Breakfast skipping and cardiometabolic risk factors in adolescents: Systematic review

OBJECTIVE To systematically review the results of the association between breakfast skipping and cardiometabolic risk factors in adolescents. METHODS The articles were searched in May 2020 from PubMed, Virtual Health Library, Scopus, Web of Science and Scientific Electronic Library Online (SciELO). The review included observational studies conducted with adolescents (10–19 years old), which estimated the association of breakfast skipping with at least one outcome (markers of body adiposity, blood pressure, serum lipid and glucose levels). Regarding the risk of bias, the articles were evaluated using the Research Triangle Institute (RTI) Item Bank on bias risk and accuracy of observational studies. The quality of the evidence was assessed by the Grade rating. RESULTS A total of 43 articles involving 192,262 participants met the inclusion criteria and were considered in this review. The prevalence of breakfast skipping ranged from 0.7% to 94% and 60.5% of studies were classified with low risk of bias. The significant association between breakfast skipping and cardiometabolic risk factors was found in twenty-nine cross-sectional articles (n = 106,031) and four longitudinal articles (n = 5,162) for excess adiposity, in three articles (n = 8,511) for high total cholesterol levels, low-density lipoprotein and triglycerides, and in three studies (n = 6,303) for high blood pressure levels. However, there was no significant association between breakfast skipping and glycemic profile. According to the Grade rating, all the associations had low quality of evidence. CONCLUSION The results of this review suggest that breakfast skipping is associated with cardiometabolic risk factors in adolescents aged 10 to 19 years. However, considering the low quality of the evidence, the present results should be interpreted carefully. In addition, our findings highlight the importance of standardizing the definition of breakfast skipping and that more prospective studies are needed to determine how skipping breakfast can affect cardiometabolic risk factors in the long time

Dietary energy density and associated factors: how is the population of Sao Paulo doing?

OBJETIVO: Avaliar a densidade energética da dieta de adultos do município de São Paulo e fatores associados. SUJEITOS E MÉTODOS: Participantes do estudo ISA-Capital, com amostragem probabilística (n = 710 adultos). O consumo alimentar foi avaliado pelo R24h. As correlações foram investigadas pelo coeficiente de correlação de Pearson. As associações com dados demográficos, socioeconômicos e de estilo de vida foram investigadas por modelos de regressão multivariados. RESULTADOS: A densidade energética média foi 1,98 kcal/g (IC95% [1,94; 2,01]) e correlacionou-se positivamente com a ingestão de energia, gordura, carboidrato, colesterol, gordura saturada, sacarose, gordura trans e açúcar adicionado e negativamente com fibras. Apenas idade e hábito de fumar apresentaram associação com a densidade energética. CONCLUSÕES: Os valores elevados da densidade energética da dieta e a relação demonstrada com outros constituintes nutricionais denotam má qualidade da dieta nessa população, o que pode estar contribuindo para crescentes taxas de excesso de peso. Arq Bras Endocrinol Metab. 2012;56(9):638-45Objective: To evaluate dietary energy density in adults living in Sao Paulo and associated factors. Subjects and methods: Subjects were participants of ISA-Capital study, which was carried out with probabilistic sampling (n = 710 adults). Food consumption was assessed by R24h. Correlations with dietary constituents were evaluated using Pearson's correlation coefficient. Associations with demographic, socioeconomic and lifestyle data were investigated by multivariate regression models. Results: The average energy density was 1.98 kcal/g (95% CI [ 1.94, 2.01]). It was positively correlated with energy, fat, carbohydrate, cholesterol, saturated fat, sucrose, trans fat and added sugar intake; and negatively correlated with fiber intake. Only age and smoking were associated with energy density. Conclusions: High values of energy density and the relationship determined with other nutritional constituents denote the poor quality of the diet in this population, which may be contributing to the rising rates of overweight. Arq Bras Endocrinol Metab. 2012; 56(9):638-4

Similarities and differences of meal quality between Brazil and United Kingdom: what lessons can we learn?

Introdução. Apesar de consumirmos alimentos combinados e estruturados em refeições, a maioria dos estudos ainda se concentra em nutrientes ou alimentos consumidos isoladamente. Além disso, comparar a alimentação entre países em diferentes fases de transição nutricional e epidemiológica pode fornecer informações relevantes relacionadas à prevenção da obesidade e DCNT. Objetivo. Caracterizar e comparar a qualidade nutricional da principal refeição consumida por adultos residentes no Brasil e Reino Unido. Materiais e Métodos. A primeira etapa do estudo consistiu na revisão sistemática da literatura, que subsidiou a etapa seguinte, o desenvolvimento do Main Meal Quality Index. Para comparar a qualidade das refeições utilizou-se dados dos inquéritos alimentares Inquérito Nacional de Alimentação INA/POF 2008/09 e National Diet and Nutrition Survey - NDNS. Para a identificação e avaliação da qualidade da refeição utilizou-se duas diferentes abordagens: (1) abordagem híbrida, com a descrição da composição das refeições por meio da árvore de decisão de classificação, e (2) abordagem dirigida pela hipótese, através da aplicação do Main Meal Quality Index. Além disto foram analisados modelos de regressão múltipla a fim de identificar os fatores associados. Resultados. Considerando o horário de consumo e a contribuição energética, os eventos alimentares definidos como principal refeição foram o almoço, para o Brasil, e jantar, para o Reino Unido. A refeição principal brasileira (58 pontos) apresentou melhor qualidade nutricional, com maior participação de fibras e carboidratos, e menor teor de gorduras total e saturada, e densidade energética. No entanto, a principal refeição do Reino Unido (54 pontos) foi composta por mais frutas, verduras e legumes. Os ingredientes culinários, como arroz e feijão, foram classificados pelo algoritmo como componentes característicos da refeição brasileira, enquanto os itens de fast food, como batatas fritas, sanduíches e bebidas açucaradas, foram classificados como refeições Britânicas. No Brasil, o escore final do indicador associou-se positivamente com a idade, e negativamente com o gênero, energia consumida, estado nutricional e renda familiar; enquanto que, no Reino Unido, o indicador associou-se apenas com a idade (positivamente). Conclusão. Embora a principal refeição consumida no Brasil, quando comparada ao Reino Unido, apresente melhor qualidade e composição, as refeições consumidas em ambos os países estão aquém do recomendado.Introduction. Although individuals consume foods combined and structured at meals, most authors still have studied nutrient or single food. Furthermore, compare countries in different stages of nutritional and epidemiological transition can provide relevant information related to the prevention of obesity and NCDs. Objective. To characterize and compare the nutritional quality of meals consumed by adults living in Brazil and UK. Subjects and methods. The first stage of the study consisted of a systematic review of the literature, which subsidized the next step, the development of the Main Meal Quality Index. Data from food surveys \"National Survey of Food - INA / HBS 2008/09\" and \"National Diet and Nutrition Survey - NDNS\" were used to analyzed and compare the main meals quality. Two different approaches for the identification and evaluation of the main meal pattern were used: (1) hybrid approach, to evaluate of the meal patters using data reduction techniques; and (2) hypothesis-driven approach, with the Main Meal Quality Index. Then, regression models were applied to analyzed associated sociodemographic factors. Results. Considering time slot and energy content, the eating events defined as main meal were lunch, for Brazil, and dinner, for UK. Brazilian main meal (58 points) had better nutritional quality, with greater participation of fiber and carbohydrates, and lower content of total and saturated fat, and energy density. However, the main meal consumed in UK (54 points) had more fruits and vegetables. Cooking ingredients, such as rice and beans, were classified as characteristic components of a Brazilian meal, while fast food items, like chips, sandwiches and sugary drinks, were classified as a British meal. In Brazil, the final score was positively associated with age, and negatively correlated with gender, energy consumption, nutritional status and family income; whereas, in the United Kingdom, the indicator is only associated with age (positively). Conclusion. Although Brazilian main meal, when compared with UK main meal, provide best quality and composition, meals consumed in both countries need improvement

Food consumption away from home and its relation to the dietary quality in São Paulo: study ISA-capital

Introdução. A alimentação é considerada pela Organização Mundial da Saúde um dos principais fatores de risco modificáveis para doenças crônicas não transmissíveis, ressaltando a importância do entendimento dos hábitos alimentares e seus determinantes no atual cenário epidemiológico. Entretanto, pouco se sabe sobre as características nutricionais e as características dos usuários da alimentação fora do lar. Objetivo. Investigar a qualidade nutricional da alimentação fora do lar e sua relação com características sociais, demográficas e de estilo de vida. Materiais e métodos. Estudo transversal, de base populacional, por meio de inquérito domiciliar, com amostra de 232 adolescentes e 602 adultos e idosos. Foi aplicado questionário sobre hábitos de vida, condições sóciodemográficas, atividade física e inquérito alimentar, por meio do recordatório de 24h. As características das refeições realizadas fora do lar foram investigadas pelo uso do Índice de Qualidade da Refeição (IQR), com base nas recomendações da Organização Mundial da Saúde e Ministério da Saúde brasileiro. A associação entre alimentar-se fora do lar e a qualidade da dieta, verificada por meio do Índice de Qualidade da Dieta Revisado para a População Brasileira (IQD-R) foi investigada pelo uso de modelos de regressão linear múltiplo. A razão de prevalência de pessoas consumindo refeições fora do lar e sua associação com as características sociais, demográficas e de estilo de vida foi analisada através da regressão de Poisson com variância robusta. Resultados. Dentre os 834 entrevistados, 32 por cento relataram ter realizado ao menos uma das três principais refeições (café da manhã, almoço e jantar) fora de casa. Foram detectadas associações estatisticamente significantes entre consumir alimentos fora do lar e ter excesso de peso. Pôde-se observar a presença tanto de alimentos marcadores de uma dieta saudável, a exemplo do arroz e feijão, como de alimentos integrantes de uma dieta não saudável, como refrigerantes, salgados, sanduíches e pizzas. O escore médio do Índice de Qualidade da Refeição realizada fora do lar foi de 42,62 (IC 95 por cento : 36,17-49,07) pontos no café da manhã; 42,54 (IC 95 por cento : 37,7547,34) pontos no almoço e 42,92 (IC 95 por cento : 36,47-49,38) pontos no jantar. Almoçar fora de casa apresentou associação negativa (p<0.05) com a qualidade da dieta, independente do sexo, renda familiar per capita e estado nutricional. Conclusão. Os achados sugerem que alimentar-se fora de casa pode contribuir como fator de risco modificável para DCNT, apresentando maior teor de gorduras total e saturada. No entanto, a qualidade nutricional das refeições realizadas dentro de casa também precisa ser melhoradaBackground. Diet is considered by the World Health Organization a major modifiable risk factors for chronic diseases, emphasizing the importance of understanding the feeding habits and their determinants in the current epidemiological scenario. However little is known about the nutritional characteristics and the characteristics of users of food away from home. O bjective. To investigate the nutritional quality of food away from home and their relationship to social, demographic and lifestyle. Methods. Crosssectional study, a population-based, through a household survey with a sample of 232 adolescents (12-19 years), 602 adults and elderly (20 years or more) of both sexes. Dietary intake was measured by application of 24hR by phone. The overall dietary quality was assessed by the Brazilian Healthy Eating Index Revised (B-HEIR) and the Meal Quality Index (MQI) was used to evaluate dietary quality of the main meals. The association between the B-HEIR and the MQI was assessed by linear regression analysis. The proportion of people that consumed meals away from home and its association with the social, demographic and lifestyle were analyzed by Poisson regression with robust variance. Results. Among the 834 respondents, 32 per cent had at least one meal away from home. The average energy consumption per meal away from home was 628 kcal (sd 101kcal), about 35 per cent of the average daily consumption reported in this population. Statistically significant associations were found between food consumption away from home and overweight. It was observed the presence of both food markers of a healthy diet, such as rice and beans as food components of a unhealthy diet as soft drinks, snacks, sandwiches and pizzas. The average MQI score of lunch consumed away from home was lower than lunch at home, with higher amounts of total and saturated fats. Have lunch away from home was associated with the MQI score. Conclusion. Our findings suggest that eating meals away from home can contribute as a modifiable risk factor for chronic diseases, with higher levels of total and saturated fat. However, the meals consumed at home also need improvemen

Nutritional quality of meals served by the cafeteria of a company located in the metropolitan region of São Paulo, Brazil

OBJETIVO: Avaliar a qualidade nutricional das refeições servidas em uma Unidade de Alimentação e Nutrição de uma fábrica da região metropolitana da cidade de São Paulo. MÉTODOS: Dentre os cardápios praticados no período de um ano (242 dias) na unidade mencionada, foram selecionados 30% por sorteio sistemático, e avaliados utilizando-se o Índice de Qualidade da Refeição, com base nas recomendações da Organização Mundial da Saúde e do Ministério da Saúde brasileiro. Esse índice compõe-se de cinco itens que variam entre zero e 20 pontos cada um: adequação na oferta de hortaliças e frutas; oferta de carboidratos; oferta de gordura total; oferta de gordura saturada e variabilidade do cardápio. No período analisado, foram servidas 367 preparações, agrupadas em 30 categorias, segundo composição e forma de preparo. A correlação de Spearman foi utilizada para investigar a correlação do índice com os nutrientes da refeição. As análises foram realizadas no pacote estatístico STATA, considerando-se o nível de significância de 5%. RESULTADOS: O valor médio do Índice de Qualidade da Refeição foi de 64,60 (DP=21,18) pontos, sendo 44% das refeições classificadas como "refeição que necessita de melhora" e apenas 25% como "adequadas". Além do arroz e do feijão, servidos diariamente, as preparações mais frequentes foram: legumes e frutas (30%), massas e cremes (12%), frituras (9%) e sobremesas com creme (8%). Encontrou-se correlação positiva entre o Índice de Qualidade da Refeição e a vitamina C (r=0,32). CONCLUSÃO: Apesar da presença constante de frutas, legumes e verduras, há a necessidade de adequar a oferta das preparações às recomendações para uma alimentação saudável, que efetivamente colaborem na promoção da saúde.OBJECTIVE: This study assessed the nutritional quality of meals served by the cafeteria of a company located in the metropolitan region of São Paulo city, Brazil. METHODS: Thirty percent of the dishes served during one year (242 days) by the said cafeteria were systematically selected and assessed by the Meal Quality Index in accordance with the recommendations of the World Health Organization and Brazilian Ministry of Health. This index consists of five items with a maximum of 20 points each: content of non-starchy vegetables and fruits; carbohydrate content; total fat content; saturated fat content; and within-meal diversity. Three-hundred sixty-seven meals grouped into 40 categories according to composition and preparation method were served during the study period. Spearman correlation was used to investigate a possible correlation between the index and nutrients in a meal. Analyses were done by the STATA software with the significance level set at 5%. RESULTS: The mean Meal Quality Index score was 64.60 points, with a standard deviation of 21.18. Forty-four percent of the meals were classified as needing improvement and only 25% were classified as appropriate. In addition to rice and beans which are served daily, the most common preparations were legumes and fruits (30%), pasta and creams (12%), deep-fried foods (9%) and deserts with cream (8%). The Meal Quality Index correlated positively with vitamin C (r=0.32). CONCLUSION: Although fruits and non-starchy vegetables were always available, the meals need improvement to meet healthy eating recommendations that effectively help to promote good health

Main meal quality in Brazil and United Kingdom:Similarities and differences

Consumption of fast food and ready-to-eat meals has been positively associated with obesity. In the UK, ready-made meals are more often consumed than in Brazil, a country in which nutrition transition is relatively low. This study aimed to compare the nutritional quality of the main meal consumed by adults in Brazil and UK. Food record data was obtained from representative samples from UK and Brazil databases. The Main Meal Quality Index (MMQI) was applied to estimate the quality of the main meal consumed in Brazil and UK. Differences in food groups consumed in the main meal in Brazil and UK were observed using classification decision tree. Meals with higher average energy content were lunch for Brazil, and dinner for the UK. On average, the Brazilian main meal had better nutritional quality (4.42 times higher), independently of sex, age, family income, nutritional status and energy consumed, with higher scores of fiber, carbohydrate, total fat, saturated fat and energy density. However, UK's main meal included more fruits and vegetables. Food preparations combined with rice and beans were classified as Brazilian main meal, while combinations with fast food items, as fried potatoes, sandwiches and sugary beverages, were classified as UK main meals. In Brazil, the main meal quality was lower among women and obese individuals, presenting significant positive association with age, and negative association with energy intake and family income; while in UK, only age was positively associated with MMQI. Although main meals in Brazil had higher nutritional quality compared to the UK, main meals consumed in both countries need nutritional improvement