Estimativa de ferro biodisponível em dietas de creches filantrópicas da cidade de São Paulo: considerações sobre a fortificação da farinha de trigo com ferro

Objetivo: Estimar o ferro biodisponível nas dietas oferecidas às crianças de um a dois anos de idade, em creches filantrópicas do município de São Paulo, e, a partir dos cardápios avaliar o ferro considerando as alterações na concentração de ferro dietético pela fortificação das farinhas de trigo. Métodos: O ferro total e o ferro biodisponível foram estimados nas quatro refeições diárias planejadas para um período de cinco dias, utilizando-se os cardápios padronizados adotados em oito creches filantrópicas do município de São Paulo. Considerando-se a concentração de ferro de cada dieta individual, bem como a de proteína animal e de vitamina C, calculou-se a quantidade de ferro biodisponível ofertada a cada refeição, utilizando-se a equação de Monsen e Balintfly, que possibilita essa estimativa, a partir da relação entre esses fatores. Estimou-se ainda, nas mesmas dietas, o ferro total e biodisponível e suas densidades, considerando-se o acréscimo na concentração de ferro não heme derivado da fortificação de farinha de trigo e de milho com 4,2 mg Fe/100 g. Para o cálculo da oferta de nutrientes das dietas, foi utilizado o Programa Nutwin®, versão 1.5. Resultados: A quantidade média diária de ferro e de ferro biodisponível oferecidos com as dietas foram de 6,2(0,8) mg/d e 0,53(0,06) mg/d. Levando-se em conta a fortificação, esses valores aumentaram para, respectivamente, 7,7(0,9) mg/d e 0,59(0,07) mg/d. As médias de densidade de ferro e de f e r ro biodi sponíve l com e sem for t i f i c a ç ão, for am de , r e spe c t ivament e , 5,8(1,3) mg/1.000 kcal e 7,7(1,7) mg/1.000 kcal, e 0,42(0,10) mg/1.000 kcal e 0,49(0,13) mg/1.000 kcal. Conclusão: Embora com a fortificação da farinha de trigo tenha havido aumento na concentração do ferro total nas dietas avaliadas (24 %), a estimativa de ferro biodisponível ofertado mudou apenas 11 %. Para garantir o atendimento das necessidades diárias de 1,26 mg/d (percentil 97,5), considerando a biodisponibilidade de 9,0 % obtida nas dietas ofertadas a essas crianças, a recomendação deveria ser de cerca de 13 mg/d, e não de 7 mg/d. Esse nível de ingestão de ferro não poderia ser atingido somente com a fortificação das farinhas

Validation of self-reported diabetes in a representative sample of São Paulo city

OBJECTIVE To validate the self-reported diabetes mellitus in adults and older adults living in the city of São Paulo, Brazil. METHODS We have used data of 569 subjects (284 adults and 285 older adults), participants of the population-based cross-sectional study Inquérito de Saúde do Município de São Paulo (Health Survey of São Paulo). Fasting glucose ≥ 7.0 mmol/L (126 mg/dL) and/or use of drugs (oral hypoglycemic and/or insulin) defined the diagnosis of diabetes mellitus. We have validated the self-reported diabetes mellitus by calculating the sensitivity, specificity, positive predictive values, and negative predictive values. We have used Poisson regression with robust variance to verify the factors associated with the sensitivity of the self-reported datum. For all analyses, we have considered the sample design of the study. RESULTS The sensitivity of self-reported diabetes mellitus was 63.8% (95%CI 49.2–76.3), specificity was 99.7% (95%CI 99.1–99.9), positive predictive value was 95.5% (95%CI 84.4–98.8), and negative predictive value was 96.9% (95%CI 94.9–98.2). The correct reporting of diabetes mellitus was more prevalent among older adults (PR = 2.0; 95%CI 1.2–3.5) than among adults. CONCLUSIONS The use of the datum of self-reported diabetes mellitus is valid, especially among older adults living in the city of São Paulo. The results highlight the need to track diabetes mellitus in asymptomatic subjects who have one or more risk factors for it, mainly in the adult population of this city

Micronutrients inadequacy in urban population of Costa Rica

La inadecuación de micronutrientes es frecuente en los países en vías de desarrollo. En Costa Rica existe poca información acerca de la ingesta de micronutrientes y del impacto de los programas de fortificación obligatoria de alimentos. El objetivo de este estudio fue evaluar la ingesta de vitaminas y minerales y el aporte de la fortificación de alimentos a la ingesta total de micronutrientes en la población urbana costarricense. Se analizó el consumo de alimentos en una muestra de la población urbana costarricense, participantes del Estudio Latinoamericano de Nutrición y Salud (ELANS). El riesgo de ingesta inadecuada se estimó según sexo y grupo de edad, utilizando el método de punto de corte del Requerimiento Medio Estimado (EAR). Para el hierro, se utilizó el método de aproximación probabilística. Más del 85% de la muestra presentó riesgo de ingesta inadecuada para vitamina E, calcio y vitamina D. Una menor prevalencia de riesgo de ingesta inadecuada se presentó para la niacina, tiamina, folatos, hierro y selenio. La fortificación de alimentos tiene un efecto notorio en la ingesta de micronutrientes, especialmente de hierro, niacina, tiamina y folatos. La ingesta de calcio, vitamina D y vitamina E es preocupantemente inadecuada, siendo las mujeres y las personas mayores de 50 años los grupos más afectados. Resulta fundamental el establecimiento de programas y políticas públicas para asegurar el cumplimiento del requerimiento establecido para los diferentes micronutrientes.Micronutrient deficiencies are still very common in developing countries. In Costa Rica there is little information on micronutrients intake and the impact of food fortification.This study aimed to determine the contribution of food fortification to the total intake, and to estimate the risk of inadequate intake of vitamins and minerals in an urban Costa Rican population. As a part of the Latin American Nutrition and Health Study, we analyzed data from a nationally representative sample of 798 urban residents from Costa Rica (15-65 years old) whom provided two 24-h dietary recalls. The prevalence of inadequate micronutrient intake was estimated according to the EAR cut-point method. Iron was analyze using the probability approach. We observed a 100% of the sample are at risk of inadequate intake of vitamin D, and similar percentages were obtained for calcium and vitamin E, ranging from 92.9 to 100% and 85.5 to 99.2% respectively. A lower risk of inadequate intake was observed for niacin, thiamin, folate, iron and selenium. Food fortificationmakes an important contribution to folate, thiamin, iron and niacin intake. Despite the efforts that have been made to ensure adequate micronutrient intake in Costa Rica, the intake of calcium, vitamin D and vitamin E is still very low, especially among women and people over 50 are the most affected. Based on the above, it is recommended to promote a healthy diet through nutritional education as part of public health policies, in order to facilitates compliance to nutritional requirementCoca Cola Company///Estados UnidosUniversidad de Costa Rica/[422-B4-320]/UCR/Costa RicaInternational Life Science Institute//ILSI/ArgentinaEstudio Latinoamericano de Nutrición y Salud/[#NCT02226627]/ELANS/Costa RicaUCR::Vicerrectoría de Docencia::Salud::Facultad de Medicina::Escuela de MedicinaUCR::Vicerrectoría de Docencia::Salud::Facultad de Medicina::Escuela de Nutrició

Is it possible to modify the obesogenic environment? - Brazil case

In recent decades, the prevalence of obesity has reached increasingly high rates among children and adolescents worldwide as the result of interactions between obesogenic environments and genetics. In Brazil, a middle-income country, the rates of overweight and obesity reached 18.9% and 8.7%, respectively, in 2015, corresponding to a prevalence of excess weight of 27.6%. Concomitant with these worrying data, the prevalence of insufficient physical activity in adolescents is 66.2% based on objective accelerometer measurements. The Brazilian government has taken concrete actions to contain the advance of obesity and physical inactivity and is taking part in political efforts combined with scientific evidence to develop laws, programs, and guidelines. While access to food outside the home, with the unstoppable intake of sweet beverages, sodium, and fat, is contributing to increased obesity, a lack of physical activity in leisure time or transportation must also be considered. However, while Brazil has been taking actions to address the obesogenic environment, with a view to reduce the prevalence and incidence of obesity and physical inactivity, more efforts are needed to implement these actions and approve measures that are still in progress.UCR::Vicerrectoría de Docencia::Salud::Facultad de Medicina::Escuela de Medicin

Contribution of food groups to energy, grams and nutrients-to-limit: The Latin American Study of Nutrition and Health/ Estudio Latino Americano de Nutrición y Salud (ELANS)

Objective: To quantify the energy, nutrients-to-limit and total gram amount consumed and identify their top food sources consumed by Latin Americans. Design: Data from the Latin American Study of Nutrition and Health (ELANS). Setting: ELANS is a cross-sectional study representative of eight Latin American countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru and Venezuela. Participants: Two 24-h dietary recalls on non-consecutive days were used to estimate usual dietary intake of 9218 participants with ages between 15-65 years. 'What We Eat in America' food classification system developed by United States Department of Agriculture was adapted and used to classify all food items consumed by the ELANS population. Food sources of energy, added sugars, SFA, Na and total gram amount consumed were identified and ranked based on percentage of contribution to intake of total amount. Results: Three-highest ranked food categories of total energy consumed were: rice (10·3%), yeast breads (6·9%), and turnovers and other grain-based items (6·8 %). Highest ranked food sources of total gram amount consumed were fruit drinks (9·6%), other 100% juice (9·3%) and rice (8·3%). Three highest ranked sources for added sugars were other 100% juice (24·1 %), fruit drinks (16·5%), and sugar and honey (12·4%). SFA ranked foods were turnovers and other grain-based (12·6 %), cheese (11·9%), and pizza (10·3%). Three top sources of Na were rice (13·9%), soups (9·1 %) and rice mixed dishes (7·3 %). Conclusion: Identification of top sources of energy and nutrients-to-limit among Latin Americans is critical for designing strategies to help them meet nutrient recommendations within energy needs.Coca Cola Company///Estados UnidosHospital Infantil Sabará///BrazilInternational Life Science Institute//ILSI/ArgentinaUniversidad de Costa Rica//UCR/Costa RicaPontificia Universidad Católica de Chile///ChilePontificia Universidad Javeriana///ColombiaUniversidad Central de Venezuela//UCV/VenezuelaInstituto de Investigación Nutricional de Perú///PerúUCR::Vicerrectoría de Docencia::Salud::Facultad de Medicina::Escuela de Medicin

Food Sources of Shortfall Nutrients among Latin Americans: Results from the Latin American Study of Health and Nutrition (ELANS)

Increased consumption of energy-dense, nutrient-poor foods can lead to inadequate intakes of shortfall nutrients, including vitamin A, D, C, and E, dietary folate, calcium, iron, magnesium, potassium, and fiber. The objective was to examine the prevalence of inadequate intake of shortfall nutrients and identify food sources of shortfall nutrients in eight Latin American countries. Data from ELANS, a multi-country, population-based study of 9218 adolescents and adults were used. Dietary intake was collected through two 24 h Recalls from participants living in urban areas of Argentina, Brazil, Chile, Colombia, Ecuador, Peru, and Venezuela. Foods and beverages were classified using the adapted version of the NHANES “What We Eat in America” system. Nutrients inadequacy was estimated using the Institute of Medicine recommendations and descriptive statistics were calculated. Prevalence of inadequacy was above 50% for most of the nutrients, which the exception of vitamin C with a prevalence of inadequacy of 39%. Milk, cheese, seafoods, breads, and fruit juices/drinks were among the top 5 sources for each of the 10 shortfall nutrients examined. Many food categories were top contributors to more than one dietary component examined. Understanding the nutrient intake and food sources can help inform dietary guidance and intervention approaches.Coca Cola Company///Estados UnidosInternational Life Science Institute//ILSI/ArgentinaUCR::Vicerrectoría de Docencia::Salud::Facultad de Medicina::Escuela de Medicin

Main foods with added sugars and their geographic and sociodemographic variation: Latin American study of nutrition and health (ELANS)

Diversos estudios epidemiológicos y de intervención apuntan a una asociación fuerte y consistente entre la ingesta excesiva de azúcares y el riesgo de desarrollar caries dentales y enfermedades crónicas no transmisibles. El objetivo fue describir los 10 principales alimentos que contribuyen a la ingesta de azúcares añadidos en muestras representativas de poblaciones urbanas de ocho países latinoamericanos, y considerar diferencias por país, sexo, nivel socioeconómico (NSE) y grupo de edad. Se realizó una encuesta transversal multinacional en hogares de Argentina, Brasil, Chile, Colombia, Costa Rica, Ecuador, Perú y Venezuela (N=9218; 15–65 años). La contribución porcentual a la ingesta total del nutriente sirvió para identificar los alimentos aportadores. Los datos se estratificaron por país, sexo, NSE y grupo de edad y se compararon los gramos por día. Excepto en Perú y en el grupo de 50 a 65 años, los refrescos figuraron como el principal contribuyente a la ingesta de azúcares añadidos. Las bebidas caseras y las industrializadas también destacaron. Argentina fue el país con mayor ingesta de azúcares añadidos aportados por bebidas industrializadas, y Chile el país con menor frecuencia de bebidas como fuentes. Entre los 10 contribuyentes, la ingesta de azúcares añadidos fue mayor en el sexo masculino, excepto para sacarosa y pasteles dulces. Mayores ingestas de azúcares provenientes del jugo de fruta natural y sacarosa fueron observadas en el NSE más bajo. Las mayores y menores ingestas en los grupos de edad cambian de acuerdo con la fuente alimentaria. En conclusión, las bebidas azucaradas fueron los principales contribuyentes a la ingesta de azúcares añadidos, y la ingesta varió según la ubicación geográfica y los factores sociodemográficos.This study aimed to describe the top 10 foods that contribute to added sugars intake in representative samples of urban populations in eight Latin American countries, and consider differences by country, sex, socioeconomic level (SEL), and age group. A household-based, multinational, crosssectional survey was conducted in Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela (N=9218; 15–65 years). Contributors to added sugars were identified and listed based on the percentage of contribution to total intake of this nutrient. Data were stratified by country, sex, SEL, and age group, and the grams per day compared. Except in Peru and in the 50 to 65 years age group, soft drinks were the leading contributor to added sugar intake. Homemade beverages together industrialized beverages have been a prominent position on ranking. In general, the highest intake of added sugars by industrialized beverages was from Argentina, and the lowest frequency of beverages as sources of added sugars was observed in Chile. Among the top 10 contributors, male sex had highest added sugar intake, except for sucrose and sweet cakes. Higher intakes of sugars from natural fruit juice and sucrose were observed in the lower SEL. The highest and lowest intakes in the age groups change according to the food source. In conclusion, sugar-sweetened beverages were main contributors to added sugar intake, and the intake vary with geographical location and sociodemographic factors.Coca Cola Company///Estados UnidosHospital Infantil Sabará///BrazilInternational Life Science Institute//ILSI/ArgentinaUniversidad de Costa Rica//UCR/Costa RicaPontificia Universidad Católica de Chile///ChilePontificia Universidad Javeriana///ColombiaUniversidad Central de Venezuela//UCV/VenezuelaUniversidad San Francisco de Quito///EcuadorInstituto de Investigación Nutricional de Perú///PerúFerrero///ItaliaUCR::Vicerrectoría de Docencia::Salud::Facultad de Medicina::Escuela de Medicin

Validation of self-reported diabetes in a representative sample of São Paulo city

ABSTRACT OBJECTIVE To validate the self-reported diabetes mellitus in adults and older adults living in the city of São Paulo, Brazil. METHODS We have used data of 569 subjects (284 adults and 285 older adults), participants of the population-based cross-sectional study Inquérito de Saúde do Município de São Paulo (Health Survey of São Paulo). Fasting glucose ≥ 7.0 mmol/L (126 mg/dL) and/or use of drugs (oral hypoglycemic and/or insulin) defined the diagnosis of diabetes mellitus. We have validated the self-reported diabetes mellitus by calculating the sensitivity, specificity, positive predictive values, and negative predictive values. We have used Poisson regression with robust variance to verify the factors associated with the sensitivity of the self-reported datum. For all analyses, we have considered the sample design of the study. RESULTS The sensitivity of self-reported diabetes mellitus was 63.8% (95%CI 49.2–76.3), specificity was 99.7% (95%CI 99.1–99.9), positive predictive value was 95.5% (95%CI 84.4–98.8), and negative predictive value was 96.9% (95%CI 94.9–98.2). The correct reporting of diabetes mellitus was more prevalent among older adults (PR = 2.0; 95%CI 1.2–3.5) than among adults. CONCLUSIONS The use of the datum of self-reported diabetes mellitus is valid, especially among older adults living in the city of São Paulo. The results highlight the need to track diabetes mellitus in asymptomatic subjects who have one or more risk factors for it, mainly in the adult population of this city