[Show abstract][Hide abstract] ABSTRACT: 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.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 10/2013; 29(10):2083-2092. · 0.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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.
Annals of Nutrition and Metabolism 07/2013; 62(4):331-338. · 1.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to compare prevalence estimates of health indicators for adults living in Campinas, São Paulo State, using data from two household surveys (ISA-SP 2001-2002 and ISA-Camp 2008-2009), analyzing data from 941 and 2,637 individuals 18 years and older, respectively. Socio-demographic variables were used to characterize the study population. Prevalence rates and 95% confidence intervals were estimated, and comparisons were performed by prevalence ratios adjusted for sex, age, and education, obtained by Poisson regression with robust variance. Statistically significant differences were observed for prevalence of morbidity, medication, smoking, and lifetime Pap smear and mammogram. Surveillance of health indicators by repeated surveys in the same population can facilitate monitoring goals and objectives by providing support to plan public health interventions.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 06/2013; 29(6):1149-60. · 0.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this paper is to calculate within-person variance component of the energy and nutrient intake that can be useful to adjust intake distribution from adolescents when is available only a single 24-hour recall for each participant. It will also give an example of its use in the intake distribution adjustment in adolescents from another sample.
It was used 24 hour recall from 215 adolescents living in São Paulo, Brazil. The variance components were estimated using the Software for Intake Distribution Estimation (PC-SIDE). It was made a model for each nutrient and sex of which were included covariates for day and month of intake and weight variable as well.
The within-person variance component ranged from 0.55 for mono saturated fat (female) up to 0.96 for folate (male). I was found higher values regarding to macronutrient and energy for males. In the example of the use of the variance component, it was estimated the distribution of intake of vitamin B6 with less bias, when compared to the distribution with no adjustment.
These results can be used to estimate habitual energy and nutrient intake for adolescent population when it is only a single dietary measurement.
Revista Brasileira de Epidemiologia 03/2013; 16(1):170-7.
[Show abstract][Hide abstract] ABSTRACT: To investigate added sugar intake, main dietary sources and factors associated with excessive intake of added sugar.
A population-based household survey was carried out in São Paulo, the largest city in Brazil. Cluster sampling was performed and the study sample comprised 689 adults and 622 elderly individuals. Dietary intake was estimated based on a 24-hour food recall. Usual nutrient intake was estimated by correcting for the within-person variance of intake using the Iowa State University (ISU) method. Linear regression analysis was conducted to identify factors associated with added sugar intake.
Average of energy intake (EI) from added sugars was 9.1% (95% CI: 8.9%; 9.4%) among adults and 8.4% (95% CI: 8.2%; 8.7%) among the elderly (p < 0.05). Average added sugar intake (% EI) was higher among women than among men (p < 0.05). Soft drink was the main source of added sugar among adults, while table sugar was the main source of added sugar among the elderly. Added sugar intake increased with age among adults. Moreover, higher socioeconomic level was associated with added sugar intake in the same group.
Added sugar intake is higher among younger adults of higher socioeconomic level. Soft drink and table sugar accounted for more than 50% of the sugar consumed.
Revista Brasileira de Epidemiologia 06/2012; 15(2):256-64.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: Quantitative assessment of nutrient intake requires knowing how much of the nutrient is needed for the normal functions of the individual and his or her habitual intake. Nutrient requirements vary between individuals; the assumed coefficient of variation is 10 to 15%. Individual intake is subject to variation of daily intake, which is known as intrapersonal variability. Currently, information on intrapersonal variation in the literature refers to the American population. This study has two objectives: 1) determine the intrapersonal standard deviation of nutrient intake for the Brazilian population that can be used for calculating the adequacy of nutrient intake; and 2) offer theoretical values that support decision making in clinical practice regarding the adequacy of nutrient intake selected by an individual, based on standard deviations and with three levels of reliability. METHODS: Data from teenagers, adults and elderly individuals who participated in the population-based health survey done in the city of São Paulo were used. These individuals (n=865) answered a 24-hour recall, replicated in a subsample of 294 individuals. These data were used for calculating the standard deviation using random effects models. RESULTS: The estimated coefficients varied from 40% for zinc to 127% for vitamin C. CONCLUSION: The standard deviations can be used for the assessment of quantitative intake adequacies of vitamin E, pyridoxine, thiamin, riboflavin, calcium, magnesium, iron, zinc, folate and niacin. Hence, one more element for nutritional status diagnosis is made available for clinical assessment.
Revista de Nutrição 12/2011; 24(6):825-832. · 0.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to estimate the prevalence of self-reported hearing loss among elderly people in São Paulo, Brazil, according to socio-demographic characteristics and to identify associated factors. Data were from the São Paulo Health Survey (ISA-Capital 2003), and the subgroup of elderly (n = 872) was analyzed. The χ(2) test was used to verify the association between self-reported hearing loss and socio-demographic characteristics. The statistical analyses used Poisson regression. Prevalence of self-reported hearing loss in the elderly was 11.2%, and was higher in men (PR = 1.86; 95%CI: 1.19-2.92). There was an important lack of knowledge among the elderly regarding the causes of their hearing loss (42.5%). Among the sample, 25.5% reported difficulties in leisure-time activities and 11.4% needed help in routine activities, while 63.3% required no assistance due to their impairment. The high prevalence of self-reported hearing loss in the elderly, especially in men, highlights the importance of this public health problem. Population aging is a new reality, placing increasing demands on healthcare professionals and government.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 07/2011; 27(7):1292-300. · 0.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To estimate the prevalence of inadequate nutrient intake among adolescents and the association between socio-economic variables and nutritional status.
Cross-sectional study with a population-based sample.
The usual nutrient intake distribution was estimated using the Iowa State University method. The Estimated Average Requirement cut-off point method was used to determine the proportion of adolescents with inadequate intake for each nutrient, according to sex, income, parental educational level and nutritional status.
Twenty-four-hour dietary recalls were applied in 525 male and female Brazilian adolescents aged 14-18 years.
The highest prevalence of inadequate nutrient intake was observed for vitamin E (99 % in both sexes). For male and female adolescents, the prevalence of inadequate intake was: Mg, 89 % and 84 %; vitamin A, 78 % and 71 %; vitamin C, 79 % and 53 %; and vitamin B6, 21 % and 33 %, respectively. The prevalence of inadequate intake for niacin, thiamin, riboflavin, Se, Cu and vitamin B12 was <15 %. Individuals in the lower income and lower parental educational level strata had the highest risk of having inadequate intake for P, riboflavin and vitamins A, B6 and B12. Compared with non-overweight individuals, overweight individuals had a higher risk of inadequate intake for Mg, vitamin A, P, thiamin and riboflavin.
The present study found a high prevalence of inadequate intake of nutrients that are recognised as being protective against chronic diseases. Adolescents in the lower income and lower parental educational level strata were less likely to have their nutrient intake requirements met.
Public Health Nutrition 05/2011; 14(9):1533-8. · 2.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: This study assessed the relationship between intake of added sugars and intake adequacy of nutrients and food groups in adolescents from São Paulo. METHODS: The study sample comprised 793 adolescents selected from a population-based cross-sectional study conducted in 2003. Food intake was assessed by 24-hour food recalls and an adjustment approach was subsequently administered using a subsample of 195 subjects. Sugar intake was considered appropriate or inappropriate when it represented ≤10% or >10% of total energy intake, respectively. Acceptable distribution ranges were used to assess macronutrient intake adequacy. The prevalence of micronutrient inadequacy was estimated using the Estimated Average Requirements as cutoffs. Median food intake and the 25th and 75th percentiles were estimated. The chi-square, Wald and median tests were used to analyze the data. The significance level was set at 5%. RESULTS: A larger proportion of adolescents with adequate carbohydrate intake were seen among those with higher added sugar intake. Protein intake by all adolescents was within the recommended ranges. A statistically significant association was found between adequacy of fat intake and added sugar intake among male adolescents. A higher median percent intake of milk, meat, fruit, processed juice, soft drink and chocolate milk was seen among adolescents with excess sugar intake. CONCLUSION: Excessive consumption of added sugars was associated with lower adequacy of nutrient intake and lower intake of nutrient-dense foods.
Revista de Nutrição 04/2011; 24(2):219-231. · 0.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This article analyzes prevalence rates in the use of medication according to demographic, socioeconomic, and health-related behavioral variables through a population-based cross-sectional study of individuals 18 years and older (n=941) in Campinas, São Paulo State, Brazil. The study used multistage sampling, both stratified and cluster. Chi-square test was performed, and adjusted prevalence ratios were estimated by gender and age, both with 95% confidence intervals. A Poisson multiple regression model was developed, and the following factors were associated with use of medication: female gender, age 40 and over, reported illness in the previous two weeks, and number of chronic diseases. The most widely consumed drugs were for the cardiovascular and nervous systems, besides herbal remedies. Prevalence of medication in Campinas was lower than in most studies. Local health surveys could help identify drug use patterns and guarantee more appropriate interventions for pharmaceutical care policy.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 04/2011; 27(4):649-58. · 0.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of the current study was to describe the sources of variation of energy and nutrient intake and to calculate the number of repetitions of diet measurements to estimate usual intake in adolescents from São Paulo, Brazil. Data was collected using 24-hour dietary recalls (24hR) in 273 adolescents between 2007 and 2008. Individuals completed a repeat 24hR around two months later. The sources of variation were estimated using the random effect model. Variance ratios (within-person to between-person variance ratio) and the number of repetitions of 24hR to estimate usual intake were calculated. The principal source of variation was due to within-person variance. The contribution of day of week and month of year was less than 8%. Variations ranged from 1.15 for calcium to 7.31 for vitamin E. The number of 24hR repeats required to estimate usual intake varied according to nutrient and gender, numbering 15 for males and 8 for females.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 11/2010; 26(11):2129-37. · 0.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective was to determine the prevalence of self-reported hearing loss in four urban areas in São Paulo State, Brazil, and to describe the causes and socio-demographic variables. This was a population-based cross-sectional study with data on individuals 12 years or older living in the areas in 2001 and 2002. Participation included 5,250 subjects selected by two-stage probability sampling, stratified in clusters. Data analysis was exploratory, including bivariate and multiple logistic regression analysis. Prevalence of hearing loss was 5.21%, and higher levels were associated with: age > 59 years (18.7%), illness in the 15 days prior to the interview (8.4%), common mental disorders (8.8%), and use of medication in the previous 3 days (8.4%). The study of factors associated with hearing loss can lead to health interventions for addressing that the population's real needs, mostly in primary care. More population-based studies on hearing are needed in Brazil, since there are few publications on the subject.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 05/2009; 25(5):1123-31. · 0.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective for this paper was to present and discuss the use of odds ratios and prevalence ratios using real data with a complex sampling design. We carried out a cross-sectional study using data obtained from a two-stage stratified cluster sample from a study conducted in 2001-2002 (n = 1,958). Odds ratios and prevalence ratios were obtained by unconditional logistic regression and Poisson regression, respectively, for later comparison using the Stata statistical package (v. 7.0). Confidence intervals and design effects were considered in the evaluation of the precision of estimates. Two outcomes of a cross-sectional study with different prevalences were evaluated: vaccination against influenza (66.1%) and self-referred lung disease (6.9%). In the high-prevalence scenario, using prevalence ratios the estimates were more conservative and we found narrower confidence intervals. In the low-prevalence scenario, we found no important numeric differences between the estimates and standard errors obtained using the two techniques. A design effect greater than one indicates that the sample design has increased the variance of the estimate. However, it is the researcher's task to choose which technique and measure to use for each data set, since this choice must remain within the scope of epidemiology.
Revista Brasileira de Epidemiologia 09/2008; 11(3):347-355.
[Show abstract][Hide abstract] ABSTRACT: We evaluated the relation between overweight and calcium intake in adults living in the municipality of São Paulo, Brazil.
This was a cross-sectional population-based study on a sample of 1459 adults that was obtained by multistage cluster sampling. Dietary intake was measured by the 24-h recall method. Poisson's and linear regression analyses were performed to evaluate the relation between overweight and quartiles of calcium intake adjusted for energy.
The prevalence of overweight was 43.1% and the average adjusted calcium intake was 448.6 mg. In the linear regression analyses, the regression coefficient for adjusted calcium was significant and negative (P = 0.019, beta(1) = -0.0001). Although evaluated by quartiles, the prevalence ratio for overweight in the first quartile of calcium intake was 1.24 (95% confidence interval 1.00-1.54) and that in the second quartile was 1.24 (95% confidence interval 1.03-1.49).
In the present study, calcium intake showed a significant negative association with body mass index.
[Show abstract][Hide abstract] ABSTRACT: To investigate the prevalence of reported pulmonary disease among elderly subjects, according to sociodemographic and economic characteristics, lifestyle, physical mobility, and health status.
This was a cross-sectional population-based study that included 1,957 elderly subjects (aged 60 and over). Information was collected by means of interviews. Subjects were selected using a two-stage probabilistic, stratified, cluster sampling strategy in six municipalities in the State of São Paulo between 2001 and 2002. Descriptive statistics, chi-squared association tests, prevalence ratios, and 95% confidence intervals were utilized. Adjusted analysis was carried out by Poisson regression.
Among the interviewees, around 7% reported pulmonary disease. There was no association between pulmonary disease and influenza vaccination. Adjusted analysis identified the following factors that were independently associated with reported disease: smoking (PR: 2.03; 95% CI: 1.39-2.97); medication use (PR: 2.05; 95% CI: 1.11-3.79); health status self-assessed as poor or very poor (PR: 1.89; 95% CI: 1.20-2.96); and depression, anxiety, or emotional problems (PR: 1.86; 95% CI: 1.11-3.10).
The findings from the present study reinforce the importance of respiratory diseases among the elderly, particularly in more vulnerable groups. Preventive measures and specific care for such groups are therefore justified.
Revista de Saúde Pública 07/2006; 40(3):428-35. · 1.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the epidemiologic profile of elderly persons who do or do not participate in influenza vaccination campaigns and to identify the variables that bear an influence on participation.
A cross-sectional population-based study was performed using data on individuals aged 60 years or older who were living in the municipalities of São Paulo, Itapecerica da Serra, Embu, Taboão da Serra, Campinas and Botucatu, Brazil, in 2001 and 2002. A stratified random sample of 1 908 elderly individuals was selected by means of two-stage cluster sampling. Exploratory data analysis was performed, including bivariate analysis and multiple logistic regression.
Sixty-six percent of the elderly subjects reported having received vaccination against influenza. After adjustment, the following factors were found to be associated with having received vaccination, based on self-report: age (OR = 1.47; 95% CI = 1.09 to 1.99), self-reported hypertension (OR = 1.39; 95% CI = 1.03 to 1.87) and educational level (OR = 0.64; 95% CI = 0.41 to 0.98). The highest number of vaccinated individuals was observed in the group > or = 70 years of age and in the hypertension group. Individuals with 9 or more years of schooling reported less adherence to influenza vaccination.
The results suggest the need for campaigns to make information on the benefits of influenza vaccination more easily accessible to the elderly and health professionals.
Revista Panamericana de Salud Pública 04/2006; 19(4):259-64. · 0.85 Impact Factor