Breakfast eating among Brazilian adolescents: Analysis of the National Dietary Survey 2008-2009

ABSTRACT Objective: To characterize breakfast eating among Brazilian adolescents. Methods: Food intake was estimated based on a 1-day food record of adolescents aged 10-19 years, according to the first National Diet Survey (2008-2009). Breakfast was considered as the first meal of the day eaten between 4 and 11 am. Results: Ninety-three percent of adolescents reported eating breakfast. This meal contributed to 17.7% of the daily energy intake. The most commonly consumed food groups were: coffee and tea, breads, butter/margarine, milk, cakes and cookies, packaged snacks, corn-based dishes, cheese, processed meats, and fruit juice. In the Northern region there was a higher frequency of coffee and tea and roots and tubers intake and lower frequency of milk intake than that in the other regions in the country. In the Northeastern region, the intake of corn and eggs was high; in the Southern region, there was high intake of processed meats and fruits. Adolescents from families in the first income quartile reported higher intake of coffee and tea, packaged snacks, corn, and roots and tubers intake, and lower intake of milk and dairy products. Adolescents from families in the highest income quartile reported higher intake of milk, fruit juice, cheese, and sugar-added beverages. Conclusion: In Brazil, the contribution of breakfast to daily energy intake among adolescents is low. The nutritional quality of breakfast improved with increased income. The three most frequently consumed items were coffee and tea, breads, and butter/margarine.

Impact of Bolsa Família Program on the nutritional status of children and adolescents from two Brazilian regions

ABSTRACT Objective: To assess and compare the impact of the Bolsa Família Program (Family Allowance) on the nutritional status of children and adolescents from the Brazilian Northeastern and Southeastern regions. Methods: The study used data from a database derived from a subsample of the Family Budget Survey conducted from 2008 to 2009. The ratios of underweight, stunted, and overweight children were calculated. Impact measurement analysis was preceded by propensity score matching, which matches beneficiary and non-beneficiary families in relation to a set of socioeconomic features. The nearest-neighbor matching algorithm estimated the program impact. Results: The ratio of underweight children and adolescents was, on average, 1.1% smaller in the beneficiary families than in the non-beneficiary families in the Northeastern region. As for the Southeastern region, the ratio of overweight children and adolescents was, on average, 4.2% smaller in the beneficiary families. The program did not affect stunting in either region. Conclusion: The results showed the positive impact and good focus of the program. Thus, once linked to structural actions, the program may help to improve the nutritional status and quality of life of its beneficiaries.

Evaluation of growth and nutritional status in children and adolescents with extrahepatic portal vein obstruction and portal hypertension

ABSTRACT Objective: This study aims to evaluate dietary intake, nutritional status, and growth rate in children and adolescents with extrahepatic portal vein obstruction and portal hypertension. Methods: Outpatients aged 1-18 years, diagnosed with extrahepatic portal vein obstruction and portal hypertension, who had no associated diseases, and who had not been subjected to a venous shunt were included in this study. Two evaluations were carried out in this study: an initial (evaluation 1) and a final evaluation (evaluation 2), with a three-month minimum interval between them. In each evaluation, dietary intake was analyzed comparing the results with recommended energy intake using the Harris & Benedict equation and participants’ anthropometric data, such as weight, height, mid-arm muscle circumference, weight-for-age, height-for-age, and body mass index-for-age, based on the World Health Organization 2006 standards. Results: A total of 22 patients participated in this study. There was a significant improvement in weight, height, body mass index, and mid-arm muscle circumference measurements (p<0.001; p<0.001; p<0.017; p=0.0018 respectively) and in the relationship between dietary intake and energy recommended energy intake, according to the Harris & Benedict equation (p=0.0001) from the first and second evaluation. Conclusion: Extrahepatic portal vein obstruction and portal hypertension were not shown to be factors predisposing to malnourishment.

Body composition and metabolic profile in adults with vitamin D deficiency

ABSTRACT Objective: To investigate the body composition and metabolic profile in individuals in terms of different concentrations of serum vitamin D, ranging from deficiency to sufficiency. Methods: A cross-sectional study of 106 adults of both genders, who were divided into three groups according to vitamin D levels: deficiency: <20ng/mL; insufficiency: 20-29.9ng/mL; and sufficiency: 30-100ng/mL. Anthropometric evaluation included weight, height, and body circumferences. Fat mass and lean mass were assessed using the Tetrapolar bioelectrical impedance method. Clinical and biochemical evaluations were also carried out. Insulin resistance was estimated using the Homeostasis Model Assessment Insulin index. Results: The analysis showed that the main alterations in individuals in the vitamin D deficiency group were higher triglycerides, very low density lipoprotein - cholesterol, fasting blood glucose, insulin, glycated hemoglobin, body mass index, body fat percentage, lean mass percentage, waist circumference, and Homeostasis Model Assessment Insulin than those of the vitamin D sufficient group (p<0.05). Conclusion: It was found that vitamin D deficiency causes important body composition and metabolic changes, which may lead to diseases such as diabetes Mellitus and metabolic syndrome.

Perinatal serotonergic activity: A decisive factor in the control of food intake

ABSTRACT The serotoninergic system controls key events related to proper nervous system development. The neurotransmitter serotonin and the serotonin transporter are critical for this control. Availability of these components is minutely regulated during the development period, and the environment may affect their action on the nervous system. Environmental factors such as undernutrition and selective serotonin reuptake inhibitors may increase the availability of serotonin in the synaptic cleft and change its anorectic action. The physiological responses promoted by serotonin on intake control decrease when requested by acute stimuli or stress, demonstrating that animals or individuals develop adaptations in response to the environmental insults they experience during the development period. Diseases, such as anxiety and obesity, appear to be associated with the body’s response to stress or stimulus, and require greater serotonergic system action. These findings demonstrate the importance of the level of serotonin in the perinatal period to the development of molecular and morphological aspects of food intake control, and its decisive role in understanding the possible environmental factors that cause diseases in adulthood.

Insufficient intake of alpha-linolenic fatty acid (18:3n-3) during pregnancy and associated factors

ABSTRACT Objective: To analyze alpha-linolenic fatty acid intake in two cohorts of pregnant women, and to identify factors associated with alpha-linolenic acid intake. Methods: This is a cohort study involving pregnant women with low obstetric risk (N=353) in public health system from a municipality of São Paulo state, Brazil. In each trimester, two 24-hour food recalls were collected. Descriptive analyses of dietary lipid profiles were performed, followed by a multiple comparison test. According to the trimester of pregnancy, differences were assessed using the mean difference test. To evaluate the adequacy of linoleic fatty acid and alpha-linolenic acid intake, the adequate intake test was used. The association between alpha-linolenic acid intake adequacy and maternal characteristics was investigated using a binary logistic regression model. Results: Total lipids intake and the percentage contribution to dietary energy met recommended levels. One-third of the diets demonstrated a lower than daily recommended intake of alpha-linolenic acid. Overweight pregnant women were twice as likely to have inadequate alpha-linolenic acid intake. Pregnant women from a more disadvantaged socioeconomic situation had greater risks of inadequate intake. Conclusion: Over-intake of lipids is not problematic, but quality is an issue, with one third of the pregnant women and their fetuses exposed to adverse effects due to low intake of omega-3 fatty acids, indicating important nutritional vulnerability in this population.

Reception of nutrition information by adult and older adult users of Primary Healthcare: Occurrence, associated factors, and sources of information

ABSTRACT Objective: To investigate reception of nutrition information (outcome), associated factors, and types of sources. Methods: This cross-sectional study, conducted in 2013, included 1,246 adult and older adult users of the Primary Healthcare network of Pelotas, Rio Grande do Sul, Brazil. The sample was characterized by reception of nutrition information, its sources, and demographic, socioeconomic, health, knowledge, and life habit variables. Prevalence ratios and their respective 95% confidence intervals investigated associations between reception of nutrition information and independent variables. Results: More than one-third of the sample (37.6%) received nutrition information (95%CI=34.9-40.3). Older adults, individuals with positive self-perceived diet, those who received health information, and those who were physically active were more likely to receive nutrition information, and normal weight individuals were less likely. The outcome differed by income strata, being highest in the highest quintile. There was a linear trend for education level and for following the Ten Steps to Healthy Eating: the outcome was more likely in individuals with at least higher education and those who followed at least four steps. The most cited sources of nutrition information were television shows (56.2%), other (46.2%), physician (41.2%), Internet (25.1%), and family members (20.9%), which did not differ by sex. Conclusion: Primary healthcare users received little nutrition information, and television could be a useful tool for the institutions responsible for the sector to disseminate the official nutritional recommendations.

Association between overweight and consumption of ultra-processed food and sugar-sweetened beverages among vegetarians

ABSTRACT Objective: To assess the consumption of ultra-processed food and sugar-sweetened beverages and to identify the association of this consumption with overweight among vegetarians. Methods: A cross-sectional study with a convenience sampling method was conducted. Data were collected using an online questionnaire from 8/24/2015 to 10/8/2015. Subjects were male and female vegetarians aged >16 years. Using a food frequency questionnaire, we assessed the weekly consumption of ultra-processed food and sugar-sweetened beverages and described the frequency of daily consumption overall and according to type of vegetarianism. The association between overweight and excessive daily intake of ultra-processed food was analyzed by multiple logistic regression (OR [95CI%]). Results: Information was retrieved from 503 individuals (29.8±8.5 years old); 83.7% were women. The most frequent types of vegetarianism in our sample were ovo-lacto (45.5%) and vegan (41.7%), and the median time of vegetarianism was 5.3 years. The consumption of sugar-sweetened beverages (≥2x/day) and ultra-processed food (≥3x/day) was 21.0% and 16.0%, respectively, and regarding the different vegetarianism types, vegans showed the lowest frequency of excessive daily sugar-sweetened beverages and ultra-processed food consumption. In the multivariable analysis, consumption of ultra-processed food ≥3x/day (2.33 [1.36-4.03]), male sex (1.73 [1.01-2.96]), age ≥35 years (2.03 [1.23-3.36]) and not preparing one’s food (1.67 [0.95-2.94]) were independently associated with overweight. Conclusion: Although vegetarianism is frequently associated with a healthier diet and, consequently, prevention of poor health outcomes, this study found that the excessive consumption of sugar-sweetened beverages and ultra-processed food was associated with overweight.

Comparison of the effects of continuous versus intermittent enteral feeding on plasma leptin and ghrelin levels in Intensive Care Units

ABSTRACT Objective: The aim of this prospective randomized trial is to verify whether there is an association between the methods of administration of enteral nutrition and the leptin and ghrelin hormones, which have a major role in the regulation of energy metabolism. Methods: This study enrolled 38 enteral-fed patients aged 18 to 85 in the Intensive Care Unit. The patients were prospectively randomized to receive either continuous infusion (n=19) or intermittent feeding (n=18) of enteral nutrition. In addition to routine biochemical assays, blood samples were taken from the patients for leptin and ghrelin analyses on the 1th, 7th, and 14th days of enteral nutrition. Results: There was no statistically significant difference between the groups regarding descriptive statistics and categorical variables such as underlying diseases, complications, steroid use and others (p>0.05). The decrease in the number of white blood cells and in creatinine and C-reactive protein levels over time were statistically significant (p=0.010, p=0.026, p<0.001 respectively). There was no statistically significant difference between the groups with respect to leptin and ghrelin levels (p=0.982 and p=0.054). Leptin levels did not change over time; however, the ghrelin levels of both groups were significantly higher on the 7th and 14th days than on the first day of analysis (p=0.003). Conclusion: This study revealed that both continuous and intermittent enteral nutrition feeding regimens were well tolerated in Intensive Care Unit patients showing minor complications. The method of administration of enteral nutrition alone did not affect the leptin and ghrelin levels. Randomized controlled large cohort trials are needed to to compare intermittent and continuous enteral nutrition to determine which one is more adaptable to diurnal patterns of secretion metabolic hormones.

Professional practice of dietitians in the Brazilian School Feeding Program: A multiple case study

ABSTRACT Objective: To assess dietician’s numerical parameters for school feeding and discuss limitations and possibilities for professional practice in the municipalities of Vale do Ivaí, in Northern Paraná, Brazil. Methods: This is a multiple case study. A semi-structured interview was administered to dietitians working at the School Feeding Program in nine cities located in Vale do Ivaí, Paraná, Brazil. Resolution nº 465/2010, from the Brazilian Federal Board of Dietitians, was used to calculate the adequacy of working hours of dietitians. The legistation of the Brazilian School Feeding Program was applied to discuss professional practice. Results: All the cities had at least one dietitian responsible for the School Feeding Program. The percentage of adequate working hours was from 20 to 66%. Some dietitians were involved in management activities, administration, procurement, and accounting, in addition to dietitian assignments for the School Feeding Program. Most dietitians worked in other sectors of the municipalities such as the health system, social assistance, and at events. This practice could compromise compliance of technical activities that must be met by the dietitians of the School Feeding Program. Conclusion: The number of dietitians in most of cities working at School Feeding Program is not sufficient to meet the number of students. The insuficient workload and excessive activities could hinder the development of dietitian’s private activities. The hiring of nutrition and dietitian technicians and administrative assistants for bureaucratic activies is recommended.