Reliability and validity of an FFQ for South American children and adolescents from the SAYCARE study

Objective:The purpose of this study was to analyse the reliability and validity of a semi-quantitative FFQ to assess food group consumption in South American children and adolescents.Design:The SAYCARE (South American Youth/Child cARdiovascular and Environmental) study is an observational, multicentre, feasibility study performed in a sample of 3-to 18-year-old children and adolescents attending private and public schools from six South American countries. Participants answered the FFQ twice with a two-week interval and three 24-h dietary recalls. Intraclass and Spearman''s correlations, weighted Cohen''s kappa (¿w), percentage of agreement and energy-adjusted Pearson''s correlation coefficients were calculated.Setting:Seven cities in South America (Buenos Aires, Lima, Medelin, Montevideo, Santiago, Sao Paulo and Teresina).Subjects:A sample of 200 children and 244 adolescents for reliability analyses and 252 children and 244 adolescents for validity analyses were included.Results:Depending on the food group, for children and adolescents, reliability analyses resulted in Spearman''s coefficients from 0·47 to 0·73, intraclass correlation coefficients from 0·66 to 0·99, ¿w coefficients from 0·35 to 0·63, and percentage of agreement between 72·75 and 83·52 %. In the same way, validity analyses resulted in Spearman''s coefficients from 0·17 to 0·37, energy-adjusted Pearson''s coefficients from 0·17 to 0·61, ¿w coefficients from 0·09 to 0·24, and percentages of agreement between 45·79 and 67·06 %.Conclusion:The SAYCARE FFQ achieved reasonable reliability and slight-moderate validity for almost all food groups intakes. Accordingly, it can be used for the purpose of ranking the intake of individuals within a population

Effect of fruit and vegetable consumption on cardiovascular health in adolescents: a systematic review

Introdução: O consumo de frutas, legumes e verduras é pouco frequente entre os adolescentes, e o possível efeito deste consumo na saúde cardiovascular durante esta faixa etária é indefinido. Objetivo: Verificar se existe associação entre o consumo de frutas, legumes e verduras e indicadores de risco cardiovascular em adolescentes (obesidade abdominal, hiperglicemia, hipertrigliceridemia, dislipidemia, hipertensão arterial sistêmica, e síndrome metabólica). Métodos: Registrou-se esta revisão sistemática no PROSPERO (CRD42013004818) para realizar uma revisão sistemática em seis bases de dados eletrônicas (Biomed Central, CINAHL, MEDLINE, PsycINFO, Scopus, Web of Science). Considerou-se o período desde a criação destas bases de dados até sete de Dezembro de 2015 como data mais recente para a atualização das buscas. A estratégia de busca utilizou os seguintes grupos de descritores: faixa etária; frutas, legumes e verduras; indicadores de risco cardiovascular; estudos transversais ou coorte. Os critérios de elegibilidade foram: Artigos em Inglês, Espanhol e Português? estudos originais? amostra composta de adolescentes (dez a 19 anos de idade segundo a organização mundial de saúde); descritores de acordo com os indicadores de risco cardiovascular estabelecidos para adolescentes. Artigos potencialmente elegíveis foram selecionados por dois revisores separadamente. Resultados: Foram identificados 5632 artigos. Após a leitura dos títulos e resumos, 102 artigos potencialmente relevantes permaneceram para a leitura na íntegra. Após seleção, 11 artigos preencheram os critérios de elegibilidade e foram incluídos (dez transversais, uma coorte). As principais razões para a exclusão dos estudos foram classificação da adolescência diferente da preconizada pela Organização Mundial de Saúde, o consumo de frutas, legumes e verduras analisado como parte de um padrão alimentar (por exemplo, juntamente com peixes, laticínios ou cereais), e os indicadores de risco cardiovascular que não foram especificados ou que diferiram das definições estabelecidas. Os artigos avaliaram a ingestão de frutas, legumes e verduras em diversas unidades de medida, utilizando-se questionários de frequência de consumo alimentar (54.5%), recordatório alimentar de 24 horas (27.3%) e registro alimentar (18.2%). Além disso, o consumo de frutas, legumes e verduras foi avaliado separadamente (54.5%), em conjunto (36.4%), apenas legumes e verduras (9.1%), e um estudo incluiu suco de frutas (9.1%). Um terço dos estudos mostraram associações significativas entre o consumo de frutas, legumes e verduras e a pressão arterial sistólica, obesidade abdominal, triglicérides, HDL colesterol e síndrome metabólica. Conclusão: As associações entre o consumo de frutas, legumes e verduras e indicadores de risco cardiovascular em adolescentes são inconsistentes. Isto se deve provavelmente à heterogeneidade nos métodos utilizados para avaliar/classificar o consumo e/ou definir o risco cardiovascular neste grupo etário. Uma vez que os benefícios deste consumo já são bem estabelecidos na saúde cardiovascular de adultos, ainda são necessários estudos adicionais que abordem alta qualidade metodológica para melhor compreender esse fenômeno nos adolescentesBackground: Fruit and vegetable consumption is infrequent among adolescents, and the possible effect of this consumption on cardiovascular health during this age group is undefined. Aim: To investigate the association between fruit and vegetable consumption on cardiovascular risk indicators in adolescents (abdominal obesity, hyperglycemia, hypertriglyceridemia, dyslipidemia, hypertension and metabolic syndrome). Methods: This systematic review was registered in PROSPERO (CRD42013004818), and a systematic review searching electronic databases (Biomed Central, CINAHL, MEDLINE, PsycINFO, Scopus, Web of Science) from inception to December 7, 2015 was conducted. The search strategy used the following sets of descriptors related to: age group; fruits and vegetables; cardiovascular risk indicators; cross-sectional and cohort studies. Eligibility criteria were: Articles in English, Spanish and Portuguese; original studies; sample of adolescents (10-19 year-old according to World Health Organization); descriptors according to the cardiovascular risk indicators. Potentially eligible articles were selected by two reviewers separately. Results: A total of 5632 articles were identified. After reading the titles and abstracts, 102 potentially relevant articles remained for full reviewed. After selection, 11 articles meeting the inclusion criteria were included (10 cross-sectional; 1 cohort). The main reasons for study exclusion were misclassifying adolescence, assessing fruits and vegetables as part of a food pattern (for example, together with fish, dairy, or cereal), and cardiovascular risk indicators that were not specified or that differed from the definitions established. Articles evaluated fruit and vegetable intake in diverse units, using food frequency questionnaires (54.5%), 24-hour-dietary-recalls (27.3%), and food records (18.2%). In addition, fruit and vegetable consumption were assessed separately (54.5%), together (36.4%), or only vegetables (9.1%); and 1 article included fruit juice (9.1%). A third of the studies showed significant inverse associations of fruit and vegetable intake with systolic blood pressure, abdominal obesity, triglycerides, HDL cholesterol, and metabolic syndrome. Conclusion: The associations between fruit and vegetable consumption and adolescent cardiovascular risk indicators are inconsistent. Since the benefits of this consumption are well established in adult cardiovascular health, further studies are necessary, addressing high methodological quality to better understand this phenomenon in adolescent

Validity of dietary assessment methods in children: SAYCARE study

Introdução: A avaliação do consumo alimentar em crianças com acurácia, é identificada como importante fator ao se investigar as associações entre a dieta e a saúde. Porém, estudos de validação de métodos para a avaliação do consumo alimentar em crianças são escassos. Objetivo: Validar dois questionários [Questionário de Frequência Alimentar (QFA) e Recordatório Alimentar de 24 horas (R24h)] para o consumo habitual de frutas, vegetais, e ferro alimentar em crianças e adolescentes sul-americanos. Métodos: Estudo multicêntrico observacional, em amostra de crianças e adolescentes (3-17 anos) participantes do SAYCARE (South American Youth/Child Cardiovascular and Environmental) study, e provenientes de cinco cidades: Buenos Aires (Argentina), Lima (Peru), Medellín (Colômbia), São Paulo e Teresina (Brasil). O QFA foi preenchido referente ao consumo nos últimos três meses; O R24h foi aplicado três vezes (dois dias semanais; um dia de fim de semana), e a ingestão média desses três dias (combinada com a frequência da ingestão) foi calculada usando o Multiple Source Method (MSM), a fim de validar os questionários para o consumo de frutas e vegetais (n = 45) com dosagens plasmáticas de retinol, beta-caroteno, alfa-tocoferol e ácido ascórbico; e para a ingestão de ferro alimentar (n = 149) com dosagens séricas de ferro e ferritina. A ingestão alimentar em relação aos biomarcadores sanguíneos foi avaliada por meio de regressão linear múltipla ou de multinível, e análise de curva de características operacionais do receptor (ROC). Resultados: A tese é composta por nove artigos, sendo tre?s artigos principais (uma revisão sistemática, um artigo de validação do consumo de frutas e vegetais, e um artigo de validação do consumo de ferro alimentar), além de seis artigos complementares a? tese. Os coeficientes de correlação foram de 0,29 e 0,35 para a ingestão de frutas e vegetais estimada pelo QFA e pelo MSM, respectivamente; e os coeficientes de correlação para o consumo de ferro alimentar variaram entre 0,81-0,87 para o QFA, e entre 0,12-0,18 para o MSM. Conclusão: O QFA desenvolvido para o SAYCARE study apresentou boa capacidade de classificar a ingestão de frutas e vegetais em crianças, e a ingestão de ferro alimentar em crianças e adolescentesBackground: Accurate dietary assessment in children is identified as an important fact to investigate the associations between diet and disease. However, there are limited studies about validity of dietary assessment methods in children. Aim: To evaluate the validity of two questionnaires [Food Frequency Questionnaire (FFQ) and 24h Dietary Recall (R24h)] to estimate fruit, vegetable, and dietary iron intake in South American children and adolescents. Methods: Multicenter observational study, in a sample of children and adolescents (3-17 years) participating in the SAYCARE (South American Youth/Child Cardiovascular and Environmental) study, from five cities: Buenos Aires (Argentina), Lima (Peru), Medellin (Colombia), São Paulo and Teresina (Brazil). The FFQ was filled out according to the consumption over the last three months; the R24h was applied three times (two weekdays, one weekend day) and the mean intake of these three days (combined with the frequency of intake) was calculated using the multiple source method (MSM), to validate the fruit and vegetable consumption (n = 45) against plasma dosages of retinol, beta-carotene, alpha-tocopherol, and ascorbic acid; and for dietary iron intake (n = 149) against serum dosages of iron and ferritin. Dietary intake in relation to blood biomarkers was assessed using multiple linear regression or multilevel regression, and receiver operating characteristics (ROC) curve analysis. Results: This thesis consists of nine articles; three principal articles (a systematic review, one article validating fruits and vegetables intake, and one article validating dietary iron intake), in addition to six complementary articles. Correlation coefficients were 0.29 and 0.35 for fruit and vegetable intake estimated by the FFQ and the MSM, respectively; and correlation coefficients for dietary iron intake ranged from 0.81-0.87 for the FFQ, and 0.12-0.18 for the MSM. Conclusion: The SAYCARE FFQ exhibited good ability to rank fruit and vegetable intake in children, and dietary iron intake in children and adolescent

The Validity of Children’s Fruit and Vegetable Intake Using Plasma Vitamins A, C, and E: The SAYCARE Study

Despite that fruits and vegetables are key elements for health promotion, there are limited studies validating their intake in children. We aimed to validate the SAYCARE (South American Youth/Child Cardiovascular and Environmental) Study Food Frequency Questionnaire (FFQ) and the combination of the FFQ frequency of intake with the 24 h-dietary-recall (24 h-DR) (mean of 3 days), for children’s fruit and vegetable intake. The reference methods were plasma dosages of β-carotene, retinol, ascorbic acid, and α-tocopherol, which were collected in the school environment. It is a validity study in a subsample of 45 children aged 6–10 years participating in the SAYCARE Study, from São Paulo (Brazil). The FFQ was answered by the parents/guardians over the previous 3 months; the 24 h-DR was answered three times (two weekdays by nutritionists, one weekend day by parents/guardians). The mean fruit and vegetable intake (combined with frequency of intake) was calculated using the multiple source method (MSM). Multiple linear regression showed pooled correlation coefficients of 0.29 to 0.35 for the reported fruit and vegetable intake estimated by the FFQ and the MSM, respectively. The SAYCARE FFQ is an accurate and useful tool for ranking fruit and vegetable intake in children between 6–10 years from the SAYCARE Study

Evaluation of the Validity of a Food Frequency Questionnaire and 24-Hour Dietary Recall to Assess Dietary Iron Intake in Children and Adolescents from the South American Youth/Child Cardiovascular and Environmental Study

Background: A food frequency questionnaire (FFQ) for South American children and adolescents was developed, but its validity for assessing dietary iron intake has not been evaluated. Objective: To evaluate the validity of the FFQ and 24-hour dietary recalls (24h-DR) for assessing dietary iron intake in children and adolescents. Design: The South American Youth/Child Cardiovascular and Environmental study is a multicenter observational study, conducted in five South American cities: Buenos Aires (Argentina), Lima (Peru), Medellin (Colombia), Sao Paulo, and Teresina (Brazil). The FFQ assessed dietary intake over the previous 3 months, and the 24h-DR was completed three times (2 weekdays and 1 weekend day) with a minimum 5-day interval between recalls. Blood samples were collected to assess serum iron, ferritin, and hemoglobin levels. Participants and setting: Data of 99 children (aged 3 to 10 years) and 50 adolescents (aged 11 to 17 years) from public and private schools were collected during 2015 to 2017. Main outcome measures: Dietary iron intake calculated from the FFQ (using the sum of daily iron intake in all food/food groups) and 24h-DR (mean of 3 days using the multiple source method). Statistical analyses performed: Dietary iron intake in relation to blood biomarkers were assessed using Spearman rank correlations adjusted for sex, age, and total energy intake, and the quadratic weighted κ coefficients for agreement. Results: Spearman correlations showed very good coefficients (range = 0.78 to 0.85) for the FFQ in both age groups; for the 24h-DR, the coefficients were weak in children and adolescents (range = 0.23 to 0.28). The agreement ranged from 59.9% to 72.9% for the FFQ and from 63.9% to 81.9% for the 24h-DR. Conclusion: The South American Youth/Child Cardiovascular and Environmental study FFQ exhibited good validity to rank total dietary iron intake in children and adolescents, and as well as the 24h-DR, presented good strength of agreements when compared with serum iron and ferritin levels.Fil: Sadalla Collese, Tatiana. Universidade de Sao Paulo; BrasilFil: De Moraes, Augusto César F.. Universidade de Sao Paulo; Brasil. University of Texas; Estados UnidosFil: Rendo Urteaga, Tara. Researcheronkologikoa Foundation; España. Universidade de Sao Paulo; BrasilFil: González Zapata, Laura I.. Universidad de Antioquia; ColombiaFil: Gaitán Charry, Diego Alejandro. Universidad de Antioquia; ColombiaFil: Delgado, Carlos A.. Universidad Nacional Mayor de San Marcos; Perú. Instituto Nacional de Salud del Niño; PerúFil: Berg, Gabriela Alicia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Bioquímica Clínica; ArgentinaFil: Torres Leal, Francisco Leonardo. Universidade Federal do Piaui; BrasilFil: Carvalho, Heráclito B.. Universidade de Sao Paulo; Brasi

How do energy balance-related behaviors cluster in adolescents?

Objectives: To delineate the clustering of energy balance-related behaviors in adolescents and investigate whether these behaviors are associated with the household socioeconomic status and parental education level. Methods: Two cross-sectional studies assessed information on sedentary behavior, physical activity, sugar-sweetened beverages and fruit and vegetable consumption, and sleep duration by self-reported questionnaires in adolescents (12.5-17.5years old) from Maringa/Brazil (BRACAH Study; n=682) and ten European cities (HELENA Study; n=1252) from nine different countries. Gender-specific cluster analyses were performed separately for each study, applying a combination of hierarchical and non-hierarchical methods. Results: Girls showed equivalent behaviors: Sedentary; Active; Unhealthy Eating; Healthy Eating; while boys differed (Brazilian: Sedentary; Active; Healthy Eating; European: Sedentary; Healthy; Unhealthy Eating). In Brazil, we found no association between socioeconomic status and parental education. In European girls, the high socioeconomic status and both parents' university degree were associated with Healthy Eating. In European boys, the high socioeconomic status was associated with Unhealthy Eating, and the mothers' university degree was associated with the Healthy cluster. Conclusions: Adolescents show Sedentary behavior, regardless of their sex, country of origin, or socioeconomic condition

How do energy balance-related behaviors cluster in adolescents?

OBJECTIVES: To delineate the clustering of energy balance-related behaviors in adolescents and investigate whether these behaviors are associated with the household socioeconomic status and parental education level. METHODS: Two cross-sectional studies assessed information on sedentary behavior, physical activity, sugar-sweetened beverages and fruit and vegetable consumption, and sleep duration by self-reported questionnaires in adolescents (12.5-17.5 years old) from Maringá/Brazil (BRACAH Study; n = 682) and ten European cities (HELENA Study; n = 1252) from nine different countries. Gender-specific cluster analyses were performed separately for each study, applying a combination of hierarchical and non-hierarchical methods. RESULTS: Girls showed equivalent behaviors: Sedentary; Active; Unhealthy Eating; Healthy Eating; while boys differed (Brazilian: Sedentary; Active; Healthy Eating; European: Sedentary; Healthy; Unhealthy Eating). In Brazil, we found no association between socioeconomic status and parental education. In European girls, the high socioeconomic status and both parents' university degree were associated with Healthy Eating. In European boys, the high socioeconomic status was associated with Unhealthy Eating, and the mothers' university degree was associated with the Healthy cluster. CONCLUSIONS: Adolescents show Sedentary behavior, regardless of their sex, country of origin, or socioeconomic condition.status: publishe

The combined effect of physical activity and sedentary behaviors on a clustered cardio-metabolic risk score: the Helena study

AbstractBackground/objectiveIncreased physical activity (PA) and decreased sedentary behaviors (SBs) may have beneficial effects on cardio-metabolic risk in adolescents. The aim of this study was to examine the associations between independent/combined effects of PA and SB with individual/clustered cardio-metabolic risk factors.MethodsA sample of 769 adolescents (12.5–17.5years) from the HELENA cross-sectional study (Healthy Lifestyle in Europe by Nutrition in Adolescence) and with valid data on metabolic risk factors were included.ResultsConcerning moderate-to-vigorous-PA (MVPA) and vigorous-PA (VPA), measured with accelerometers, girls tended to do more MVPA (36%) and VPA (114%) than boys. Unadjusted analyses show a positive association between “PA≥60min/d; SB≥2h” and the ratio TC/HDL-c (β=0.27; 95%CI 0.01 to 0.52; p<0.05), and a negative association between “MVPA≥60min/d; SB<2h” with the ∑4Skinfolds (β=−0.32; 95%CI −0.61 to −0.02; p<0.05). Moreover, “SB≥2h/d” was associated with increased cardio-metabolic risk (PR 1.59; 95%CI 1.05 to 2.39; p<0.05), while “PA≥60min/d; SB<2h” had a protective effect against cardio-metabolic risk (PR 0.48; 95%CI 0.25 to 0.91; p<0.05). After adjustment for potential confounders, a positive association between SB and ∑4Skinfolds was shown (β=0.28; 95%CI 0.04 to 0.53; p<0.05). Furthermore, VO2max (mL/kg/min) tends to increase in those participants who do higher VPA and less SB (p=0.042), and there was a protective effect of “VPA≥30min/d; SB<2h” against cardio-metabolic risk (PR 0.24; 95%CI 0.07 to 0.85; p<0.05).ConclusionThe current study suggests that adolescents should be encouraged to decrease sedentary lifestyle and increase physical activity, especially vigorous physical activity, in order to reduce cardio-metabolic risk