Reproducibilidad y validación relativa de un cuestionario de frecuencia de consumo de alimentos semicuantitativo en población adulta de Rosario, Argentina

Introduction: Dietary assessment of nutrients and food groups by food frequency questionnaire needs to be validated in each population. The objective of this cross-sectional study was to evaluate the reproducibility and relative validity of a semi-quantitative food frequency questionnaire among adults of Rosario, Argentina.Material and Methods: Two food frequency questionnaires and four 24-hour dietary recalls were applied in a sample of 88 adults. Reproducibility of food frequency questionnaire was estimated by correlation coefficients, and validity was assessed comparing the second food frequency questionnaire and the average of the 24-hour dietary recalls using cross-classification and Bland–Altman analyses.Results: Pearson and intraclass correlation coefficients showed higher correlation for food groups than for energy and nutrients. More than 65% of the subjects were classified into the same quintile or into the adjacent quintile by both food frequency questionnaires. Bland–Altman plots showed reasonably acceptable agreement between the second food frequency questionnaire and 24-hour dietary recalls, especially for the main Argentinian foods groups (meat, cereal, dairy products, vegetables and fruits).Conclusions: Overall, food frequency questionnaire showed acceptable reproducibility and relative validity for assessment main food groups and nutrient intakes for adult population in Rosario.Introducción: La evaluación del consumo de nutrientes y grupos de alimentos mediante cuestionarios de frecuencia de consumo requiere ser validada en cada población. El objetivo de este estudio transversal fue evaluar la reproductibilidad y la validez relativa de un cuestionario semicuantitativo de frecuencia de consumo en población adulta de Rosario, Argentina.Material y Métodos: Dos cuestionarios de frecuencia de consumo y cuatro recordatorios de 24 horas fueron aplicados en una muestra de 88 adultos. La reproductibilidad del cuestionario de frecuencia de consumo fue estimada mediante el coeficiente de correlación y la validez fue evaluada comparando el segundo cuestionario de frecuencia de consumo y el promedio de los recordatorios de 24 horas mediante clasificación cruzada y análisis de Bland–Altman.Resultados: Los coeficientes de Pearson e intraclase mostraron mayor correlación para los grupos de alimentos que para energía y nutrientes. Más del 65% de los individuos fue clasificado en el mismo quintil o en el adyacente por ambos cuestionarios de frecuencia de consumo. El gráfico de Bland–Altman mostró una razonable concordancia entre el segundo cuestionario de frecuencia de consumo y recordatorios de 24 horas, especialmente para los principales grupos de alimentos de la dieta Argentina (carne, cereales, lácteos, vegetales y frutas).Conclusiones: En general, el cuestionario de frecuencia de consumo presentó una reproductibilidad aceptable y validez relativa para evaluar los principales grupos de alimentos y la ingesta de nutrientes en la población adulta de Rosario

Consumo de vitaminas e minerais por atletas de futebol de campo

Introdução e objetivo: O futebol é um esporte que requer treinamentos contínuos e exige uma alimentação balanceada em macro e micronutrientes. As vitaminas e os minerais são de extrema importância para a saúde dos atletas, visto que, fornecem energia, transportam oxigênio, dão suporte ao sistema imunológico e formam a massa óssea do atleta. Este estudo objetiva avaliar o consumo de vitaminas e minerais por atletas de futebol de campo. Materiais e métodos: Estudo transversal descritivo, oriundo de uma análise de dados secundários provenientes de um estudo experimental com jogadores da categoria de base de um time de futebol de campo. Discussão: Estudos mostram que o planejamento alimentar proporciona à oferta adequada de nutrientes, melhora de desempenho físico e previne fadiga e auxilia na manutenção do peso, medidas e gordura corporal. Resultados: A maioria da amostra (83,3%) apresentou ingestão calórica insuficiente, o consumo de carboidratos era insuficiente em 91,7% dos atletas e estava acima do recomendado em proteínas (91,7%) e lipídios (66,7%). O consumo de vitaminas B1, B2, B3 e B6 estava adequado e das vitaminas A, C e D estava inadequado. Quanto à adequação dos minerais, estava inadequado em cálcio (54,2%), potássio (70,8%) e magnésio (83,3%). Conclusão: É de extrema importância que os atletas tenham um acompanhamento nutricional para terem uma alimentação adequada

Consumo de alimentos ultraprocessados por crianças de uma Coorte de Nascimentos de Pelotas

OBJETIVO Avaliar o consumo habitual de alimentos ultraprocessados aos 24 meses de idade por crianças pertencentes à Coorte de Nascimentos de Pelotas de 2015 e os principais fatores demográficos, socioeconômicos e comportamentais relacionados ao consumo desses produtos. MÉTODOS Coorte de base populacional na cidade de Pelotas-RS, onde foram avaliadas 4.275 crianças ao nascimento, das quais 95,4% foram acompanhadas até os 24 meses. O consumo alimentar foi avaliado por meio de um questionário de consumo habitual de alimentos ultraprocessados, coletando informações sobre sexo, renda familiar, cor da pele, escolaridade e idade da mãe, frequentar creche, ter irmãos, status de amamentação e obesidade. O desfecho foi a somatória de alimentos ultraprocessados consumidos habitualmente pela criança. Análise multivariada por regressão de Poisson foi utilizada para estimar a associação entre consumo habitual de alimentos ultraprocessados e as variáveis de exposição. RESULTADOS O número médio de alimentos ultraprocessados consumidos habitualmente foi de 4,8 (DP = 2,3). O consumo habitual de alimentos ultraprocessados foi associado positivamente à cor da pele preta e ter irmãos e negativamente associado com renda familiar, escolaridade e idade materna. CONCLUSÕES A média de consumo habitual de alimentos ultraprocessados por crianças pertencentes à Coorte de Nascimentos de 2015 da cidade de Pelotas é elevada, o que pode causar um efeito negativo na dieta das crianças. O risco de consumo desses alimentos foi maior entre crianças de famílias de menor posição socioeconômica, filhas de mães de baixa escolaridade, de cor da pele preta, mais jovens e de baixa renda.OBJECTIVE Assessing the regular consumption of ultra-processed foods by children at 24 months of age from the 2015 Pelotas Birth Cohort and the main demographic, socioeconomic, and behavioral factors related to the consumption of these products. METHODS Population-based cohort in the city of Pelotas, RS, where 4,275 children were assessed at birth and 95.4% of them were followed up until 24 months of age. Food consumption was assessed by a questionnaire on regular consumption of ultra-processed foods, which collected information regarding sex, household income, maternal skin color, schooling level, and age, the child attending day care and having siblings, breastfeeding status, and obesity. The outcome was the sum of ultra-processed foods regularly consumed by a child. A multivariate Poisson regression analysis was used to calculate the association between the regular consumption of ultra-processed foods and exposure variables. RESULTS The mean number of ultra-processed foods consumed was 4.8 (SD = 2.3). The regular consumption of ultra-processed foods was positively associated with black skin color and having siblings, and negatively associated with household income and maternal schooling level and age. CONCLUSION The mean regular consumption of ultra-processed foods by children from the 2015 Pelotas Birth Cohort is high, which can negatively affect the children’s diet. The risk of consuming this kind of food was higher among children from families of lower socioeconomic status, whose mothers present lower education level, black skin color, and younger age

Anemia among indigenous women in Brazil:findings from the First National Survey of Indigenous People's Health and Nutrition

BACKGROUND: Anemia is recognized as a major public health problem that disproportionately affects vulnerable populations. Indigenous women of reproductive age in Brazil are thought to be at high risk, but lack of nationwide data limits knowledge about the burden of disease and its main determinants. This study aimed to assess the prevalence of anemia and associated factors in this population using data from The First National Survey of Indigenous People’s Health and Nutrition in Brazil. METHODS: Data were collected from Indigenous women between 15 and 49 years old based on a nationwide sample of villages. The outcomes of interest were hemoglobin levels (g/dL) and anemia (< 12 g/dL for nonpregnant and < 11 g/dL for pregnant women). Multilevel models were used to explore associations with contextual (village) and individual (household/woman) level variables. RESULTS: Based on data for 6692 Indigenous women, the nationwide mean hemoglobin level was 12.39 g/dL (95 % CI: 12.29–12.50). Anemia prevalence was high (33.0 %; 95 % CI: 30.40–35.61 %) and showed pronounced regional disparities. No village-level characteristics were associated with anemia or hemoglobin levels in the multilevel model. Even after controlling for upper level variables, socioeconomic status, parity, body mass index, and having been treated for malaria were associated with anemia and hemoglobin levels. CONCLUSION: The prevalence of anemia in Brazilian Indigenous women was 12 % greater than the national estimates for women of reproductive age. Anemia prevalence and mean hemoglobin levels among Indigenous women appear to be partly explained by some previously recognized risk factors, such as socioeconomic status, body mass index, and malaria; however, part of the variability in these outcomes remains unexplained. Knowledge of health status and its potential determinants is essential to guide public policies aimed at controlling anemia burden in Indigenous communities

Growth across life course and cardiovascular risk markers in 18-year-old adolescents:the 1993 Pelotas birth cohort

ObjectiveTo evaluate the association between growth trajectories from birth to adolescence and cardiovascular risk marker levels at age 18 years in a population-based cohort. In order to disentangle the effect of weight gain from that of height gain, growth was analysed using conditional weight relative to linear growth (CWh) and conditional length/height (CH).DesignProspective study.Setting1993 Pelotas birth cohort, Southern Brazil.ParticipantsIndividuals who have been followed up from birth to adolescence (at birth, 1, 4, 11, 15 and 18 years).Primary outcome measuresC-reactive protein (CRP), total cholesterol (TC), LDL cholesterol (LDL-C), HDL-cholesterol (HDL-C), triglycerides (TGL), systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI) and waist circumference (WC).ResultsIn both sexes, greater CWh at 1 year was positively associated with BMI and WC, whereas greater CWh at most age periods in childhood and adolescence predicted higher CRP, TC, LDL-C, TGL, SBP, DBP, BMI and WC levels, as well as lower HDL-C level. Higher CH during infancy and childhood was positively related with SBP in boys and girls, and with BMI and WC only in boys.ConclusionOur study shows that rapid weight gain from 1 year onwards is positively associated with several markers of cardiovascular risk at 18 years. Overall, our results for the first year of life add evidence to the ‘first 1000 days initiative’ suggesting that prevention of excessive weight gain in childhood might be important in reducing subsequent cardiovascular risk.</jats:sec

Intimate partner violence victimisation and its association with maternal parenting (the 2015 Pelotas [Brazil] Birth Cohort): a prospective cohort study

Intimate partner violence (IPV) is highly prevalent in low-income and middle-income countries and has been a major obstacle towards reaching global health targets for women and children. We aimed to investigate cross-sectional and longitudinal associations between IPV victimisation and maternal parenting practices of young children in a population-based birth cohort study in Brazil. The 2015 Pelotas Birth Cohort is an ongoing, prospective cohort, including all hospital births occurring between Jan 1 and Dec 31, 2015, in the city of Pelotas, Brazil. When children were aged 4 years, mothers reported on emotional, physical, and sexual IPV victimisation in the past 12 months. Parenting outcomes were assessed through filming the mother and child in interactive tasks at age 4 years and maternal interviews at ages 4 years and 6-7 years. Interactive tasks were filmed at the Centre for Epidemiological Research facilities. Directly observed outcomes included negative (eg, coercive) and positive (eg, sensitivity and reciprocity) parenting interactions independently coded by a team of psychologists. Self-reported parenting was measured using the subscales on quality of parent-child relationship, positive encouragement, parental consistency, and coercive behaviour of the Parenting and Family Adjustment Scales questionnaire. Unadjusted and adjusted linear regression analyses were performed to assess the associations. Of the 4275 livebirths enrolled in the cohort, 3730 mother-child dyads were included in our analytical sample at age 4 years and 3292 at age 6-7 years. After adjusting for all potential confounders, emotional IPV and physical or sexual IPV were associated with the following self-reported parenting outcomes: poor parent-child relationship quality (emotional IPV: p=0·011), lower parental consistency (emotional IPV: p<0·001, physical or sexual IPV: p=0·0053), and more coercive behaviour (emotional IPV: p<0·001, physical or sexual IPV: p=0·0071) at age 4 years. Associations were not observed for self-reported positive encouragement and filmed parenting outcomes in fully adjusted models. Longitudinally, IPV at age 4 years predicted similar outcomes when children were aged 6-7 years. In this large cohort study, maternal IPV victimisation was consistently associated with poorer parent-child relationship, decreased parental consistency, and increased harsh parenting reported by mothers of young children. As well as initiatives to prevent IPV, parenting interventions focused on supporting the capacity of caregivers to provide nurturing care delivered at key stages early in the life course are crucial. Wellcome Trust. For the Portuguese translation of the abstract see Supplementary Materials section

Parent-Related Normative Perceptions of Adolescents and Later Weight Control Behavior: Longitudinal Analysis of Cohort Data From Brazil

Purpose Body image-related norms can be imposed by parents and can shape adolescents' body satisfaction in consequential ways, yet evidence on long-term effects is scarce. Longitudinal data from a country with strong body image focus provided a unique opportunity to investigate long-term influences of normative parent-related perceptions. Methods Multinomial logistic regression was used on data from a 1993 birth cohort in Brazil to investigate the association of normal-body mass index (BMI) adolescents' perception of their parent's opinion of their weight at age 11 years with their weight control attempts at 18 years, testing a mediating role for body dissatisfaction at age 15 years. All models controlled for body dissatisfaction at age 11 years and BMI change between ages 11 and 15 years. Results A total of 1150 boys and 1336 girls were included. Girls were more likely than boys to diet without nutritionist advice to lose weight (51.5% vs. 34.3% among boys) and use medication to gain weight (12.7% vs. 4.2%). Normal-BMI adolescents who reported at age 11 years that their parents thought they were thin had higher odds of feeling thinner than ideal at age 15 years (odds ratio 2.8, 95% confidence interval 1.8-3.2; and odds ratio 2.0, 95% confidence interval 1.5-2.7) among boys and girls, respectively). Feeling thinner than ideal at age 15 years was associated among girls with higher odds of weight gain attempts at age 18 years. Similar patterns appeared among girls reporting that their parents thought they were fat at age 11 years, feeling fatter than ideal at age 15 years and having higher odds of weight loss attempts at age 18 years. Body dissatisfaction was a statistically significant mediator among girls but not boys. Conclusions A long-term influence of parent-related perceptions via a likely trajectory of body dissatisfaction is evident among girls

Epidemiology of glycated hemoglobin (HbA1c) in two birth cohorts - Pelotas/RS

Glycated haemoglobin (HbA1c) is the best index for long-term glucose control in diabetic patients and a screening tool for detecting diabetes in general population. The HbA1c measurement offers some advantages compared with other glycemic indicators. It can be performed at any time of the day, irrespective of fasting or feeding, and it is relatively cheap. In epidemiological studies, HbA1c has been found to be associated with the incidence of diabetes and cardiovascular diseases (CVD), and all-cause mortality in populations free of disease. Therefore, HbA1c is used to examine the disease risk associated to hyperglycaemia in healthy populations. This thesis aimed to describe the epidemiology of HbA1c (distribution and associated factors) and to evaluate the association of growth patterns with cardiometabolic risk markers in adolescents and young adults. A better understanding of the these relations may help to identify groups of the population with increased risk of cardiometabolic diseases. The thesis includes three papers. In the first paper, we systematically reviewed literature assessing the relationship between growth (change in weight, height or BMI) during infancy, childhood and adolescence and indicators of glucose and insulin metabolism in adulthood (fasting glycemia, 2 hours glycemia after an Oral Glucose Tolerance Test, hyperglycemia, HOMA-IR). Some inconsistencies in growth definitions and age intervals were identified. The most consistent evidence was documented for rapid weight or body mass index (BMI) gain from childhood onwards and a worse glucose and insulin metabolism profile at adult age. In the second paper, we described the distribution of HbA1c levels in 18 and 30 years old individuals according to early-life and contemporary factors in the 1993 and 1982 Pelotas Birth Cohorts. The distribution of the HbA1c was approximately normal. HbA1c mean levels were significantly higher in individuals self-reported as black/brown skin color compared to those self-reported as white in both cohorts. Parental history of diabetes was associated with higher HbA1c mean in adults, while stunting at one year old presented an inverse relation with the outcome in adolescents. No other early and contemporary factors were associated with HbA1c levels in adults or adolescents. In the third paper, we evaluated the effect of growth trajectories (linear growth and relative weight gain) from birth to adolescence on cardiometabolic risk markers levels at age 18 years in the 1993 Pelotas Birth Cohort. The outcomes were random glucose, HbA1c, Creactive protein, total cholesterol, LDL-C, HDL-C, triglycerides, systolic and diastolic blood pressure, BMI and waist circumference. Our study showed that rapid weight gain from childhood onwards is positively associated with several markers of cardiometabolic risk in adolescents. Evidence on linear growth needs further analyses. Overall, our results suggest that prevention of excessive weight gain after the two first postnatal years might be important in reducing cardiometabolic risk later in life.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPESA hemoglobina glicada (HbA1c) é o melhor marcador de controle glicêmico em longo prazo em pacientes diabéticos e uma importante ferramenta na triagem e diagnóstico de diabetes na população em geral. O teste de HbA1c oferece algumas vantagens em comparação com outros indicadores glicêmicos: pode ser realizado a qualquer hora do dia, independentemente do tempo de jejum, e, é relativamente barato. Em estudos epidemiológicos, a HbA1c foi associada com a incidência de diabetes e doenças cardiovasculares (CVD) e com mortalidade por todas as causas em populações livres de doença. Portanto, a HbA1c pode ser utilizada para examinar o risco de doença associado à hiperglicemia em populações saudáveis. Esta tese teve por objetivo descrever a epidemiologia da HbA1c (distribuição e fatores associados) e avaliar a associação de padrões de crescimento com a HbA1c e outros marcadores de risco cardiometabólico em adolescentes e adultos jovens. Uma melhor compreensão dessas relações pode ajudar a identificar grupos da população com maior risco de doenças cardiometabólicas. A tese inclui três artigos. No primeiro, realizamos uma revisão sistemática da literatura que avalia a relação entre crescimento (mudanças de peso, altura ou índice de massa corporal (IMC) durante a infância, adolescência e indicadores de metabolismo glicêmico e da insulina na idade adulta (glicemia de jejum, glicemia de duas horas após o teste de tolerância oral à glicose, hiperglicemia, HOMA-IR). Foram identificadas algumas inconsistências nas definições de crescimento e nos intervalos de idade avaliados. A evidência mais consistente foi a relação entre ganho acelerado de peso ou IMC depois dos dois anos de vida e alterações no metabolismo da glicemia e de insulina na idade adulta. No segundo artigo, descrevemos a distribuição dos níveis de HbA1c em indivíduos em adolescentes e adultos (18 e 30 anos, respectivamente) participantes das coortes de nascimentos de Pelotas de 1993 e 1982, de acordo com fatores precoces e contemporâneos. A distribuição da HbA1c foi aproximadamente normal em ambas as coortes. Os níveis médios de HbA1c foram mais elevados nos indivíduos com cor de pele preta/morena em comparação com aqueles de pele branca em ambas as coortes. A história familiar de diabetes esteve associada com uma maior média de HbA1c em adultos, enquanto o baixo comprimento para idade no primeiro ano de vida apresentou uma relação inversa com o desfecho em adolescentes. Nenhum outro fator precoce e contemporâneo foi associado aos níveis de HbA1c em adultos ou adolescentes. No terceiro artigo, avaliamos a associação entre padrões de crescimento (crescimento linear e ganho de peso relativo) desde o nascimento até a adolescência e marcadores de risco cardiometabólico aos 18 anos, na Coorte de Nascimento de Pelotas de 1993. Os desfechos avaliados foram: glicemia ao acaso, HbA1c, proteína C reativa, colesterol total, LDL-C, HDL-C, triglicerídeos, pressão arterial sistólica e diastólica, IMC e circunferência da cintura. O estudo mostrou que o ganho de peso acelerado, especialmente depois dos dois primeiros anos de vida, está positivamente associado a vários marcadores de risco cardiometabólico em adolescentes. Mais estudos são necessários para esclarecer a evidência sobre crescimento linear e fatores cardiometabólicos. Em geral, os nossos resultados sugerem que a prevenção do ganho de peso excessivo após os dois primeiros anos pode ser importante na redução do risco cardiometabólico na vida adulta