Publications by authors named "Eliseu Verly-Jr"

22 Publications

  • Page 1 of 1

The cost of eating more sustainable diets: A nutritional and environmental diet optimisation study.

Glob Public Health 2021 Mar 15:1-14. Epub 2021 Mar 15.

MOISA, INRAE, CIHEAM-IAMM, CIRAD, Montpellier SupAgro, Université de Montpellier, Montpellier, France.

We aim to identify the dietary changes to improve nutrition and reduce diet-related greenhouse gas emission (GHGE) simultaneously in Brazil, taking into account the heterogeneity in food habits and prices across the country. Food consumption and prices were obtained from two nationwide surveys ( = 55,970 households and 34,003 individuals). Linear programming models were performed to design optimised diets most resembling the observed diets, and meeting different sets of constraints: (i) nutritional, for preventing chronic diseases and meeting nutrient adequacy; (ii) socio-cultural: by respecting food preferences; and (iii) environmental: by reducing GHGE by steps of 10%. Moving toward a diet that meets nutritional recommendations led to a 14% to 24% cost increase and 10% to 27% GHGE reduction, depending on the stringency of the acceptability constraints. Stronger GHGE reductions were achievable (up to about 70%), with greater departure from the current diet, but not achieving calcium and potassium goals. Diet cost increment tended to be mitigated with GHGE reduction in most models, along with reductions in red meat, chicken, eggs, rice, and high-fat sugar sodium foods.
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http://dx.doi.org/10.1080/17441692.2021.1900315DOI Listing
March 2021

Reducing ultra-processed foods and increasing diet quality in affordable and culturally acceptable diets: a study case from Brazil using linear programming.

Br J Nutr 2021 Aug 4;126(4):572-581. Epub 2020 Nov 4.

Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, 20550-013, Brazil.

The aim was to design culturally acceptable and healthy diets with reduced energetic share of ultra-processed foods (UPF%) at no cost increment and to evaluate the impact of the change in the UPF% on diet quality. Food consumption and price data were obtained from the Household Budget Survey (n 55 970 households) and National Dietary Survey (n 32 749 individuals). Linear programming models were performed to design diets in which the mean population UPF% was reduced up to 5 % with no cost increment relative to the observed costs. The models were isoenergetic or allowed the energy content to vary according to the UPF%, and they were not constrained to nutritional goals (nutrient-free models) or maximised the compliance with dietary recommendations (nutrient-constrained models). Constraints regarding food preference were introduced in the models to obtain culturally acceptable diets. The mean population UPF% was 23·8 %. The lowest UPF% attained was approximately 10 %. The optimised diet cost was up to 20 % cheaper than the observed cost, depending on the model and the income level. In the optimised diets, the reduction in the UPF% was followed by an increase in fruits, vegetables, beans, tubers, dairy products, nuts, fibre, K, Mg, vitamin A and vitamin C in the nutrient-constrained models, compared with the observed consumption in the population. There was little variation in most nutrients across the UPF% reduction. The UPF% reduction in the nutrient-free models impacted only trans-fat and added sugar content. UPF% reduction and increase in diet quality are possible at no cost increment.
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http://dx.doi.org/10.1017/S0007114520004365DOI Listing
August 2021

Treatment of Childhood Obesity Based on Brazilian Dietary Guidelines Plus Energy Restriction (PAPPAS HUPE Study): Protocol for a Randomized Clinical Trial.

JMIR Res Protoc 2020 Jun 8;9(6):e16170. Epub 2020 Jun 8.

Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil.

Background: The Food Guide for the Brazilian Population relies on natural or minimally processed foods mainly of plant origin such as beans and rice with low oil, salt, and sugar content and limited consumption of ultraprocessed foods. Reduction of ultraprocessed foods improves diet quality and energy consumption.

Objective: The goal of this study is to evaluate the effectiveness of an intervention for the treatment of obesity in children, with counseling based on the Brazilian Food Guide plus control of total energy intake.

Methods: A parallel, randomized clinical trial will include children aged 7 to 12 years. Randomization will be performed in blocks of 10 individuals using computer-generated random sequence numbers. Both the control and intervention groups will participate in 6 standardized educational activities based on the 10 steps of the Brazilian Food Guide. These activities will be conducted at the University Hospital Toy Library, located in the pediatric outpatient clinic. For the intervention group, in addition to the educational activities, an individualized food plan based on the nutritional recommendations of the Brazilian Society of Pediatrics will be prescribed and discussed with the mothers and fathers. The primary outcome of the study will be variations in body mass index, and secondary outcomes will include analysis of insulin resistance, blood pressure, body fat percentage, and waist and neck circumference.

Results: This project was funded by the National Council for Scientific and Technological Development in December 2017 (grant no 408333/2017-0). Recruitment began in August 2018 and by September 2019, we had enrolled the 101 participants. In addition to the patients referred by the national system of regulation, recruitment was made by medical outpatient referral and external indication. This is an ongoing study. We expect the results to be published in November 2020.

Conclusions: At the end of the project, in case of a positive result, a protocol for the treatment of obesity based on the Brazilian Food Guide will be proposed to the Unified Health System. A successful method to reduce childhood obesity is expected.

Trial Registration: Brazilian Registry of Clinical Trials RBR-3st5sn; http://www.ensaiosclinicos.gov.br/rg/RBR-3st5sn.

International Registered Report Identifier (irrid): DERR1-10.2196/16170.
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http://dx.doi.org/10.2196/16170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308900PMC
June 2020

Reaching culturally acceptable and adequate diets at the lowest cost increment according to income level in Brazilian households.

PLoS One 2020 11;15(3):e0229439. Epub 2020 Mar 11.

Center for Research in Complex Systems Modeling, School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil.

Objective: To identify food choices allowing the fulfillment of nutritionally adequate diets resembling actual food patterns at the lowest cost achievable for the Brazilian population, stratified by income level.

Methods: Food consumption and prices were obtained from the Household Budget Survey (n = 55,970 households) and National Dietary Survey (n = 32,749 individuals). The sample was stratified into capitals of the states and further by income levels according to the official minimum wage (totaling 108 geographic-economic strata, or GES). Linear programming models were performed for each GES in order to find the lowest cost of diets that meet a set of nutritional constraints. In order to find realistic diets, constraints referring to preferences were introduced in the models allowing optimized food quantities to depart progressively from the current intake for each food and food group. The impact of meeting each target nutrient was assessed by performing models removing each nutrient at the time.

Results: The observed and optimized diet costs were US$2.16 and US$2.58 per capita/day. The highest cost increment and the greatest food shifts were observed in the lowest income level. The nutrient adequacy was reached by mainly increasing fruits and vegetables, beans, fish and seafood, dairy, nuts, and eggs; and reducing red and processed meat, chicken, margarine and butter, cookies, cakes, sugar-sweetened beverages, and sauces. As the departure from the current intakes increase, the optimized healthy diet cost reduced. In the lowest income, the lowest cost increment was about US$ 0.10; in the higher income levels, it tended to be cheaper than the observed cost. Calcium was the most expensive nutrient to meet adequacy.

Conclusion: Nutritionally adequate diets are possible but costlier than the observed.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0229439PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7065914PMC
July 2020

Prevalence of inadequate intake of folate after mandatory fortification: results from the first National Dietary Survey in Brazil.

Eur J Nutr 2020 Sep 31;59(6):2793-2803. Epub 2019 Oct 31.

Department of Nutrition, School of Public Health, University of Sao Paulo (USP), Av. Dr. Arnaldo, 715, Sao Paulo, SP, 01246-904, Brazil.

Purpose: Our aim was to estimate the prevalence of folate inadequacy (POFI) according to life stage, socio-economic status, and geographical regions after the mandatory fortification of wheat and maize flour in Brazil.

Methods: This was a population-based study. Data from two non-consecutive food records from the National Dietary Survey/Household Budget Survey 2008-2009 were used to estimate the usual dietary folate intake in µg dietary folate equivalents (DFEs). The National Cancer Institute method was used to account for within-person variance and the Estimated Average Requirement (EAR) cut-point method was used to calculate the POFI. The survey included 32,749 individuals, 15,700 males and 17,049 females, over 10 years old. Pregnant women, lactating women, and individuals with unreliable energy intake data were excluded.

Results: Overall POFI was 31.5% and mean dietary folate intake was 411.1 µg DFE. The lowest POFI occurred in the youngest age group of 10-13 years in both sexes, while the highest POFI was observed in the group ≥ 71 years. In women of childbearing age, POFI was around 32%. The lowest income strata had the highest POFI. The most developed regions (South and Southeast) had the lowest POFI compared to less developed regions.

Conclusions: Our data show that folate inadequacy is still prevalent in Brazil mainly in low-income groups and less developed regions. Actions need to be taken to ensure that women of childbearing age, who presented a high prevalence of inadequate folate intake, achieve the recommended daily intake of 400 µg DFEs.
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http://dx.doi.org/10.1007/s00394-019-02127-wDOI Listing
September 2020

Planning dietary improvements without additional costs for low-income individuals in Brazil: linear programming optimization as a tool for public policy in nutrition and health.

Nutr J 2019 07 20;18(1):40. Epub 2019 Jul 20.

Center for Research in Complex Systems Modeling, School of Arts, Sciences and Humanities, University of São Paulo, Av. Arlindo Bettio, 1000, São Paulo, 03828-000, Brazil.

Background: Meeting nutrient intake recommendations may demand substantial modifications in dietary patterns, and may increase diet cost. Incentives for modifying one's dietary intake that disregard prices are unlikely to be effective in the general population, especially among low-income strata, due to the high percentage of income committed to food purchases. The aim of this study is to evaluate how much the nutrient content can be increased through a modeled diet, without any cost increase, for low-income Brazilian households.

Methods: Low-income households were selected from the Household Budget Survey (24,688 households) and National Dietary Survey (6,032 households, 16,962 individuals), from where we obtained food prices and consumption data. Food quantities were modeled using linear programming to find diets that meet nutritional recommendations in two sets of models: cost-constrained (the cost should not be higher than the observed diet cost) and cost-free. Minimum and maximum amounts of each food in the modelled diets were allowed at three levels of food acceptability: rigorous (least deviance from the current observed diets), moderate, and flexible (higher deviance from the current observed diets).

Results: We found no feasible solution that would accommodate all the nutritional targets. The most frequent limiting nutrients were calcium; vitamins D, E, and A; zinc; fiber; sodium; and saturated and trans-fats. However, increases in nutrient contents were observed, especially for fiber, calcium, copper, magnesium, vitamin A, vitamin C, and vitamin E. In general, the best achievement was obtained with cost-free models. Fruits and beans increased in all models; large increase in whole cereals was observed only in the flexible models; large increase in vegetables was observed only in the cost-free models; and fish increased only in the cost-free models. Reductions were observed for rice, red and processed meats, sugar-sweetened beverages, and sweets. The mean observed cost was US$2.16 per person/day. The mean cost in the cost-free models was US$2.90 (moderate), US$2.70 (rigorous), and US$2.60 (flexible).

Conclusion: The complete nutritional adequacy is unattainable, although feasible changes would substantially improve diet quality by improving nutrient content without additional costs.
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http://dx.doi.org/10.1186/s12937-019-0466-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6642478PMC
July 2019

Comparison between household food purchase and individual food consumption in Brazil.

Public Health Nutr 2019 04 7;22(5):841-847. Epub 2018 Dec 7.

1Institute of Social Medicine,Rio de Janeiro State University (UERJ),São Francisco Xavier 524 - UERJ,Rio de Janeiro,RJ20550-013,Brazil.

Objective: The present study aimed to compare Household Budget Survey (HBS) data on food purchasing and individual food consumption, collected in the same nationwide survey.

Design: Food purchase information for each household was collected by a seven-day collective acquisition diary, applied to 55 970 households. Food consumption information was obtained from household members over 10 years old by the application of two non-consecutive food records in a sub-sample of the HBS. Cooking and correction factors were applied when necessary, and all food items reported were grouped into twelve main food groups. Food purchase and consumption data were presented as absolute weight (g/person per d) and as relative contribution to energy intake (%) for the overall study population, which was stratified according to household income.

Setting: Brazil.ParticipantsNational estimates of food consumption and purchase for Brazil.

Results: The greatest differences between purchase and consumption data (purchase minus consumption) were observed for meat (-168 g), beans/legumes (-48 g), roots/tubers (-36 g) and fruits (-31 g). When expressed in terms of energy contribution, the highest differences were found for cereals (13 %) and oils and fats (11 %). Differences between purchase and consumption data were generally lower in the highest compared with the lowest household income quintile; and were lower for most main food groups when considering only foods reported as being eaten at home.

Conclusions: With few exceptions, food purchase expressed as relative energy contribution, as opposed to absolute weight, can provide a good picture of actual consumption in the Brazilian population.
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http://dx.doi.org/10.1017/S1368980018002987DOI Listing
April 2019

Correction of diet-outcome association for day-to-day variance in dietaray intake: performance evaluation by simulation.

Cad Saude Publica 2017 07 3;33(6):e00173216. Epub 2017 Jul 3.

Instituto de Saúde Coletiva, Universidade Federal Fluminense, Niterói, Brasil.

The use of one or a few 24-hour recalls (24hR) to measure dietary exposure in models to estimate diet-outcome association leads to attenuation of the measure of association and a decrease in the test's power. This is due to daily variation in food intake. The measure of association can be corrected using regression calibration and requires at least one repetition of the 24hR in a subsample of the study population. However, the calibration's performance and the precision of the corrected coefficients can vary according to the characteristics of the study to which it is applied. The aim of this study is to evaluate the performance of correction in different research scenarios in relation to the estimated measure of association and its precision. A population (n = 1,000) was simulated with information on food intake for 200 days and an outcome with an association defined with usual intake (mean for the 200 intake days). The scenarios evaluated were: (a) 100%, 60%, 40%, and 20% of the sample with 2 intake days; (b) individuals with 2, 3, 4, and 5 24hR; and (c) populations with 1,000, 600, and 300 individuals. The coefficients were estimated for 300 random combinations of intake days; mean corrected coefficients were similar to the true coefficient. Precision was lower in all the scenarios: the probability of finding a significant association (when true) varied from 0.47 to 0.29 (100% to 20% with repetition, respectively); 0.47 to 0.78 (2 to 5 days); and 0.47 to 0.15 (1,000 to 300 individuals).
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http://dx.doi.org/10.1590/0102-311X00173216DOI Listing
July 2017

Perception of food consumed at home and dietary intake: A nationwide study from Brazil.

Appetite 2017 09 24;116:487-492. Epub 2017 May 24.

Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rua São Francisco Xavier, 524, 7° Andar, Bloco E, 20550-900, Rio de Janeiro, RJ, Brazil.

Perception of food consumed is a key factor in acknowledging the need for behavioral change to improve diet quality. We analyzed family dietary intake according to the head of household's perception of satisfaction with food consumed by the family. Households (n = 13,351) that participated in the Brazilian Household Budget Survey and the National Dietary Survey were classified as satisfied or dissatisfied with the food consumed in the home. We compared the family dietary intake of the two groups considering their socio-demographic characteristics. Satisfied families (n = 4429) reported statistically higher intake (in grams/1000 kcal) of vegetables (47.3 vs 33.7), fruits (46.9 vs 21.4), sugar-sweetened beverages (118 vs 71.7), milk and dairy (57.9 vs 34.6), and ultra-processed products (18.6 vs 9.8); and lower intake of rice (86.2 vs 112), beans (91.7 vs 136), and meat (76.5 vs 84.0) when compared to dissatisfied families (n = 1717). Among satisfied families, in the youngest group we found lower consumption of fruits and higher intake of sugar-sweetened beverages and ultra-processed products when compared to the oldest group. Also among satisfied families, those in the highest per capita income group presented higher intake of fruits and lower intake of beans than those in the lowest income group. Satisfied families in the highest income group also consumed more fruits and less beans than dissatisfied families in the same income group. Socio-demographic characteristics may influence perception of satisfaction with food consumed and potentially influence the success of public health efforts to offer nutrition guidance for families satisfied with diets that may or may not be comprised of healthy food and beverages.
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http://dx.doi.org/10.1016/j.appet.2017.05.036DOI Listing
September 2017

Brazilians' experiences with iron fortification: evidence of effectiveness for reducing inadequate iron intakes with fortified flour policy.

Public Health Nutr 2017 02 17;20(2):363-370. Epub 2016 Aug 17.

1Department of Nutrition,School of Public Health,University of São Paulo,Avenida Dr Arnaldo 715,Cerqueira César,CEP 01246-904,São Paulo,SP,Brazil.

Objective: To assess Fe intake, calculate the prevalence of inadequate Fe intake and identify food contributors to Fe intake during 2003 and 2008 in a population-based study, reflecting before and after the mandatory fortification of flour with Fe.

Design: Two cross-sectional population-based studies conducted in 2003 and 2008. Dietary intake was evaluated by 24 h recall and the Software for Intake Distribution Estimation (PC-SIDE) was used to estimate within-person variance and prevalence of inadequate Fe intake. The statistical analysis was conducted considering the complex survey design.

Setting: São Paulo, Brazil.

Subjects: Adolescents, adults and elderly adults of both sexes, interviewed in 2003 (n 2386) and 2008 (n 1661).

Results: The Fe intake mean increased in all populations in the post-fortification period. A reduction of over 90 % was observed in the prevalence of inadequate Fe intake among men for all age groups analysed. When evaluating women, despite the substantial reduction (over 63 %), prevalence of inadequate Fe intake remained high (34 %) in those aged 19-50 years. Major food contributors to Fe intake before fortification were beans, beef, vegetables and dairy. There was an alteration in the contributors in the post-fortification period, with bread, beef, beans and biscuits as main contributors.

Conclusions: The mandatory fortification with Fe significantly furthered the reduction in the prevalence of inadequacy, except among women of reproductive age, and changed the main contributors to this nutrient in the studied population. Therefore, monitoring of Fe addition in flour is essential to assess compliance to the fortified flour policy and to guarantee a safe Fe intake for all the population.
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http://dx.doi.org/10.1017/S1368980016001981DOI Listing
February 2017

Performance of statistical methods to correct food intake distribution: comparison between observed and estimated usual intake.

Br J Nutr 2016 09;116(5):897-903

2School of Public Health,University of São Paulo,São Paulo, 01246-904,Brazil.

There are statistical methods that remove the within-person random error and estimate the usual intake when there is a second 24-h recall (24HR) for at least a subsample of the study population. We aimed to compare the distribution of usual food intake estimated by statistical models with the distribution of observed usual intake. A total of 302 individuals from Rio de Janeiro (Brazil) answered twenty, non-consecutive 24HR; the average length of follow-up was 3 months. The usual food intake was considered as the average of the 20 collection days of food intake. Using data sets with a pair of 2 collection days, usual percentiles of intake of the selected foods using two methods were estimated (National Cancer Institute (NCI) method and Multiple Source Method (MSM)). These estimates were compared with the percentiles of the observed usual intake. Selected foods comprised a range of parameter distributions: skewness, percentage of zero intakes and within- and between-person intakes. Both methods performed well but failed in some situations. In most cases, NCI and MSM produced similar percentiles between each other and values very close to the true intake, and they better represented the usual intake compared with 2-d mean. The smallest precision was observed in the upper tail of the distribution. In spite of the underestimation and overestimation of percentiles of intake, from a public health standpoint, these biases appear not to be of major concern.
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http://dx.doi.org/10.1017/S0007114516002725DOI Listing
September 2016

Breastfeeding duration and associated factors between 1960 and 2000.

J Pediatr (Rio J) 2017 Mar - Apr;93(2):130-135. Epub 2016 Jul 21.

Universidade do Estado do Rio de Janeiro (UERJ), Instituto de Medicina Social (IMS), Rio de Janeiro, RJ, Brazil. Electronic address:

Objective: To describe a historical series on the median duration of breastfeeding in a population of mothers whose children were born from the 1960s onwards, identifying factors associated with the interruption of breastfeeding in each decade.

Methods: Data were analyzed from the Pró-Saúde Study, a longitudinal epidemiological investigation started in 1999 among technical and administrative employees of a university in the state of Rio de Janeiro. Breastfeeding duration was collected in two study phases: Phase 1 (1999), and phase 4 (2011-2012). Of these, those who had at least one child and reported the duration of breastfeeding for the first child were selected (n=1539). To analyze the duration of breastfeeding, survival curves were constructed using the Kaplan-Meier method and the effect of covariates on the duration of breastfeeding was estimated by Cox regression model.

Results: It was found that the median duration of breastfeeding was higher in the 1990s and 2000s and lower in the 1970s, compared to the 1960s. In addition, there was an association between higher income and maternal age with breastfeeding interruption, which was focused in the 1970s.

Conclusion: There was shorter duration of breastfeeding in the 1970s compared to the 1960s. Increased duration and prevalence of breastfeeding from the 1970s onwards coincided with the national trend and the promotion of this practice since 1980.
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http://dx.doi.org/10.1016/j.jped.2016.05.005DOI Listing
August 2017

Caloric compensation for sugar-sweetened beverages in meals: A population-based study in Brazil.

Appetite 2016 03 18;98:67-73. Epub 2015 Dec 18.

Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rua São Francisco Xavier, 524, 7º Andar, Bloco E, Cep 20550-900, Rio de Janeiro, RJ, Brazil. Electronic address:

Sugar-sweetened beverage (SSB) consumption can cause positive energy balance, therefore leading to weight gain. A plausible biological mechanism to explain this association is through weak caloric compensation for liquid calories. However, there is an ongoing debate surrounding SSB calorie compensation. The body of evidence comes from a diversity of study designs and highly controlled settings assessing food and beverage intake. Our study aimed to test for caloric compensation of SSB in the free-living setting of daily meals. We analyzed two food records of participants (age 10 years or older) from the 2008-2009 National Dietary Survey (Brazil, N = 34,003). We used multilevel analyses to estimate the within-subject effects of SSB on food intake. Sugar-sweetened beverage calories were not compensated for when comparing daily energy intake over two days for each individual. When comparing meals, we found 42% of caloric compensation for breakfast, no caloric compensation for lunch and zero to 22% of caloric compensation for dinner, differing by household per capita income. In conclusion, SSB consumption contributed to higher energy intake due to weak caloric compensation. Discouraging the intake of SSB especially during lunch and dinner may help reduce excessive energy intake and lead to better weight management.
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http://dx.doi.org/10.1016/j.appet.2015.12.014DOI Listing
March 2016

A quantile regression approach can reveal the effect of fruit and vegetable consumption on plasma homocysteine levels.

PLoS One 2014 3;9(11):e111619. Epub 2014 Nov 3.

Department of Nutrition, School of Public Health, Sao Paulo University, São Paulo, Brazil.

Introduction: A reduction in homocysteine concentration due to the use of supplemental folic acid is well recognized, although evidence of the same effect for natural folate sources, such as fruits and vegetables (FV), is lacking. The traditional statistical analysis approaches do not provide further information. As an alternative, quantile regression allows for the exploration of the effects of covariates through percentiles of the conditional distribution of the dependent variable.

Objective: To investigate how the associations of FV intake with plasma total homocysteine (tHcy) differ through percentiles in the distribution using quantile regression.

Materials And Methods: A cross-sectional population-based survey was conducted among 499 residents of Sao Paulo City, Brazil. The participants provided food intake and fasting blood samples. Fruit and vegetable intake was predicted by adjusting for day-to-day variation using a proper measurement error model. We performed a quantile regression to verify the association between tHcy and the predicted FV intake. The predicted values of tHcy for each percentile model were calculated considering an increase of 200 g in the FV intake for each percentile.

Results: The results showed that tHcy was inversely associated with FV intake when assessed by linear regression whereas, the association was different when using quantile regression. The relationship with FV consumption was inverse and significant for almost all percentiles of tHcy. The coefficients increased as the percentile of tHcy increased. A simulated increase of 200 g in the FV intake could decrease the tHcy levels in the overall percentiles, but the higher percentiles of tHcy benefited more.

Conclusions: This study confirms that the effect of FV intake on lowering the tHcy levels is dependent on the level of tHcy using an innovative statistical approach. From a public health point of view, encouraging people to increase FV intake would benefit people with high levels of tHcy.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0111619PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4218785PMC
February 2016

[Evaluation of the safety of different doses of folic acid supplements in women in Brazil].

Rev Saude Publica 2013 Oct;47(5):952-7

Objective: To evaluate the distribution of folic acid intake and the safety of different doses of supplements in women of childbearing age.

Methods: Data were used from two non-consecutive days of food records of 6,837 women of childbearing age (19-40 years old) participants of the National Food Survey, a module of the Household Budget Survey 2008-2009. Means and percentiles of usual consumption of natural folate and folic acid were estimated using the National Cancer Institute method. Five scenarios were simulated by adding different daily doses of fortification (400 mcg, 500 mcg, 600 mcg, 700 mcg and 800 mcg) to folic acid derived from food consumed by the women. To define a safe dose of the supplement, the total folate (dietary + supplement) was compared with the tolerable upper intake level (UL = 1,000 mcg).

Results: Women with usual intake of folic acid above the tolerable upper intake levels were observed only for doses of supplement of 800 mcg (7.0% of women). Below this value, any dose of the supplement was safe.

Conclusions: The use of supplements of up to 700 mcg of folic acid was shown to be safe.
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http://dx.doi.org/10.1590/s0034-8910.2013047004769DOI Listing
October 2013

Children's nutrient intake variability is affected by age and body weight status according to results from a Brazilian multicenter study.

Nutr Res 2014 Jan 28;34(1):74-84. Epub 2013 Sep 28.

Department of Nutrition, School of Public Health, University de São Paulo, Sao Paulo, Brazil. Electronic address:

A major challenge in nutritional studies focusing on children is estimating "true" intake because the type and amount of foods eaten change throughout growth and development, thereby affecting the variability of intake. The present study investigated the hypothesis that age and body weight status affect the ratio of the within- and between-subject variation of intakes (VR) as well as the number of days of dietary assessment (D) of energy and nutrients. A total of 2,981 Brazilian preschoolers aged 1-6 years were evaluated in a cross-sectional study. Weighed food records and estimated food records were used to assess dietary intake inside and outside of school. Within- and between-subject variations of intakes were estimated by multilevel regression models. VR and D were calculated according to age group and body weight status. VR ranged from 1.17 (calcium) to 8.70 (fat) in the 1- to 2-year-old group, and from 1.47 (calcium) to 8.95 (fat) in the 3- to 6-year-old group. Fat, fiber, riboflavin, folate, calcium, phosphorus, and iron exhibited greater VR and D in the 3- to 6-year-old group. For energy, carbohydrates, and protein, both within- and between-subject variation increased with increasing age. In both body weight groups, calcium showed the lowest VR. Fat showed the highest VR in nonoverweight/obese children (9.47), and fiber showed the highest VR in overweight/obese children (8.74). For most nutrients, D = 7 was sufficient to correctly rank preschoolers into tertiles of intake. In conclusion, age and body weight status affected the within- and between-subject variation and the VR of energy and nutrient intakes among Brazilian preschool children.
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http://dx.doi.org/10.1016/j.nutres.2013.09.006DOI Listing
January 2014

[Folic acid intake before and after mandatory fortification: a population-based study in São Paulo, Brazil].

Cad Saude Publica 2013 10;29(10):2083-92

Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil.

This study analyzed folic acid intake before and since mandatory fortification. Dietary data were collected by 24-hour recall in a health survey in São Paulo (ISA-Capital) in 2003 and 2007-2008, stratifying the population according to life stage and gender. Estimated average requirement (EAR) and tolerable upper intake level (UL) were used to assess intake. Prevalence of inadequate folic acid intake decreased in all groups, especially adolescents and adult males (72% to < 1% and 76% to 6%, respectively) but remained high in adult women (38%). Beans were the main source of folic acid before fortification. With fortification, bread became the main source, but beans remained important. Fortification was successful (increased intake within safe levels), but it raised concerns about the high proportion in the target group (adult women) who still fail to meet the recommended intake.
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http://dx.doi.org/10.1590/0102-311x00084712DOI Listing
October 2013

[Use of dietary supplements among inhabitants of the city of São Paulo, Brazil].

Cad Saude Publica 2013 07;29(7):1467-72

Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil.

This cross-sectional population-based study in the city of São Paulo, Brazil, aimed to assess prevalence of use of dietary supplements according to life stage and socio-demographic and behavioral characteristics. Prevalence of supplement use was low (6.35%) among the 865 individuals interviewed, with a higher prevalence among women (PR = 1.88; 95%CI: 1.08-1.25). However, no statistically significant difference was found for the other variables. Combined vitamin and mineral supplements headed the list. Intake of supplements is still low in this population. However, the current weak evidence of benefits from regular use and the risks of excessive consumption justify monitoring the use of supplements.
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http://dx.doi.org/10.1590/s0102-311x2013000700020DOI Listing
July 2013

Are plasma homocysteine concentrations in Brazilian adolescents influenced by the intake of the main food sources of natural folate?

Ann Nutr Metab 2013 2;62(4):331-8. Epub 2013 Jul 2.

Department of Nutrition, School of Public Health (FSP), University of São Paulo, São Paulo, Brazil.

Background: Folate, a B vitamin, has been associated with a reduced concentration of plasma homocysteine (phcy), a marker of cardiovascular disease. The contribution of fruits and vegetables (FV) and other natural folate-rich foods to folate intake and folate status in Brazilian adolescents has hardly been determined.

Objectives: To investigate the intake of FV and beans and its association with the concentration of phcy in adolescents.

Methods: This was a cross-sectional population-based study with a complex sample survey, with 198 adolescents who completed two 24-hour dietary recalls, a food frequency questionnaire, and a fasting blood draw. Usual dietary intake estimates were derived applying the Multiple Source Method. Three different generalized linear models with a gamma distribution were developed for each sex to evaluate the relationship between phcy and tertiles of FV intake as well as to evaluate the relationship between phcy and tertiles of FV and bean intake.

Results: No association was found between phcy concentration and FV intake or between phcy and FV and beans. Serum folate and female sex were inversely related to phcy.

Conclusion: Phcy was not related to FV or FV and beans; this may be attributable to a low intake of these food groups.
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http://dx.doi.org/10.1159/000348883DOI Listing
October 2013

Inadequate nutrient intake among the Brazilian elderly: National Dietary Survey 2008-2009.

Rev Saude Publica 2013 Feb;47 Suppl 1:222S-30S

Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil.

Objective: To estimate the prevalence of inadequate nutrient intake in the Brazilian elderly.

Methods: This study was based on data from the National Dietary Survey, part of the Household Budget Survey 2008-2009. All individuals aged 60 and over, totaling 4,322 individuals, were included. Individual food intake was obtained from food records from two non-consecutive days. The habitual intake for each nutrient was estimated by the National Cancer Institute method, in which sex and region were included as covariates. The prevalence of inadequate nutrient intake was estimated stratified by sex and region using the EAR method to define cut-off points.

Results: A high prevalence of inadequate intake (> 50%) of vitamins E, D and A, calcium, magnesium and pyridoxine was observed for both sexes. In all regions, 100% inadequate vitamin E intake was observed. Vitamin D showed almost 100% inadequate intake except in the North region. The prevalence of inadequate vitamin A intake was higher than 70% in the North, Northeast, and Midwest regions. Among the minerals evaluated, calcium and magnesium showed the highest prevalence of inadequate intake (> 80%) in all regions.

Conclusions: The present study found a high prevalence of inadequate intake of nutrients recognized as being protective against chronic diseases among the Brazilian elderly.
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http://dx.doi.org/10.1590/s0034-89102013000200008DOI Listing
February 2013

Prevalence and correlates of calcium and vitamin D status adequacy in adolescents, adults, and elderly from the Health Survey-São Paulo.

Nutrition 2013 Jun 16;29(6):845-50. Epub 2013 Feb 16.

Nutrition Department, School of Public Health, University of São Paulo, Brazil.

Objective: In addition to the importance of adequate calcium and vitamin D status for health and prevention of several chronic diseases, a high prevalence of both nutrient inadequacy and 25-hydroxyvitamin D (25[OH]D) insufficiency has been observed. The aim of this study was to estimate calcium and vitamin D status correlates and adequacy from a population-based epidemiologic study.

Methods: This is a subsample of a cross-sectional study of a representative sample of individuals living in São Paulo that includes 636 participants. A 24-h dietary record and a blood sample were collected. Nutrient adequacy was estimated by adjusting for the within-person variance of the nutrient intake. Serum concentration of 25(OH)D was measured by high-performance liquid chromatography and considered adequate when ≥ 50 nmol/L.

Results: Calcium and vitamin D intake decrease according to life stages in both men and women, and increases with family income and educational level. The prevalence of calcium intake inadequacy is higher than 70% and almost 100% for vitamin D. The highest 25(OH)D concentration was observed in the fall-51.7 (20.4) nmol/L-and lowest in the summer-30.1 (8.8) nmol/L. Sex, body mass index, physical activity, alcohol and smoking habits, life stage, family income, skin color, waist circumference, and season of the year could explain 22% of the variability of 25(OH)D.

Conclusions: The present study demonstrates important inadequacies regarding the nutritional status of calcium and vitamin D and indicates an urgent need not only for health professionals, but also for government and food industries to undertake new initiatives that could result in a real improvement in terms of calcium and vitamin D nutrition.
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http://dx.doi.org/10.1016/j.nut.2012.12.009DOI Listing
June 2013

Precision of usual food intake estimates according to the percentage of individuals with a second dietary measurement.

J Acad Nutr Diet 2012 07;112(7):1015-20

Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil.

Background: Statistical methods for estimating usual intake require at least two short-term dietary measurements in a subsample of the target population. However, the percentage of individuals with a second dietary measurement (replication rate) may influence the precision of estimates, such as percentiles and proportions of individuals below cut-offs of intake.

Objective: To investigate the precision of the usual food intake estimates using different replication rates and different sample sizes.

Participants/setting: Adolescents participating in the continuous National Health and Nutrition Examination Survey 2007-2008 (n=1,304) who completed two 24-hour recalls.

Statistical Analyses Performed: The National Cancer Institute method was used to estimate the usual intake of dark green vegetables in the original sample comprising 1,304 adolescents with a replication rate of 100%. A bootstrap with 100 replications was performed to estimate CIs for percentiles and proportions of individuals below cut-offs of intake. Using the same bootstrap replications, four sets of data sets were sampled with different replication rates (80%, 60%, 40%, and 20%). For each data set created, the National Cancer Institute method was performed and percentiles, CI, and proportions of individuals below cut-offs were calculated. Precision estimates were checked by comparing each CI obtained from data sets with different replication rates with the CI obtained from original data set. Further, we sampled 1,000, 750, 500, and 250 individuals from the original data set, and performed the same analytical procedures.

Results: Percentiles of intake and percentage of individuals below the cut-off points were similar throughout the replication rates and sample sizes, but the CI increased as the replication rate decreased. Wider CIs were observed at 40% and 20% of replication rate.

Conclusions: The precision of the usual intake estimates decreased when low replication rates were used. However, even with different sample sizes, replication rates >40% may not lead to an important loss of precision.
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http://dx.doi.org/10.1016/j.jand.2012.03.028DOI Listing
July 2012
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