Differences in Portion Sizes in Brazil, France, and the USA.

Portion size is recognized as a major determinant of food intake, at least over the short term, and could be related to overconsumption and obesity. In this study, we developed and evaluated a new visual measure of portion size (PS), examined whether the PS of chicken, ice cream, and soda varied among people in Brazil, France, and the USA, and tested whether PS was related to gender, body mass index, body weight, and socioeconomic status. We conducted a cross-sectional study using online convenience samples of university students (total N = 1391). Across all three foods, French personal and country PSs were significantly smaller than the other three countries. Estimated country PS was reliably larger than personal PS. Women's personal PSs were smaller than men's, but women's and men's estimates for country PS were similar. French personal and country PSs were the lowest. Some PSs had a weak but significant correlation with SES but were not significantly related to either weight or BMI. The study confirms French-American differences in personal PS and demonstrates that perceived norms correspond to individual PS.

Body Composition Assessment in Adult Females with Anorexia Nervosa and Bulimia Nervosa-A Cross-Sectional Study Comparing Dual-Energy X-Ray Absorptiometry Scan and Isotopic Dilution of Deuterium.

BACKGROUND: Eating disorders (EDs) compromise individuals' nutritional status, affecting, among other organs and systems, bone health. OBJECTIVES: This study aimed to assess and compare bone mineral density (BMD) from DXA scan and deuterium (D2O) dilution of adult females with anorexia nervosa (AN) and bulimia nervosa (BN). METHODS: This was a cross-sectional study with 53 female participants (18-49 y) with a diagnosis of AN (n = 25) or BN (n = 28). DXA scan was performed to assess BMD, FM, and FFM, and D2O dilution was used to assess total body water (TBW), FM, and FFM. Interviews/questionnaires were used to assess symptoms, illness trajectory, and physical activity. t-test, chi-square test, Pearson's linear correlation, linear regressions, and Bland-Altman analyses were performed, with a significance level of 5%. RESULTS: TBW below the recommended level for adult females (≥ 45%) was more frequent in BN (60%) compared with AN (21%; P = 0.013). FM index (FMI) (soft tissue only) (t-test P = 0.06), and FFM index (FFMI) (t-test P = 0.08) agreed between DXA scan and D2O dilution. Only FFMI did not show systematic bias of proportion (ß: -0.2, P = 0.177). The diagnosis of BN, binge-eating episodes, and physical activity in AN were associated with the differences in the methods' results. FMI was positively associated with BMD in AN, and both FMI and FFMI were positively associated with BMD in BN. CONCLUSIONS: In adult females with EDs, DXA scan and D2O dilution achieved agreement for FMI and FFMI. Changes in FM and FFM are important in understanding the mechanisms behind bone loss in EDs. Protocols for body composition assessment in EDs can help to minimize the effect of the ED diagnosis, ED behaviors (that is, excessive exercise and purging behaviors), and weight on the accuracy of measurements.

Strategies designed to increase the motivation for and adherence to dietary recommendations in patients with chronic kidney disease.

Chronic kidney disease (CKD) often requires several dietary adjustments to control the disease-related disturbances. This is challenging for both patients and healthcare providers, and particularly for dietitians, who deal closely with the poor adherence to dietary recommendations. Factors associated with poor adherence within the CKD scenario and the need for a shift in the paradigm have already been indicated in several studies; however, rarely are any different and/or potential strategies actually formulated in order to change this paradigm. In this review, we aimed to explore the concepts and factors surrounding adherence to dietary recommendations in CKD and further describe certain potential strategies for a nutritional counseling approach. Such strategies, while poorly explored within CKD, have shown positive results in other chronic disease scenarios. It is timely, therefore, for healthcare providers to acquire these new counseling skills; nevertheless, this would require a rethinking of the traditional attitudes and approaches in order to build a partnership, based on a nonjudgmental and compassionate style in order to guide behavior change. The reflections presented in this review may contribute towards enhancing motivation and the adherence to dietary recommendations in CKD patients.

Cirurgia bariátrica e transtornos alimentares: uma revisão integrativa / Bariatric surgery and eating disorders: integrative review

RESUMO Objetivo Realizar revisão sobre transtornos alimentares e comportamentos alimentares transtornados relacionados à cirurgia bariátrica. Métodos Revisão integrativa da literatura nas bases de dados PubMed, Lilacs, Bireme, portal SciELO com descritores indexados com critérios de inclusão: oferecer dado sobre a presença ou frequência de transtorno alimentar e/ou comportamentos alimentares disfuncionais previamente e/ou após a cirurgia. Resultados Foram selecionados 150 estudos (14 nacionais e 136 internacionais): 80,6% eram com avaliação de pacientes pré-/pós-cirúrgicos; 12% eram estudos de caso e 7,3% eram estudos de revisão. Diferentes instrumentos foram usados para avaliação, principalmente o Questionnaire on Eating and Weight Patterns, a Binge Eating Scale e Eating Disorders Examination Questionnaire. A compulsão alimentar foi o comportamento mais avaliado, com frequências/prevalências variando de 2% a 94%; no caso do transtorno da compulsão alimentar as frequências/prevalências variaram de 3% a 61%. Houve também a descrição de anorexia e bulimia nervosa, síndrome da alimentação noturna e comportamento beliscador. Alguns estudos apontam melhora dos sintomas no pós-cirúrgico e/ou seguimento enquanto outros apontam surgimento ou piora dos problemas. Conclusão Apesar da variabilidade entre métodos e achados, comportamentos alimentares disfuncionais são muito frequentes em candidatos à cirurgia bariátrica e podem ainda surgir ou piorar após a intervenção cirúrgica. Profissionais de saúde devem considerar de maneira mais cuidadosa tais problemas neste público, dadas às consequências para o resultado cirúrgico e qualidade de vida.

ABSTRACT Objective To conduct a revision about disordered eating and eating disorders related to bariatric surgery. Methods Integrative literature’s review on databases PubMed, Lilacs, Bireme, portal SciELO using indexed keywords; inclusion criteria was provide data about the presence or frequency of eating disorders or disordered eating behaviors previously and/or after surgery. Results One hundred and fifty studies were selected (14 in Brazil and 136 other countries): 80.6% were evaluation of patient’s pre or post-surgery; 12% were case studies and 7.3% were revision studies. Diverse scales and questionnaires were used for evaluation, mostly the Questionnaire on Eating and Weight Patterns, the Binge Eating Scale and the Eating Disorders Examination Questionnaire. Binge eating was the most common behavior evaluated, with frequencies/prevalence from 2% to 94%; for Binge Eating Disorder frequencies/prevalence’s range from 3% to 61%. Studies also describe anorexia and bulimia nervosa, night eating syndrome and grazing. Some studies point improvement of symptoms while others call attention for the emergence or aggravation of problems. Conclusion Despite the variability among methods and results, the presence of disordered eating behaviors is highly frequent among bariatric surgery candidates, and could emerge or get worse after surgery. Health care providers must consider carefully these problems due their impact on surgery results and quality of life.

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.

Attitudes toward beef and vegetarians in Argentina, Brazil, France, and the USA.

Meat is both the most favored and most tabooed food in the world. In the developed world, there is a tension between its high nutritional density, preferred taste, and high status on the one hand, and concerns about weight, degenerative diseases, the ethics of killing animals, and the environmental cost of meat production on the other hand. The present study investigated attitudes toward beef, and toward vegetarians, among college students in Argentina, Brazil, France, and the USA. Across countries, men were more pro-beef, in free associations, liking, craving, and frequency of consumption. By country, Brazil and Argentina were generally the most positive, followed by France and then the United States. Ambivalence to beef was higher in women, and highest in Brazil. Only Brazilian and American women reported frequent negative associations to beef (e.g. "disgusting", "fatty"). Overall, most students had positive attitudes to beef, and the attitude to vegetarians was generally neutral. America and Brazilian women showed some admiration for vegetarians, while only French men and women had negative attitudes to vegetarians. In spite of frequent negative ethical, health, and weight concerns, in the majority of the sample, liking for and consumption of beef was maintained at a high level.

A cross-cultural comparison of eating behaviors and home food environmental factors in adolescents from São Paulo (Brazil) and Saint Paul-Minneapolis (US).

OBJECTIVE: Describe cross-cultural differences in nutrition-related factors among adolescents from São Paulo, Brazil and St Paul-Minneapolis, US. DESIGN: Two large-population-based studies with cross-cultural comparisons. SETTING: Twelve São Paulo and 10 St Paul-Minneapolis high schools in 2009-2010. PARTICIPANTS: A total of 1,148 adolescents from São Paulo and 1,632 adolescents from St Paul-Minneapolis. MAIN OUTCOME MEASURE(S): Meal consumption, family meals, fast-food consumption, and home food availability. ANALYSIS: Binomial regressions, weighted for age distributions and adjusted for gender, were used to compare identical measures from each sample. RESULTS: Generally, São Paulo adolescents reported healthier nutritional outcomes than St Paul-Minneapolis adolescents. São Paulo adolescents were 7 times less likely to report high fast-food consumption than St Paul-Minneapolis adolescents (P < .001). Whereas most measures of the home environment indicated healthier home environments in São Paulo, more São Paulo adolescents reported that sugar-sweetened beverages were usually available at home than did St Paul-Minneapolis adolescents (P < .001). CONCLUSIONS AND IMPLICATIONS: São Paulo youth tended to have healthier eating behaviors and home food environment factors than St Paul-Minneapolis youth. Brazilian eating patterns tend to be healthier and support a connection with food and culture. Interventions are needed to encourage youth and their families to maintain these patterns.