Flávia Emília Leite de Lima Ferreira

This study aimed to identify the predominant dietary patterns among adult women using the Brazilian Unified Health System (SUS) in João Pessoa, Paraíba, Brazil, and to estimate the effects of different factors on adherence to these patterns. This cross-sectional study included 268 women aged 18–59 years recruited from 10 Family Health Units. Face-to-face interviews were conducted to characterize the study population, assess nutritional status, and evaluate dietary intake using 24-hour dietary recalls. Dietary patterns were identified through exploratory factor analysis using principal component extraction. Factors with eigenvalues greater than 1 were retained, followed by varimax rotation. Adherence to the dietary patterns was assessed using tests for comparison of means, including Student’s t-test and analysis of variance (ANOVA). The effect of each independent variable was evaluated using multiple logistic regression models, with each dichotomized factor considered as the dependent variable. Four dietary patterns were identified, designated as “Unhealthy,” “Mixed 1,” “Mixed 2,” and “Traditional,” accounting for 36% of the total variance. Pregnancy was associated with greater adherence to both the “Unhealthy” pattern (OR: 7.62; 95% CI: 3.59–16.19) and the “Traditional” pattern (OR: 6.00; 95% CI: 2.82–12.78). Being older than 35 years was associated with the “Traditional” pattern (OR: 2.10; 95% CI: 1.06–4.18), whereas lower educational attainment was associated with the “Unhealthy” pattern (OR: 3.10; 95% CI: 1.18–8.12). Low income was also associated with this pattern but lost statistical significance in the multivariable model. Unhealthy food choices among women of lower socioeconomic status should be considered when developing health strategies aimed at promoting nutrition education and access to healthy foods. Older women showed greater adherence to the traditional dietary pattern, suggesting that the worsening in diet quality may be a relatively recent phenomenon.

Background/Objectives: Dietary patterns have changed over time, characterising a process of nutritional transition that reflects socioeconomic and demographic inequalities among different populations. This study assessed changes in dietary consumption patterns and the associated social determinants, comparing two time periods in a sample of individuals from a state in the Northeast Region of Brazil. Methods: Data from the 2008–2009 and 2017–2018 Household Budget Survey for the state of Paraíba were analysed, totalling 951 and 1456 individuals, respectively. Foods were categorised according to the NOVA classification and compared based on sociodemographic and economic variables. To determine the factors that most strongly explain the contribution of each NOVA food group to the diet, beta regression analysis was conducted. Results: Differences were observed between the two periods regarding the dietary contribution of the NOVA food groups, with a decrease in consumption of unprocessed foods and an increase in ultra-processed foods. Living in urban areas, being an adolescent, and having an income above the minimum wage were associated with reduced intake of unprocessed foods in both periods. Additionally, being an adolescent and having more than eight years of schooling were associated with higher consumption of ultra-processed foods. Conclusions: The population under study showed changes in food consumption, reflecting a transition process that is occurring unevenly across socioeconomic and demographic groups, thereby reinforcing social inequalities. These findings can guide priorities in food and nutrition policies, highlighting the need for intervention studies to evaluate the effectiveness of such actions.

Background/Objectives: The study prospectively assessed the association between sleep duration and the consumption of ultra-processed foods in adolescent students from a Brazilian capital. Methods: We observed 1431 adolescents participating in the Longitudinal Study on sedentary behavior, physical activity, dietary habits, and adolescent health, aged 10 to 14 years, in the years 2014 to 2017. The percentage of consumption of ultra-processed foods was evaluated by the Friedman test. Generalized Estimation Equation (GEE) models with parameters for robust analysis were used to verify the prospective association between sleep and the consumption of ultra-processed foods. Results: The percentage consumption of ultra-processed foods in relation to total daily calories increased in boys between 15 and 17 years old (31.8% in 2015 to 35.8% in 2017), being more stable among older girls (36.7% in 2015 to 37.7% in 2017), which may have occurred due to the influence of the social environment, reduced critical capacity, and lower concern for nutrition. This excessive consumption can lead to health and body composition impairments. Over time, adolescents who were in the fourth quartile of sleep had a 1.4% reduction (95% CI −2.49; −0.28) in the energy percentage from ultra-processed foods. When adjusting the initially used model in the GEE (Generalized Estimation Equation) with sociodemographic variables (income, maternal education, age) and lifestyle factors, sleep duration decreased by 2.1% (95% CI −4.09; −0.22) only in boys. The shorter duration of sleep in adolescents has been shown to be associated with unhealthy behavioral factors, such as a preference for fatty and sugary foods. There were no statistically significant associations for girls in this model. Conclusions: Sleep influences the consumption of ultra-processed foods in adolescents, showing that as sleep time increases, the consumption of foods classified as ultra-processed decreases.

Excess sugar is considered one of the primary factors contributing to overweight status. In Brazil, sugar-sweetened beverages (SSBs) contain a significant amount of this nutrient and are consumed excessively. These beverages are associated with adverse health outcomes and impose costs on the healthcare system. The literature currently lacks studies that aim to attribute specific nutrients or foods as causes of diseases and also evaluate their economic impact, especially in middle- and low-income countries. This study aims to estimate the direct and indirect costs of obesity, stratified by sex and age group, resulting from the excessive consumption of sugar-sweetened beverages in Brazil from 2008 to 2020, and to project these costs for the year 2036. The estimation of obesity costs attributable to excessive consumption of SSBs was based on relative risks and the population prevalence of obesity, considering expenditures on hospitalizations and outpatient procedures in the Unified Health System (SUS). Cost information was obtained from the health information systems available at SUS. The highest burden attributable to the consumption of SSBs was observed among younger individuals and progressively decreased with advancing age. The total direct costs in the period between 2008 and 2020 amounted to approximately US$ 6.33 million, 87% of which was related to expenses for females. Additionally, deaths resulting from the consumption of SSBs cost the economy US$ 40 million due to the premature loss of productivity. The total costs of obesity attributable to the consumption of SSBs are substantial, impacting public spending and generating social and productivity losses that burden the economy. It is crucial to develop and implement cost-effective fiscal and regulatory policies aimed at preventing and combating obesity.

Introdução. Com o aumento populacional dos idosos, surge a necessidade de maior uso dos serviços de saúde, devido ao perfil epidemiológico dessa população, caracterizado por doenças crônicas, declínio funcional e aumento de morbidade. Objetivo: analisar, com enfoque cartográfico, a prevalência de internação por Hipertensão Arterial Sistêmica (HAS) e Diabetes Mellitus Tipo 2 (DM2) e Índice de Desenvolvimento Humano na rede hospitalar pública em idosos no Brasil. Metodologia: Estudo agregado, de abordagem quantitativa e qualitativa, ecológico, de séries temporais, sobre a distribuição dos coeficientes de prevalência de Hipertensão Arterial Sistêmica e Diabetes Mellitus Tipo 2 a partir de 534.691 casos de internações dispostos nos 27 Estados brasileiros, nos anos de 2010 a 2016. Os dados, foram obtidos do Sistema de Informação Hospitalar do Sistema Único de Saúde. O programa estatístico R, permitiu uma visualização do padrão espacial dessas morbidades usando o método de k-means clustering e desenvolveu-se um modelo de regressão múltipla. Resultados: Observou-se relação entre prevalência de internação por: Hipertensão Arterial Sistêmica e Índice de Desenvolvimento Humano (IC 95%= -5,4%;-2,6% e coeficiente -4,040%, p=0,000) ; Diabetes Mellitus e Índice de Desenvolvimento Humano (IC 95%= -4,8%;-1,7% e coeficiente -3,293%, p=0,000), Hipertensão Arterial e renda familiar per capita (IC 95%= -1,7%;-0,3% e coeficiente 0,773%, p= 0,000) e relação entre prevalência de internação por Diabetes Mellitus e taxa de analfabetismo (IC 95%= 0,0;0,5% e coeficiente 0,278%, p= 0,039) no modelo de regressão múltipla com dados em painel. Conclusão: Observou-se tendência para estabilização e redução nas prevalências de internações dos idosos por Hipertensão Arterial e Diabetes Mellitus Tipo 2 mas ainda permaneceram em patamares elevados e identificou-se relação negativa entre o Índice de Desenvolvimento Humano e as prevalências de internações.

The aim of the present study was to analyze the relationship between time spent engaged in sedentary behaviors, type of diet, and overweight in adolescents. A cross-sectional study using data from the Longitudinal Study on Sedentary Behavior, Physical Activity, Eating Habits, and Health of Adolescents - LONCAAFS Study. A total of 1,438 adolescents (10 to 14 years old) from public schools in the city of João Pessoa, Brazil, participated in the study. To evaluate the combined effects of excessive time in sedentary behavior and consumption from two food groups: Convenience and Prudent on overweight, we performed multiple logistic regression analyses, adjusted for energy, level of physical activity, sex, and age. Excessive time in sedentary behavior increased the chance of adolescents being overweight by 37% (OR = 1.37; 95%CI: 1.04-1.80). This chance increased to 43% when the adolescents were simultaneously engaged in excessive sedentary behavior and had high consumption of the Convenience food group (OR = 1.43; 95%CI: 1.05-1.94) and increased to 39% on those who engaged in excessive sedentary behavior and had low consumption of foods from the Prudent (OR = 1.39; 95%CI: 1.04-1.84). Excessive sedentary behavior is associated with being overweight and the chance increases with the consumption of convenient foods.

Resumo O objetivo deste artigo é analisar a relação entre duração insuficiente do sono, sobrepeso/obesidade e o consumo de alimentos ultraprocessados em adolescentes de 10 a 14 anos. Trata-se de um estudo transversal, com avaliação de 1.384 adolescentes de escolas públicas de João Pessoa-PB, participantes do Estudo Longitudinal sobre Comportamento Sedentário, Atividade Física, Hábitos Alimentares e Saúde de Adolescentes (LONCAAFS). Foram mensuradas variáveis sociodemográficas, duração do sono, turno de aula, estado nutricional antropométrico, comportamento sedentário e consumo alimentar. Foram realizadas regressão linear e logística por meio do Software Stata 13.0. Prevalência de curta duração do sono de 29,5% (<9h/noite). Associação significativa entre a curta duração do sono e o excesso de peso somente para adolescentes <12 anos. Quanto à relação entre a duração do sono e o consumo de alimentos ultraprocessados, quanto maior a duração do sono, menor o consumo de lanches pelos adolescentes menores de 12 anos, com associação positiva para ≥12 anos apenas com ajuste pela variável atividade física. Não houve associação com os grupos “bebidas açucaradas” e “biscoitos” para nenhuma das faixas etárias analisadas.

Resumo Objetivou-se identificar padrões alimentares e sua associação com características socioeconômicas, de estilo de vida, estado nutricional, perfil lipídico e inflamatório em adolescentes. Estudo transversal, com amostra probabilística, utilizando dados da linha de base (2014) do Estudo Longitudinal sobre Comportamento Sedentário, Atividade Física, Hábitos Alimentares e Saúde de Adolescentes (LONCAAFS). Participaram 1.438 adolescentes (10 a 14 anos), da rede pública de João Pessoa-PB. Foram obtidos dados socioeconômicos, medidas antropométricas, estilo de vida e exames bioquímicos. Os dados dietéticos foram obtidos por recordatórios de 24h, sendo os padrões alimentares identificados por análise fatorial exploratória e as associações de interesse estimadas por regressão logística múltipla. Foram encontrados três padrões alimentares: “Tradicional”, “Lanches” e “Ocidental” que se associaram com idade, nível socioeconômico, escolaridade dos pais e estilo de vida. O padrão “Tradicional” se mostrou associado a menor adiposidade e melhor perfil lipídico, porém com a maior idade, há maior adesão aos padrões “Lanches” e “Ocidental”. Os resultados da análise do padrão alimentar de adolescentes apontam para necessidade de estratégias que incentivem comportamentos saudáveis.

Objetivo: Averiguar a relação entre o consumo alimentar habitual de vitamina D e o peso corporal em diferentes faixas etárias de uma mesma população. Metodologia: Estudo epidemiológico transversal de base populacional, envolvendo 866 indivíduos de um município do Nordeste do Brasil. Foram coletados dados demográficos e recordatórios de 24 horas, além de avaliação antropométrica. A adequação de nutrientes foi estimada ajustando-se a variância intrapessoal da ingestão de nutrientes. Aplicou-se a regressão múltipla entre as variáveis estudadas. Resultados: Na amostra total, 45,27% dos participantes apresentavam sobrepeso ou obesidade. A média de ingestão habitual de vitamina D foi aproximadamente 2µg. Ocorreu uma relação entre o consumo alimentar habitual de vitamina D e o peso corporal na amostra total (t=-2,34; p=0,019), no grupo de adolescentes (t=-2,51; p=0,012) e de adultos (t=-2,75; p=0,006). Para as crianças e os idosos estas relações não foram observadas. Conclusão: A existência de uma relação entre o consumo alimentar habitual de vitamina D e o peso corporal em adolescentes e adultos, no entanto, não foi observada em crianças e idosos, sugerindo que nesses grupos etários, mais vulneráveis, as vias metabólicas da vitamina D que, provavelmente, favorecem a perda de peso, não estão sendo estimuladas ou atuantes, embora, o consumo das crianças tenha sido superior e o dos idosos semelhante aos demais grupos.

Methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism associated with body fat accumulation could possibly trigger an inflammatory process by elevating homocysteine levels and increasing cytokine production, causing several diseases. This study aimed to evaluate the effects of food intervention, and not folate supplements, on the levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β) in overweight and obese women with the MTHFR C677T polymorphism. A randomized, double-blind eight-week clinical trial of 48 overweight and obese women was conducted. Participants were randomly assigned into two groups. They received 300 g of vegetables daily for eight weeks containing different doses of folate: 95 µg/day for Group 1 and 191 µg/day for Group 2. MTHFR C677T polymorphism genotyping was assessed by digestion with HinfI enzyme and on 12% polyacrylamide gels. Anthropometric measurements, 24-h dietary recall, and biochemical analysis (blood folic acid, vitamin B12, homocysteine (Hcy), TNF-α, IL-1β, and IL-6) were determined at the beginning and end of the study. Group 2 had a significant increase in folate intake (p < 0.001) and plasma folic acid (p < 0.05) for individuals with the cytosine–cytosine (CC), cytosine–thymine (CT), and thymine–thymine (TT) genotypes. However, only individuals with the TT genotype presented reduced levels of Hcy, TNF-α, IL-6, and IL-1β (p < 0.001). Group 1 showed significant differences in folate consumption (p < 0.001) and folic acid levels (p < 0.05) for individuals with the CT and TT genotypes. Food intervention with folate from vegetables increased folic acid levels and reduced interleukins, TNF-α, and Hcy levels, mainly for individuals with the TT genotype.