysis of variance with repeated measures compared TEE and energy intake values, and energy intake-to-TEE ratios and energy intake-TEE values between dietary assessment methods. Bland and Altman plots were provided for each method. chi(2) test compared proportion of underreporters between the methods. RESULTS: Mean TEE was 2,622 kcal (standard deviation [SD]=490 kcal), while mean energy intake was 2,078 kcal (SD=430 kcal) for the diet recalls; 2,044 kcal (SD=479 kcal) for the food record and 1,984 kcal (SD=832 kcal) for the FFQ (all energy intake values significantly differed from TEE; P<0.0001). Bland and Altman plots indicated great dispersion, negative mean differences between measurements, and wide limits of agreement. Obese subjects underreported more than normal-weight subjects in the diet recalls and in the food records, but not in the FFQ. Years of education, income and ethnicity were associated with reporting accuracy. CONCLUSIONS: The FFQ produced greater under- and overestimation of energy intake. Underreporting of energy intake is a serious and prevalent error in dietary self-reports provided by Brazilian women, as has been described in studies conducted in developed countries.

Does creatine supplementation improve the plasma lipid profile in healthy male subjects undergoing aerobic training?

UNLABELLED: We aimed to investigate the effects of creatine (Cr) supplementation on the plasma lipid profile in sedentary male subjects undergoing aerobic training. METHODS: Subjects (n = 22) were randomly divided into two groups and were allocated to receive treatment with either creatine monohydrate (CR) (~20 g.day-1 for one week followed by ~10 g.day-1 for a further eleven weeks) or placebo (PL) (dextrose) in a double blind fashion. All subjects undertook moderate intensity aerobic training during three 40-minute sessions per week, over 3 months. High-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), very low-density lipoprotein cholesterol (VLDL), total cholesterol (TC), triglyceride (TAG), fasting insulin and fasting glycemia were analyzed in plasma. Thereafter, the homeostasis model assessment (HOMA) was calculated. Tests were performed at baseline (Pre) and after four (Post 4), eight (Post 8) and twelve (Post 12) weeks. RESULTS: We observed main time effects in both groups for HDL (Post 4 versus Post 8; P = 0.01), TAG and VLDL (Pre versus Post 4 and Post 8; P = 0.02 and P = 0.01, respectively). However, no between group differences were noted in HDL, LDL, CT, VLDL and TAG. Additionally, fasting insulin, fasting glycemia and HOMA did not change significantly. CONCLUSION: These findings suggest that Cr supplementation does not exert any additional effect on the improvement in the plasma lipid profile than aerobic training alone.

Under-reporting of energy intake is more prevalent in a healthy dietary pattern cluster.

The aim of the present study was to determine whether under-reporting rates vary between dietary pattern clusters. Subjects were sixty-five Brazilian women. During 3 weeks, anthropometric data were collected, total energy expenditure (TEE) was determined by the doubly labelled water method and diet was measured. Energy intake (EI) and the daily frequency of consumption per 1000 kJ of twenty-two food groups were obtained from a FFQ. These frequencies were entered into a cluster analysis procedure in order to obtain dietary patterns. Under-reporters were defined as those who did not lose more than 1 kg of body weight during the study and presented EI:TEE less than 0.82. Three dietary pattern clusters were identified and named according to their most recurrent food groups: sweet foods (SW), starchy foods (ST) and healthy (H). Subjects from the healthy cluster had the lowest mean EI:TEE (SW = 0.86, ST = 0.71 and H = 0.58; P = 0.003) and EI - TEE (SW = - 0.49 MJ, ST = - 3.20 MJ and H = - 5.08 MJ; P = 0.008). The proportion of under-reporters was 45.2 (95 % CI 35.5, 55.0) % in the SW cluster; 58.3 (95 % CI 48.6, 68.0) % in the ST cluster and 70.0 (95 % CI 61.0, 79) % in the H cluster (P = 0.34). Thus, in Brazilian women, under-reporting of EI is not uniformly distributed among dietary pattern clusters and tends to be more severe among subjects from the healthy cluster. This cluster is more consistent with both dietary guidelines and with what lay individuals usually consider 'healthy eating'.

Underreporting of energy intake in developing nations.

Under conditions of energy balance, energy intake (EI) equals energy expenditure (EE), and the validity of EI may be determined by comparing these two measures. The doubly labeled water (DLW) method is the gold standard for the determination of EE. Its use in developed countries has showed an intense underreporting of EI. Few studies concerning underreporting have been conducted in developing nations, and none of them has used DLW. This review will present the results of such studies, extrapolating data using DLW and providing EE and EI estimates, but which were not concerned with underreporting. A panorama of underreporting and its implications in developing nations is discussed and future directions for research are identified.

Selective underreporting of energy intake in women: magnitude, determinants, and effect of training.

OBJECTIVE: The aim of this study was to quantify underreporting of energy intake in Brazilian women; identify underreporting determinants; find out if underreporting was selective and; test if a motivational multimethod training, in combination with providing the subjects some results from the prior recording period, was able to reduce underreporting. DESIGN: Energy intake (EI) was assessed by a 7-day diet record. Energy expenditure (EE) was calculated by heart rate monitoring. EI:EE ratio lower than one in subjects who did not lose weight in one month was considered underreporting. Underreporting was correlated with anthropometric, behavioral, and psychological parameters. Food and nutrient consumption was compared between underreporters and non-underreporters. A focus group investigated the main causes of underreporting. Subjects were told that the earlier food records' results were unrealistic and submitted to a motivational training. Then, they were reevaluated for underreporting. SUBJECTS: Subjects were recruited by advertisements for a physical activity program. Thirty-eight healthy women, 13 normal-weight (34%), 13 overweight (34%), and 12 obese (32%), enrolled in the study. Three subjects (2 normal-weight and 1 obese) (8%) withdrew. STATISTICAL ANALYSIS PERFORMED: Analysis of variance, paired t tests, and simple linear regression. RESULTS: Seventeen women (49%) underreported their EI by 21%. A significant negative correlation was found between social desirability and EI:EE. Undereating, errors in portion sizes estimation and the inconvenience of having to record everything that was eaten seemed to explain underreporting. Mean portion sizes did not differ for underreporters and non-underreporters. Fewer self-reported years of education was correlated with underreporting only among normal-weight women. Training and confrontation with earlier results reduced underreporting rate to 33%, but did not affect macronutrient densities. Applications/conclusions Subjects tended to report their intake in a socially desirable way, by eating or reporting less frequently foods considered unhealthful or fattening, like sweets and fried foods. Inclusion of social desirability score as a covariate in studies that rely on self-reports of food intake may be useful. A motivational training program, developed in such a way that subjects are comfortable reporting intake of foods considered socially undesirable, in combination with confrontation with earlier results of dietary assessment and use of portion size measurement aids, can be used to attenuate underreporting.