Development and application of the Meal and Snack Assessment (MESA) quality scale for children and adolescents using item response theory.

BACKGROUND: Meals differ in terms of food items and nutritional quality. The aim of the present study was to propose a scale to measure the meals quality of schoolchildren according to food processing degree, perform a preliminary evaluation of the scale's validity and reliability and apply the scale to a representative sample of schoolchildren in a city in southern Brazil. METHODS: A methodological study based on the generalized graded unfolding model (GGUM) of item response theory (IRT) with analysis of secondary data was carried out in 6,399 schoolchildren of 6-15y-old attending 2nd to 5th grades of public elementary schools in Florianópolis, Brazil, in 2013-2015 who answered the validated Food Intake and Physical Activities of Schoolchildren (WebCAAFE) questionnaire. Meal quality was the latent trait. The steps for the development of the scale included: latent trait definition; item generation; dimensionality analysis; estimation of item parameters; scale levels definition; assessment of validity and reliability; and assessment of the meal quality of a subsample of schoolchildren aged 7 to 12 years (n = 6,372). RESULTS: Eleven out of eighteen items had adequate parameters, without differential item functioning for sex or age. Meal quality was categorized into three levels: healthy, mixed, and unhealthy. Higher scores indicate a greater prevalence of ultra-processed foods in daily meals. Most schoolchildren had mixed (40.6%) and unhealthy (41%) meal patterns. CONCLUSIONS: IRT analysis allowed the development of the scale, which measures the quality of meals and snacks based on the degree of food processing. At all snack times, there was a higher frequency of ultra-processed foods consumption, therefore foods consumed as snacks are a potential focus for nutritional interventions.

Juçara (Euterpe edulis Martius) improves time-to-exhaustion cycling performance and increased reduced glutathione: a randomized, placebo-controlled, crossover, and triple-blind study.

To examine the effects of 7-days juçara powder (JP) intake on oxidative stress biomarkers and endurance and sprint cycling performances. In a randomized, placebo-controlled, crossover, and triple-blind study, 20 male trained cyclists were assigned to intake 10 g of JP (240 mg anthocyanins) or placebo (PLA) for 7 days and performed a cycling time-to-exhaustion (TTE). A 5 s cycling sprint was performed before and after the cycling TTE. Blood oxidative stress biomarkers and lactate concentration where evaluated 1 h before (T-1), immediately after (T0), and 1 h after (T1) the cycling TTE. The mean duration time for the cycling TTE was 8.4 ± 6.0% (63 ± 17 s) longer in the JP condition (JP: 751 ± 283 s) compared to PLA (688 ± 266 s) (P < 0.019). Two-way repeated measures Analysis of variance showed an increase in the JP condition for reduced glutathione (GSH) (P = 0.049) at T0 (P = 0.039) and T1 (P = 0.029) compared to PLA with a moderate effect size at T0 (d = 0.61) and T1 (d = 0.57). Blood lactate levels increased over time in both conditions (P ≤ 0.001). No differences were observed for the post-TTE sprint fatigue index, total phenols, protein carbonyls, and glutathione peroxidase activity. Seven-day intake of JP improved cycling endurance performance and increased GSH levels but had no effect on lactate and cycling sprint-induced fatigue.

Trends in the prevalence of obesity, overweight, and thinness among schoolchildren aged 7-14 years from southern Brazil (2002-2019).

OBJECTIVE: To analyze the obesity, overweight, and thinness trends among Brazilian schoolchildren by sex, age group, and type of school according to World Health Organization (WHO) and International Obesity Task Force (IOTF) criteria. METHODS: We conducted four surveys between 2002 and 2018/19 involving schoolchildren aged 7-14 years from a state capital in southern Brazil. Weight status was classified using both WHO and IOTF criteria. RESULTS: In the total sample, obesity prevalence based on the IOTF and the WHO criteria were 72% and 44% higher in 2018/19 compared with 2002, respectively. Over the whole period, the obesity prevalence increased among children (WHO: 10.1% vs. 14.1%; IOTF: 5.0% vs. 8.3%), and those from public schools (WHO: 10.5% vs. 16.4%; IOTF: 5.6% vs. 10.1%). There was no significant reduction in thinness prevalence over the analyzed period. CONCLUSION: Obesity prevalence remains on an upward trend in a state capital in southern Brazil, especially among children from public schools. A higher prevalence of overweight and obesity was observed using the WHO criteria compared with IOTF criteria.

Association between screen use at night, food consumption at dinner, and evening snack in schoolchildren aged 7 to 14 years with and without overweight, Florianópolis, Santa Catarina, Brazil / Associação entre o uso de tela no período noturno e consumo alimentar no jantar e lanche da noite em escolares de 7 a 14 anos com e sem sobrepeso, Florianópolis, Santa Catarina, Brasil

ABSTRACT Objective Analyze the association between screen use at night, food consumption at dinner, and evening snack in schoolchildren with and without overweight. Methods Cross-sectional study with a probabilistic sample of 1396 schoolchildren from 7 to 14 years of age from public and private schools of Florianópolis, Santa Catarina, Brazil. Dietary intake and frequency of screen use of the previous day were obtained through the questionnaire Consumo Alimentar e Atividades Físicas de Escolares (Food Consumption and Physical Activities of Schoolchildren). The association between screen use at night (exposure) and consumption of food groups (outcome) according to weight status was assessed using multivariate logistic regression. Results At dinner, schoolchildren without overweight who used screens once had a lower chance of consuming fruits and vegetables (OR: 0.62, p=0.017) compared to those who did not use screens. In addition, those who used screens twice were more likely to consume sweets (OR: 2.01, p=0.002), and screen use three times or more was inversely associated with beans (OR: 0.24, p=0.003) and meat, eggs, and seafood (OR: 0.35, p=0.011) consumption. Overweight schoolchildren who used screens three times or more were more likely to consume ultra-processed foods and pizza/hamburger/hot dogs (OR: 2.51, p=0.009). For the evening snack, it was observed that schoolchildren without overweight who used screens three times or more had a greater chance of consuming ultra-processed foods and pizza/hamburger/hot dogs (OR: 8.26; p=0.016). Conclusion Overweight and non-overweight schoolchildren who used screens were more likely to consume ultra-processed foods. Schoolchildren without overweight and who use screens more often at night are less likely to consume healthy foods.

RESUMO Objetivo Analisar a associação entre o uso de dispositivo de tela no período noturno, o consumo alimentar no jantar e lanche da noite em escolares com e sem sobrepeso. Métodos Estudo transversal com uma amostra probabilística de 1.396 escolares de 7 a 14 anos de idade de escolas públicas e privadas de Florianópolis, Santa Catarina, Brasil. O consumo alimentar e a frequência de uso de dispositivos de telas do dia anterior foram obtidas por meio do questionário Consumo Alimentar e Atividades Físicas de Escolares. A associação entre o uso de dispositivo de tela no período noturno (exposição) e o consumo alimentar (desfecho) foi verificada por meio de regressão logística. Resultados No jantar, os escolares sem sobrepeso que utilizaram dispositivo de tela uma vez tiveram menor chance de consumir frutas, verduras e legumes (OR: 0,62, p=0,017) comparado com aqueles que não usaram dispositivos de telas. Além disso, aqueles que usaram dispositivo de tela duas vezes, tiveram maior chance de consumir doces (OR: 2,01, p=0,002) e a utilização de dispositivo de tela três vezes ou mais foi inversamente associado ao consumo de feijão (OR: 0,24, p=0.003), carnes, ovos e peixes (OR: 0,35, p=0,011). Os escolares com sobrepeso que utilizaram dispositivo de tela três vezes ou mais tiveram maior chance de consumirem ultraprocessados e lanches tipo pizza/hambúrguer/cachorro-quente (OR: 2,51, p=0,009). No lanche da noite, observou-se que os escolares sem sobrepeso que utilizaram dispositivo de tela três vezes ou mais, tiveram maior chance de consumir ultraprocessados e lanches (OR: 8,26; p=0,016). Conclusão Os escolares com e sem sobrepeso que utilizaram dispositivo de tela tiveram mais chances de consumir alimentos ultraprocessados. Os escolares sem sobrepeso que utilizam dispositivo de tela mais vezes a noite possuem menor chance de consumir alimentos saudáveis.

Association between Sleep Timing, Being Overweight and Meal and Snack Consumption in Children and Adolescents in Southern Brazil.

Sleep timing is one of the dimensions of sleep that refers to the time of day when sleep occurs. It has been included in sleep-related research because of the potential associations between being overweight and the consumption of meals and snacks. This cross-sectional study aimed to investigate associations between sleep timing, meal and snack consumption and weight status in 1333 schoolchildren aged 7-14 years. The midpoint of sleep was used as a sleep timing measure obtained by the midpoint between bedtime and wake-up time, classified as Early, Intermediate, and Late. Schoolchildren in the Early group were less likely to be overweight (OR: 0.83, 95% CI 0.69; 0.99), and had higher odds of mid-morning snack consumption (OR: 1.95, 95% CI 1.56; 2.44) and lower probability to consume an evening snack (OR: 0.75, 95% CI 0.59; 0.94) compared with the Intermediate group. The Late group had lower odds of mid-morning snack consumption (OR: 0.67, 95% CI 0.55, 0.80) than the Intermediate group. The consumption of mid-morning and evening snacks was associated with the Early and Late midpoints of sleep. These results suggest that bedtime and wake-up time are relevant to consuming meals and snacks and may also be related to a greater probability of being overweight in children and adolescents.

Kinetic Profile of Urine Metabolites after Acute Intake of a Phenolic Compounds-Rich Juice of Juçara (Euterpe edulis Mart.) and Antioxidant Capacity in Serum and Erythrocytes: A Human Study.

The juçara palm tree produces a small spherical and black-purple fruit similar to açaí. It is rich in phenolic compounds, especially anthocyanins. A clinical trial evaluated the absorption and excretion of the main bioactive compounds in urine and the antioxidant capacity in serum and erythrocytes of 10 healthy subjects after juçara juice intake. Blood samples were collected before (0.0 h) and 0.5 h, 1 h, 2 h, and 4 h after a single dose (400 mL) of juçara juice, while urine was collected at baseline and 0-3 and 3-6 h after juice intake. Seven phenolic acids and conjugated phenolic acids were identified in urine deriving from the degradation of anthocyanins: protocatechuic acid, vanillic acid, vanillic acid glucuronide, hippuric acid, hydroxybenzoic acid, hydroxyphenylacetic acid, and ferulic acid derivative. In addition, kaempferol glucuronide was also found in urine as a metabolite of the parent compound in juçara juice. Juçara juice caused a decrease in the total oxidant status of serum after 0.5 h in comparison to baseline values (p < 0.05) and increased the phenolic acid metabolites excretion. This study shows the relationship between the production of metabolites of juçara juice and the total antioxidant status in human serum, indicating evidence of its antioxidant capacity.

Consumption and Breakfast Patterns in Children and Adolescents with Congenital Heart Disease.

Little is known about skipping breakfast and breakfast patterns (BP) and their evaluation according to sociodemographic, clinical, lifestyle, cardiometabolic and nutritional data in children and adolescents with congenital heart disease (CHD). This cross-sectional study with 232 children and adolescents with CHD identified the prevalence and patterns of the breakfast, described these according to sociodemographic, clinical and lifestyle characteristics, and assessed their association with cardiometabolic and nutritional markers. Breakfast patterns were identified by principal components, and bivariate and linear regression analysis were applied. Breakfast consumption was observed in 73% of participants. Four BP were identified: pattern 1 "milk, ultra-processed bread, and chocolate milk", pattern 2 "margarine and processed bread", pattern 3 "cold meats/sausages, cheeses and butter/cream" and pattern 4 "fruits/fruit juices, breakfast cereals, yogurts, and homemade cakes/pies and sweet snacks". Family history for obesity and acyanotic CHD were associated with breakfast skipping. Younger participants and greater maternal education were associated with greater adherence to pattern 1 and pattern 4. Older participants and longer post-operative time showed greater adherence to pattern 3. No association between skipping breakfast or BP and cardiometabolic and nutritional markers was observed. Nonetheless, the findings reinforce the need for nutritional guidance for healthy breakfast, aiming to reduce the consumption of ultra-processed foods and to prioritize fresh and minimally processed foods.

Changes in lifestyle behaviors during the COVID-19 pandemic in children and adolescents with congenital heart disease.

OBJECTIVE: To describe the changes in lifestyle behaviors during the COVID-19 pandemic in children and adolescents with congenital heart disease and to investigate the association of congenital heart disease complexity with lifestyle behavior changes. METHODS: Cross-sectional study with 127 children and adolescents with congenital heart disease, who underwent cardiac procedure (mean postoperative time: 10.11±3.13 years), conducted between December 2020 and January 2021. Lifestyle behaviors, such as dietary intake, physical activity, sedentary behavior, and sleep, were assessed through telephone interview based on validated questionnaires. Dietary patterns were identified using principal component analysis. Frequency of general and specific combinations of healthy and unhealthy lifestyle behavior changes was evaluated. Multinomial logistic regressions were used to test the association between congenital heart disease complexity and changes in lifestyle behavior. RESULTS: The main lifestyle behaviors acquired during pandemic were: 83.5% decreased physical activity; 37.0% increased sedentary behavior; 26.0% slept more than usual; and 23.6% adopted a less-healthy dietary pattern. Almost half of the participants (41.8%) had at least one unhealthy change in lifestyle behavior. Complex congenital heart diseases were associated with increased sedentary behavior (OR 3.49, 95%CI 1.23-9.90). CONCLUSIONS: Children and adolescents with congenital heart disease had unhealthy lifestyle behavior during the pandemic, mainly in the form of reduced physical activity and increased sedentary behavior.

How Brazilian Schoolchildren Identify, Classify, and Label Foods and Beverages-A Card Sorting Methodology.

This study examined how Brazilian schoolchildren identified, classified, and labeled foods and beverages. Semi-structured interviews were conducted with 133 schoolchildren aged 7 to 10 years old from a public school located in southern Brazil in 2015. A set of cards with pictures of 32 food and beverage items from the web-based Food Intake and Physical Activity of Schoolchildren tool (Web-CAAFE) were used. Participants identified each item, formed groups for them based on similarity, and assigned labels for those groups. Student's t-tests and analysis of variance (ANOVA) tests were used to verify the mean difference between the groups of items. K-means cluster analysis was applied to identify similar clusters. Schoolchildren made an average of 9.1 piles of foods and beverages that they thought were similar (±2.4) with 3.0 cards (±1.8) each. Five groups were identified: meats, snacks and pasta, sweets, milk and dairy products, and fruits and vegetables. The most frequently used nomenclature for labeling groups was taxonomic-professional (47.4%), followed by the specific food item name (16.4%), do not know/not sure (13.3%), and evaluative (health perception) (8.8%). The taxonomic-professional category could be applied to promote improvements in the identification process of food and beverage items by children in self-reported computerized dietary questionnaires.

Low to moderate adherence to 2018 diet and physical exercise recommendations of the World Cancer Research Fund/American Institute for Cancer Research is associated with prooxidant biochemical profile in women undergoing adjuvant breast cancer treatment.

Adequate adherence to the 2018 diet and exercise recommendations of the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) can possibly result in less oxidative stress, lower risk to chemo- and radiotoxicity, lower risk of relapse, and increased quality of life in breast cancer survivors. This observational study aims to investigate the influence of adherence to updated recommendations of the WCRF/AICR on oxidative stress biomarkers in women with breast cancer undergoing adjuvant treatment (AT). We hypothesized that adherence to WCRF/AICR recommendations is inversely related to oxidative damage biomarkers and directly associated with antioxidant status. Women (n = 78) were evaluated before (T0) and after AT. After collecting anthropometric, physical activity, and food consumption data, a standardized score of adherence to WCRF/AICR recommendations was applied. The sample was divided into low-medium adherence and high adherence groups. Blood samples were collected at both timepoints for oxidative stress biomarkers analysis. Multiple linear regression analyzes were applied to verify associations between WCRF/AICR score and biomarkers. We found that low-medium adherence to WCRF/AICR recommendations at T0 affected lower levels of reduced glutathione (P= .003) and higher levels of lipid hydroperoxides (P= .002) and plasma carbonylated proteins (P= .001) after AT. The WCRF/AICR score at T0 was inversely associated with changes in plasma carbonylated protein concentrations after AT (adjusted ß = -0.359; P= .01). Our findings suggest that high WCRF/AICR score before and during AT may provide greater stability of antioxidant capacity and protection against exacerbated oxidative stress.

Methodological aspects and characteristics of participants in the study on the prevalence of obesity in children and adolescents in Florianópolis, Southern Brazil, 2018-2019: EPOCA study.

PURPOSE: To describe the methodological aspects and characteristics of the participants of the EPOCA survey. METHODS: The study was conducted with schoolchildren aged between seven to 14 years old from 30 schools in Florianópolis, Southern Brazil. Body mass, height, girths, and skinfold thicknesses were measured. Food consumption and physical activity from the previous day were self-reported using the validated Web-CAAFE questionnaire. Adolescents completed a specific questionnaire about physical activity, meal consumption, and weight control behaviors. Parents/guardians responded to a sociodemographic and habits questionnaire. RESULTS: A total of 1671 schoolchildren participated in the study (response rate: 27.2%). About 63% of schoolchildren were enrolled in public schools. Most studied in the morning shift (54.2%), were female (53.1%) and aged between seven and 10 years (58.1%). The prevalence of overweight was 33.7% and obesity was 11.3%. CONCLUSIONS: The data obtained will allow us to assess the trend in the prevalence of overweight and obesity and associated factors when compared to other surveys performed. Descriptions of the logistics and protocols can help in the development and improvement of similar studies. It is hoped that the results of EPOCA 2018/2019 may help in the design of obesity prevention policies and programs for this population.

Changes in lifestyle behaviors during the COVID-19 pandemic in children and adolescents with congenital heart disease / Mudanças nos comportamentos de estilo de vida durante a pandemia COVID-19 em crianças e adolescentes com cardiopatia congênita

Abstract Objective: To describe the changes in lifestyle behaviors during the COVID-19 pandemic in children and adolescents with congenital heart disease and to investigate the association of congenital heart disease complexity with lifestyle behavior changes. Methods: Cross-sectional study with 127 children and adolescents with congenital heart disease, who underwent cardiac procedure (mean postoperative time: 10.11±3.13 years), conducted between December 2020 and January 2021. Lifestyle behaviors, such as dietary intake, physical activity, sedentary behavior, and sleep, were assessed through telephone interview based on validated questionnaires. Dietary patterns were identified using principal component analysis. Frequency of general and specific combinations of healthy and unhealthy lifestyle behavior changes was evaluated. Multinomial logistic regressions were used to test the association between congenital heart disease complexity and changes in lifestyle behavior. Results: The main lifestyle behaviors acquired during pandemic were: 83.5% decreased physical activity; 37.0% increased sedentary behavior; 26.0% slept more than usual; and 23.6% adopted a less-healthy dietary pattern. Almost half of the participants (41.8%) had at least one unhealthy change in lifestyle behavior. Complex congenital heart diseases were associated with increased sedentary behavior (OR 3.49, 95%CI 1.23-9.90). Conclusions: Children and adolescents with congenital heart disease had unhealthy lifestyle behavior during the pandemic, mainly in the form of reduced physical activity and increased sedentary behavior.

Resumo Objetivo: Descrever as mudanças nos estilos de vida durante a pandemia em crianças e adolescentes com cardiopatia congênita e investigar a associação da complexidade da cardiopatia congênita com as mudanças de estilo de vida. Métodos: Estudo transversal com 127 crianças e adolescentes com cardiopatia congênita, que realizaram procedimento cardíaco (tempo médio de pós-operatório: 10,11 (3,13) anos), realizado entre dezembro de 2020 e janeiro de 2021. O estilo de vida (alimentação, atividade física, comportamento sedentário e sono) foi avaliado por entrevista telefônica, com base em questionários validados. Padrões alimentares foram identificados por meio da análise de componentes principais. Frequência de combinações gerais e específicas de mudanças de estilo de vida saudável e não saudável foram avaliadas. Regressões logísticas multinominais foram utilizadas para testar associações. Resultados: Os principais comportamentos de estilo de vida adquiridos durante a pandemia foram: 83,5% reduziram a atividade física, 37,0% aumentaram o comportamento sedentário, 26,0% dormiram mais e 23,6% mudaram para um padrão alimentar menos saudável. Quase metade (41,8%) dos participantes teve pelo menos uma mudança não saudável no estilo de vida. Cardiopatias congênitas complexas foram associadas ao aumento do comportamento sedentário durante a pandemia (odds ratio 3,49, IC95% 1,23-9,90). Conclusões: Crianças e adolescentes com cardiopatia congênita apresentaram estilo de vida não saudável durante a pandemia, principalmente na forma de redução da atividade física e aumento do comportamento sedentário.

Diet Quality Influences the Occurrence of Food Aversions in Women Undergoing Adjuvant Chemotherapy for Breast Cancer.

Food aversions in women undergoing adjuvant chemotherapy for breast cancer may be linked to oxidative stress and gastrointestinal consequences underlying it, and diet possibly plays a role in this association. This follow-up study included 73 women with breast cancer treated in Florianopolis City, Brazil. Dietary antioxidant capacity-DaC (mmol/d), diet quality-Brazilian Healthy Eating Index Revised (BHEI-R score), and oxidative stress biomarkers were accessed before the treatment, and women were asked if they developed food aversions during adjuvant chemotherapy. Red meat was the main aversion-causing food reported (37.9%, n = 9). There was no difference in DaC, BHEI-R score, or oxidative stress biomarkers between women with no food aversion occurrence and those showing food aversions. A logistic regression adjusted model showed that women exhibiting higher BHEI-R scores were 1.08 times more likely to not develop food aversions during adjuvant chemotherapy (p = 0.041). In summary, this innovative investigation showed that diet quality before adjuvant chemotherapy may influence the non-occurrence of food aversion. Considering this, the result opens new areas for early nutritional interventions, focusing on reducing the occurrence of food aversions and consequently benefiting women with breast cancer by having better outcomes in oncologic treatment.

Is breakfast consumption among Brazilian schoolchildren associated with an ultra-processed food dietary pattern?

Omission of breakfast starts at school age and can be explained as a reflection of the independent behaviour acquired in this phase of life. Breakfast has been investigated for its association with healthier diet quality, but few studies have investigated this relationship in schoolchildren aged 7 to 13 years. The objective of this study was to assess breakfast consumption in schoolchildren aged 7 to 13 years and to examine associations with dietary patterns (DPs). It was a cross-sectional study carried out in 2017 with 1069 students in Florianopolis, southern Brazil. Previous-day food consumption, physical activity and screen activities were self-reported. Factor analysis was used to identify DPs. Associations between breakfast consumption and overall DPs were evaluated using multivariate linear regression. Breakfast consumption was reported by 85% of the children, with the highest proportion observed among students on the afternoon school shift. Five DPs were identified explaining 41% of the total variance in daily food consumption: Ultra-processed, Mixed, Traditional Brazilian Lunch, Healthy + Sweets and Traditional Brazilian Breakfast. Breakfast consumption was directly associated with a Traditional Brazilian Breakfast DP (ß = 0.335; 95% CI = 0.227, 0.442), a Mixed DP (ß = 0.241; 95% CI = 0.160, 0.323), and a Healthy + Sweets DP (ß = 0.160; 95% CI = 0.061, 0.260), and inversely associated with an Ultra-processed DP (ß = -0.116; 95% CI = -0.207, -0.026). Breakfast consumption was associated with overall DPs, suggesting the importance of eating this meal by schoolchildren. We emphasise the relevance of offering a healthy breakfast at public schools for students who do not take this meal at home, contributing to health promotion.

Most meal and snack patterns are stable over a 3-year period in schoolchildren in southern Brazil.

This study aimed to identify meal and snack patterns in Brazilian schoolchildren and assess their stability over 3 years. This is a repeated cross-sectional study carried out in 2013, 2014 and 2015 with 6353 schoolchildren aged 7-12 years from public schools in Florianópolis, Brazil. Previous-day food consumption data for six pre-defined meals (breakfast, mid-morning snack, lunch, mid-afternoon snack, dinner and evening snack) were collected using the validated Web-CAAFE (Food Consumption and Physical Activity of Schoolchildren) questionnaire. Latent class analysis was performed to derive meal and snack patterns. The stability of patterns was analysed using multinomial logistic regression, and the probability of belonging to a meal pattern was calculated for each year. Three patterns were identified for breakfast and four patterns for a mid-morning snack, lunch, mid-afternoon snack, dinner and evening snack. Most meal and snack patterns were stable over the 3-year evaluation period. In the total sample, for a mid-afternoon snack, there was an increase in the probability of the children belonging to the 'Fruits and porridge' pattern (14.5%, 95% CI 12%-17% in 2015 vs. 9.2%, 95% CI 6.8%-11.7% in 2013) and a reduction in the 'Ultra-processed' pattern (42.5%, 95% CI 39.4%-45.6% in 2015 vs. 51.3%, 95% CI 46.5%-56.1% in 2013). These results appear to be in line with the recommendations of the Brazilian Dietary Guidelines and regional policies to increase the intake of healthy foods and limit that of ultra-processed, high fat, sugar and salt foods.

Age at menarche and its association with overweight including obesity and socio-economic conditions of Brazilian schoolgirls: A time-trend analysis.

This study aims to describe the time trend of age at menarche in Brazilian schoolgirls evaluated in 2007, 2012/2013 and 2018/2019, and to assess its association with having overweight, including obesity and socio-economic conditions. Three cross-sectional studies were carried out in 2007, 2012/2013 and 2018/2019 in schoolchildren enrolled between the second and ninth years of elementary school and comprising 838, 688 and 326 schoolgirls, respectively. Body mass index Z scores were calculated and categorised as either without overweight or with overweight (including obesity). The type of school (a proxy of socio-economic condition) was categorised as either public or private. Menarche data were collected using the status quo and recall methods. The mean age at menarche was estimated by survival analysis. Differences in age at menarche according to the year of survey, weight status and type of school were verified by the Log-Rank test and Cox's univariate and multiple regression. There was an increase in the prevalence of overweight in girls throughout the surveys, with 21.4% in 2007, 27.2% in 2012 and 28.5% in 2018 (p = 0.007) having overweight. There was a decrease in the mean age at menarche between 2007 and 2018/2019 (12.3 vs. 11.9 years, respectively). The mean age at menarche in girls with overweight was lower in the three time periods when compared to girls without overweight (11.9, 11.8 and 11.5 vs. 12.4, 12.4 and 12.1, respectively). Girls with overweight were more likely to have had earlier age at menarche than girls without overweight (Hazard Ratio 1.57; 95% CI 1.36; 1.80). There were no differences in the age at menarche according to the type of school. The increase in the prevalence of girls with overweight (including obesity) may be associated with the age at menarche. Girls with overweight had a higher risk of earlier age at menarche than girls without overweight.

Association between lifestyle patterns and overweight and obesity in adolescents: a systematic review.

The purpose of this systematic review was to summarize the evidence from observational studies regarding the association between lifestyle patterns and overweight and obesity in adolescents. To our knowledge, no review study has analyzed this association in this age group. A systematic search was conducted in LILACS, Scopus, PubMed Central, and Web of Science databases, with no language or time restrictions. Studies that included adolescents (10-19 years old) were selected using data-driven methods that combined the diet domain with at least one of the following behavioral domains: physical activity, sedentary behavior, and sleep. Twenty-one articles met all eligibility criteria. Of these, 12 studies were used for synthesizing the results. Studies differed in many aspects, such as sample size, behavioral assessment tools, and lifestyle pattern and weight status indicators. Overall, cross-sectional studies found no association between lifestyle patterns and overweight and obesity, even when the data were stratified by sex. However, when analyzing the results stratified by risk of bias, a positive association between predominantly unhealthy and mixed lifestyle patterns with overweight/obesity was identified in cross-sectional studies with moderate risk of bias. A prospective study revealed an increase in body mass index over time associated with mixed and predominantly unhealthy lifestyle patterns. Current findings regarding the association between lifestyle patterns and overweight and obesity in adolescents are inconsistent. More studies are needed to clarify possible associations.

Food consumption according to degree of food processing, behavioral variables, and sociodemographic factors: Findings from a population-based study in Brazil.

OBJECTIVES: This study aimed to investigate the consumption levels of foods at different degrees of processing and their associations with sociodemographic and behavioral characteristics of Brazilian adults. METHODS: This is a cross-sectional, population-based study involving 976 adult individuals (ages 20 to 59 y) of both sexes, living in the municipality of Viçosa, Minas Gerais State, Brazil. Participants were selected using a probabilistic sampling technique. Consumed foods were categorized into four groups: unprocessed or minimally processed foods, processed culinary ingredients, processed foods, and ultraprocessed foods. Associations were tested using linear regression. RESULTS: Unprocessed and minimally processed foods accounted for 61.3% of the total energy intake and were positively associated with age and negatively associated with level of education (ß = -6.86; 95% confidence interval [CI] [-10.16 to -3.57]) and sedentary behavior (ß = 3.24; 95% CI [-5.88 to -0.61]). Ultraprocessed foods accounted for 23.6% of the total energy intake, and consumption was negatively associated with age and positively associated with sedentary behavior (ß = 0.005; 95% CI [0.00008-0.01]) and tertiary education (ß = 5.42; 95% CI [2.71-8.13]). CONCLUSIONS: Ultraprocessed foods contribute more to the daily energy intake of younger individuals, and ultraprocessed food consumption is positively associated with sedentary activity and level of education.

Ilex paraguariensis (A. St.-Hil.) leaf infusion decreases iron absorption in patients with hereditary hemochromatosis: a randomized controlled crossover study.

This study proposed to investigate the effect of Ilex paraguariensis infusion on the absorption of non-heme iron in hereditary hemochromatosis (HH) patients with the HFE genotype. A two-way randomized, controlled, crossover trial was conducted on patients, aged 29-69 years, undergoing maintenance therapy. Fourteen HFE-HH patients ingested a meal containing 11.4 mg iron and 200 mL either of water (control) or of Ilex paraguariensis leaf infusion. The beverages were offered in random order, at intervals separated by a washout period of 7 days. Active surveillance showed no adverse effects. Blood samples were drawn shortly before and 1, 2, 3, and 4 h after the meal for serum iron measurement. A significant reduction in the postprandial serum iron was observed for HH patients after intake of the Ilex paraguariensis infusion (area under the curve (AUC) expressed as mean ± SEM: 173.3 ± 44.7 µmol h-1 L-1) compared to water (1449.4 ± 241.5 µmol h-1 L-1) (p < 0.001). In summary, intake of Ilex paraguariensis leaf infusion significantly inhibited the absorption of iron in patients with HH and, therefore, should be considered as a potential adjuvant for iron overload control.

Dietary patterns are associated with central adiposity and carotid intima-media thickness in children and adolescents with congenital heart disease.

PURPOSE: Unhealthy dietary patterns (DP) in childhood are associated with cardiovascular disease in adulthood. DP in children and adolescents with congenital heart disease (CHD) are unknown. The aims of this study were to describe DPs of children and adolescents with CHD and to evaluate their associations with central adiposity, high-sensitivity C-reactive protein (hs-CRP) and carotid intima-media thickness (cIMT). METHODS: A cross-sectional study including 232 children and adolescents with CHD. Dietary data were based on three 24-h dietary recalls. Central adiposity was evaluated by waist circumference. hs-CRPs were determined by nephelometry. The cIMT was measured using ultrasound. DPs were identified using principal component analysis. Data were examined using logistic and linear regressions. RESULTS: Six DPs were identified. In multivariable-adjusted analysis, unhealthy DP (high intake of poultry, red meat, cold cuts and processed meats, soft drinks and sweetened beverages) and healthy DP (high intake of fish, eggs, bread, beans, tubers and roots, fruit and fruit juice) were associated with increased and decreased odds of central adiposity, respectively (Odds ratio (OR): 2.10; 95% confidence interval (95% CI) 1.09; 4.02; OR: 0.48 95% CI 0.24; 0.93). Besides, low-fat dairy DP (high intake of low-fat milk and dairy, mixed dishes, ultra-processed breads, candy and chocolate) was inversely associated with cIMT (ß: - 0.024; 95% CI - 0.04; - 0.01). CONCLUSION: Unhealthy DP seems to increase the risk of central adiposity, while the healthy DP seems to decrease the risk of central adiposity. Still, low-fat dairy DP was inversely associated with cIMT. These findings may be helpful to develop nutrition recommendations for early cardiovascular disease prevention in children and adolescents with CHD.