IMPACT OF ADHERENCE TO A HIGH-PROTEIN DIET IN CLINICAL TRIALS: METHODOLOGICAL CONSIDERATIONS IN ELDERLY GROUPS

Background/objectives: several randomized clinical trials (ECRs) showed no consistent responses of dietary treatments to clinical outcomes. It is speculated that it is due to low adherence to dietary guidelines. It is aimed at identifying the proportion of samples that joined the protein-rich diet and the effect of adhesion in different health outcomes in postmenopausal women. Methods: it was performed in 52 women participating in a physical activity program, all with a protein -rich diet for 12 weeks, with nutritional follow -up. The prescribed diet contained 1.3-1.6g/kg/day of protein, minimum intake of 1.2g/kg/day was considered adhesion. Eight 24 -hour memories were performed by participant. Adhesion was also analyzed in the urinary excretion of urea and uric acid. The effect was analyzed in anthropometric and cardiometabolic parameters. The analysis of unilateral variance was used. Results: Despite significant increase in protein intake, only 38.5% reached the desired intake. A significant increase in urea was observed only in the high protein group (1.16 x 2.57, p <0.05). Women who joined the protein -rich diet (n = 20) had significant clinical results in body mass index, plasma cholesterol and urea levels, both with p <0.05. Conclusion: postmenopausal women showed low adherence to the protein-rich diet, according to metabolite analysis and statistics by unilateral variance analysis. Thus, in ECRs it is essential to consider nutrient intake and not just prescription, also highlighting the importance of food and nutritional education actions to stimulate adherence to the proposed

Iron intake: dietary intake and its association with insulin resistance and metabolic syndrome in the era of mandatory fortification

Introdução: A fortificação mandatória de ferro foi implantada no Brasil em 2004 com o intuito de combater a deficiência desse micronutriente. No entanto, alguns estudos indicam que o consumo excessivo de ferro pode estar relacionado ao desenvolvimento de síndrome metabólica, resistência à insulina e alterações do metabolismo lipídico. Objetivos: Avaliar a ingestão de ferro antes e após a implementação da política de fortificação mandatória, investigar a associação da ingestão de ferro heme, não heme e total com a síndrome metabólica e seus componentes, avaliar o papel da ingestão do ferro heme, não heme e total na resistência à insulina mediado pela interleucina-6, malondialdeído e leptina. Metodologia: Os dados foram provenientes de dois estudos transversais de base populacional (ISA-Capital 2003 e 2008), conduzidos em amostra representativa de residentes do município de São Paulo, de ambos os sexos e com idade superior a 12 anos. O consumo alimentar foi avaliado por meio de recordatórios de 24 horas e utilizou-se um questionário estruturado para obter informações socioeconômicas, demográficas e de estilo de vida. Coletou-se amostras de sangue em jejum de 12h para as análises bioquímicas e aferiu-se pressão arterial, peso, estatura e circunferência da cintura. Os analitos avaliados foram glicemia plasmática de jejum, insulina sérica de jejum, triglicerídeos plasmáticos, lipoproteína de alta densidade, malondialdeído, proteína C reativa ultrassensível, interleucina-6 e leptina sérica. As análises estatísticas foram realizadas utilizando os softwares Stata®, versão 13 e Mplus®, versão 7.4, com nível de 7 significância de 0,05. Resultados: A média do consumo de ferro aumentou em todas as faixas etárias no período pós-fortificação. Houve uma redução superior a 90 por cento na prevalência de inadequação dos homens em todas as faixas etárias, no entanto, apesar da substancial redução nas mulheres em idade fértil (63 por cento ), estas ainda possuem alta prevalência de inadequação desse micronutriente (34 por cento ). Maior ingestão de ferro total (OR=3,98; IC 95 por cento =1,2113,12) e não heme (OR= 2,92; IC 95 por cento =1,10-7,72) foram positivamente associadas a hiperglicemia. Houve uma associação positiva entre maior ingestão de ferro heme com síndrome metabólica (OR=2,39; IC 95 por cento =1,105,21) e concentrações elevadas de triglicérides (OR=2,51; IC 95 por cento =1,065,91). A ingestão de ferro heme, não heme e total tiveram um efeito direto e positivamente associado às concentrações de interleucina-6 e negativamente associado às concentrações de malondialdeído. Observou-se um efeito indireto da ingestão do ferro heme, não heme e total na resistência à insulina mediado pela interleucina-6. Conclusão: Este estudo sugere que os diferentes tipos de ferro estão associados a importantes fatores de risco para doenças crônicas não transmissíveis. Assim, o monitoramento da adição de ferro na farinha de trigo e milho é essencial para garantir uma ingestão ferro segura para toda a população.Introduction: The mandatory fortification of foods with iron was initiated in Brazil in 2004 with order to combat this micronutrient deficiency. However, some studies indicate that excessive consumption of iron can be related to the development of metabolic syndrome, insulin resistance and alterations in lipid metabolism. Objectives: To assess the iron intake before and after the implementation of the mandatory fortification policy, to investigate the association of haem, nonhaem iron and total iron intake with metabolic syndrome and its components, and to evaluate the role of haem, nonhaem iron, and total iron intake in insulin resistance mediated by interleukin 6, leptin and malondialdehyde. Methods: Data were drawn from two cross-sectional population based studies (ISA-Capital 2003 and 2008), conducted with a representative sample of residents of São Paulo, of both sexes and aged over 12 years old. Dietary intake was measured by two 24-hour dietary recall. Socioeconomic, demographic and lifestyle data were obtained through a structured questionnaire. Blood samples were collected after a 12-hour fasting for biochemical analysis and blood pressure, weight, height and waist circumference were measured. The analytes analysed were fasting plasma glucose, fasting serum insulin, plasma triglyceride, high-density lipoprotein cholesterol, malondialdehyde, C-reactive protein, interleukin-6 and serum leptin. All analyses were performed with Stata®, version 13 e Mplus®, version 7.4, and a p-value < 0.05 was considered statistically significant. Results: The iron intake mean increased in all the population in the post fortification period. The prevalence of inadequate iron intake decreased by over 90 per cent in men in all 9 analyzed age groups. Although despite the substantial decrease (over 63 per cent ), women in reproductive age remain with a high inadequate intake (34 per cent ). Higher total iron intake (OR=3.98, 95 per cent CI=1.21 13.12) and nonhaem iron intake (OR=2.92, 95 per cent CI=1.107.72) were positively associated with hyperglycaemia. There was a positive association between higher haem iron intake with metabolic syndrome (OR=2.39, 95 per cent CI=1.105.21) with elevated triglyceride levels (OR=2.51, 95 per cent CI=1.065.91). Haem, nonhaem iron and total iron intake had a direct and positive effect on levels of interleukin-6 and negative effect on malondialdehyde levels. There was an indirect effect of haem, nonhaem iron and total iron intake on insulin resistance mediated by interleukin-6. Conclusion: This study suggests that the different types of dietary iron are associated with major risk factors of noncommunicable diseases. Thus, monitoring of iron addition in wheat and maize flour is essential to guarantee a safe iron intake for all the population

Nutritional quality of dietary patterns of children: are there differences inside and outside school?

Objectives: To describe the dietary patterns of children inside and outside school and investigate their associations with sociodemographic factors and nutritional status. Methods: This was a multicenter cross‐sectional study in which children of both sexes, aged 1–6 years, attending private and public daycare centers and preschools in Brazil, were evaluated (n = 2979). Demographic, socioeconomic and dietary data (weighed food records and estimated food records) were collected. Dietary patterns were derived by factor analysis from 36 food groups. Results: Four dietary patterns were identified inside school, and three outside. Inside school, the “traditional” pattern was associated to low income and presented high nutritional quality. The “dual” pattern was associated with low income and with high intake of added sugar and glycemic load. The “snack” pattern was associated with children enrolled at private schools and with high intake of added sugar and glycemic load. The “bread and butter” pattern was associated with high intake of added sugar and trans fat. Outside school, the “traditional” pattern was associated with high intake of saturated fat, trans fats, sodium, and total fiber. The “bread and butter” pattern was associated with high intake of trans fats and glycemic load, whereas the “snack” pattern was associated with overweight, private schools, high income, and high intake of trans fats, sodium, and total fiber. Conclusion: There are differences in the nutritional quality of dietary patterns inside and outside school, and heterogeneity in adherence to these patterns were observed across regions and socioeconomic classes

Nutritional quality of dietary patterns of children: are there differences inside and outside school?

Abstract: Objectives: To describe the dietary patterns of children inside and outside school and investigate their associations with sociodemographic factors and nutritional status. Methods: This was a multicenter cross-sectional study in which children of both sexes, aged 1-6 years, attending private and public daycare centers and preschools in Brazil, were evaluated (n = 2979). Demographic, socioeconomic and dietary data (weighed food records and estimated food records) were collected. Dietary patterns were derived by factor analysis from 36 food groups. Results: Four dietary patterns were identified inside school, and three outside. Inside school, the "traditional" pattern was associated to low income and presented high nutritional quality. The "dual" pattern was associated with low income and with high intake of added sugar and glycemic load. The "snack" pattern was associated with children enrolled at private schools and with high intake of added sugar and glycemic load. The "bread and butter" pattern was associated with high intake of added sugar and trans fat. Outside school, the "traditional" pattern was associated with high intake of saturated fat, trans fats, sodium, and total fiber. The "bread and butter" pattern was associated with high intake of trans fats and glycemic load, whereas the "snack" pattern was associated with overweight, private schools, high income, and high intake of trans fats, sodium, and total fiber. Conclusion: There are differences in the nutritional quality of dietary patterns inside and outside school, and heterogeneity in adherence to these patterns were observed across regions and socioeconomic classes

Influence of Haem, Non-Haem, and Total Iron Intake on Metabolic Syndrome and Its Components: A Population-Based Study

Studies suggest that haem, non-haem iron and total iron intake may be related to non-communicable diseases, especially metabolic syndrome. This study was undertaken to investigate the association of haem, non-haem iron and total iron intake with metabolic syndrome and its components. A cross-sectional population-based survey was performed in 2008, enrolling 591 adults and elderly adults living in São Paulo, Brazil. Dietary intake was measured by two 24 h dietary recalls. Metabolic syndrome was defined as the presence of at least three of the following: hypertension, hyperglycaemia, dyslipidaemia and central obesity. The association between different types of dietary iron and metabolic syndrome was evaluated using multiple logistic regression. After adjustment for potential confounders, a higher haem iron intake was positively associated with metabolic syndrome and with elevated triglyceride levels. A higher total iron intake was positively associated with hyperglycaemia. Non-haem iron intake was positively associated with hyperglycaemia in the fourth quintile. In conclusion, this study suggests that the different types of dietary iron are associated with metabolic syndrome, elevated triglyceride levels and hyperglycaemia. In addition, it emphasises the importance of investigating the roles of dietary iron in health outcomes, since its consumption may have different impacts on health

The traditional lunch pattern is inversely correlated with body mass index in a population-based study in Brazil

Abstract\ud \ud Background\ud The association of obesity and dietary patterns has been well documented in scientific literature; however, information on the impact of meal patterns on obesity is scarce. The objective of this study was to investigate the association of adherence to lunch patterns and body mass index (BMI) in a representative sample of individuals aged 20 years or older in Sao Paulo.\ud \ud \ud Methods\ud Data for 933 participants were retrieved from the Health Survey of São Paulo (ISA-Capital 2008), a cross-sectional population-based survey. The usual dietary intake of individuals with at least one 24-h recall was estimated by the Multiple Source Method. The definition of lunch was self-reported by the participant. Five lunch patterns were derived from twenty-two food groups by exploratory factor analysis: Traditional, Western, Sweetened juice, Salad, and Meats. To estimate the effect of lunch patterns on BMI, we used a generalized linear model with link identity and inverse Gaussian distribution. Analyses were adjusted by age, gender, household income per capita, physical activity levels, smoking status, alcohol consumption, total energy intake, and misreporting status.\ud \ud \ud Results\ud The greater adherence to the traditional pattern at the lunch meal was associated with lower BMI, only in insufficiently active individuals (ß = −0.78; 95% CI -1.57; −0.02).\ud \ud \ud Conclusions\ud The traditional Brazilian lunch pattern might protect the insufficiently active individuals against obesity.This research was supported by the Health Department of the City of Sao\ud Paulo, São Paulo Research Foundation (FAPESP process no. no 2009/15831–\ud 0), and the National Council for Scientific and Technological Development\ud (CNPq process no. proceeding no 473100/2009–6). ROS received a graduate\ud student stipend from the Coordination for improvement of Higher Education\ud Table 2 Regression coefficients for the association of the\ud dietary patterns with body mass index in the study population\ud Lunch Patterns\ud Crude model β 95% CI\ud Traditional Pattern (ref. 1st tertile)\ud 2nd tertile −0.27 −1.01; 0.48\ud 3rd tertile −1.07 −1.80;-0.34\ud Western Pattern (ref. 1st tertile)\ud 2nd tertile 0.01 −0.74; 0.75\ud 3rd tertile −0.38 −1.11; 0.35\ud Sweetened juice Pattern (ref. 1st tertile)\ud 2nd tertile 0.22 −0.53; 0.97\ud 3rd tertile −0.56 −1.29; 0.17\ud Salads Pattern (ref. 1st tertile)\ud 2nd tertile 0.78 0.04; 1.52\ud 3rd tertile 0.46 −0.27; 1.19\ud Meats Pattern (ref. 1st tertile)\ud 2nd tertile 0.22 −0.52; 0.96\ud 3rd tertile −0.16 −0.90; 0.56\ud Model adjusteda β 95% CI\ud Traditional Insufficiently active Pattern (ref. 1st tertile)\ud 2nd tertile −0.50 −1.23, 0.24\ud 3rd tertile −0.78 −1.57, −0.02\ud Sufficiently active 2nd tertile 1.99 −0.99, 5.05\ud 3rd tertile 0.84 −2.09, 3.82\ud Western Pattern (ref. 1st tertile)\ud 2nd tertile −0.07 −0.77, 0.63\ud 3rd tertile 0.14 −0.58, 0.85\ud Sweetened juice Pattern (ref. 1st tertile)\ud 2nd tertile 0.17 −0.54, 0.87\ud 3rd tertile −0.29 −0.99, 0,40\ud Salads Pattern (ref. 1st tertile)\ud 2nd tertile 0.37 −0.33, 1.07\ud 3rd tertile 0.06 −0.62, 0.75\ud Meats Pattern (ref. 1st tertile)\ud 2nd tertile 0.01 −0.68, 0.70\ud 3rd tertile −0.29 −0.98, 0.39\ud a\ud Adjusted for age, sex, household per capita income, physical activity levels,\ud smoking status, alcohol consumption, total energy intake, misreporting status\ud and lunch patterns\ud ISA-Capital 2008. Sao Paulo. Brazil\ud de Oliveira Santos et al. BMC Public Health (2018) 18:33 Page 5 of 7\ud Personnel (CAPES). DASV and AAMM received a graduate student stipend\ud from the FAPESP

The traditional lunch pattern is inversely correlated with body mass index in a population-based study in Brazil

Abstract Background The association of obesity and dietary patterns has been well documented in scientific literature; however, information on the impact of meal patterns on obesity is scarce. The objective of this study was to investigate the association of adherence to lunch patterns and body mass index (BMI) in a representative sample of individuals aged 20 years or older in Sao Paulo. Methods Data for 933 participants were retrieved from the Health Survey of São Paulo (ISA-Capital 2008), a cross-sectional population-based survey. The usual dietary intake of individuals with at least one 24-h recall was estimated by the Multiple Source Method. The definition of lunch was self-reported by the participant. Five lunch patterns were derived from twenty-two food groups by exploratory factor analysis: Traditional, Western, Sweetened juice, Salad, and Meats. To estimate the effect of lunch patterns on BMI, we used a generalized linear model with link identity and inverse Gaussian distribution. Analyses were adjusted by age, gender, household income per capita, physical activity levels, smoking status, alcohol consumption, total energy intake, and misreporting status. Results The greater adherence to the traditional pattern at the lunch meal was associated with lower BMI, only in insufficiently active individuals (ß = −0.78; 95% CI -1.57; −0.02). Conclusions The traditional Brazilian lunch pattern might protect the insufficiently active individuals against obesity