[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: Antecedentes/Objetivos: A utilização do serviço de saúde, que in- clui o fornecimento de medicamentos e a vacinação, representa im- portante fator no controle de doenças crônicas como a hipertensão arterial e o diabetes mellitus. O estudo teve como objetivos descrever a utilização de serviços de saúde e analisar a vacinação, o gasto com medicamentos e o fornecimento de medicamentos à população adul- ta do município de São Paulo-Brasil, em 2003, que referiu ser porta- dora de hipertensão e/ou diabetes, segundo características sociodemográficas e de condições de vida e saúde. Métodos: Os dados foram coletados pelo Inquérito Multicêntrico de Saúde de São Paulo (ISA-Capital), estudo transversal de base popu- lacional realizado por meio de entrevistas domiciliares. Foi estudada a população de ambos os sexos, maior de 20 anos e que referiu ser portadora das doenças crônicas acima descritas. Foram realizadas análises descritivas e também estimativas de prevalências e calcula- das as razões de prevalência por meio da regressão de Poisson. Resultados: Grande parte da população estudada relatou utilizar regularmente o serviço de saúde para controle da hipertensão e do diabetes. A vacinação contra a gripe e a pneumonia foi realizada prin- cipalmente por intermédio do serviço público de saúde, no forneci- mento de medicamentos, houve participação significativa do setor privado. Na população que referiu diabetes, após ajuste por raça, si- tuação conjugal, atividade remunerada e renda per capita, o forneci- mento de medicamentos pelo serviço público de saúde foi 16,9 vezes maior na população com avaliação negativa de saúde, comparada à população com avaliação positiva. As médias de gasto per capita men- sal com medicamentos foram R$47,58 e R$44,32 na população que referiu diabetes e hipertensão, respectivamente. A população maior de 60 anos que referiu hipertensão teve gasto 1,8 vezes maior, compa- rada à população com 20 a 59 anos, após ajuste por escolaridade e condição do domicílio. Conclusiones: A investigação dos fatores envolvidos na utilização dos serviços de saúde pelos portadores de hipertensão arterial e dia- betes mellitus, realizada no presente estudo, pode contribuir para a formulação de políticas que visem ao aprimoramento e a ampliação do acesso da população ao serviço, considerando a importância de informações para o delineamento do serviço de saúde.
[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: Objective: 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. Methods: 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.
Results: 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. Conclusion: These results can be used to estimate
habitual energy and nutrient intake for adolescent population when it is only a
single dietary measurement.
Keywords: Nutrients. Adolescents. Diet surveys. Nutrition assessment. Energy consumption.
Revista Brasileira de Epidemiologia 01/2013; 16(1):170-177.
[Show abstract][Hide abstract] ABSTRACT: To measure added sugars intake among adolescents and describe its demographic, socioeconomic, and nutritional status determinants.
The study was conducted based on a household survey carried out between March and December 2003. Food intake was assessed through 24-hour food recalls, and an adjustment approach was applied using external variance estimates derived from 195 adolescents of the same age in 2007.
Population-based cross-sectional study, city of São Paulo, Brazil.
Seven hundred and ninety-three male (n = 410) and female (n = 383) adolescents aged 10-19 years. Measure of outcome: Foods with greater contributions toward the added sugars intake were identified. Multiple linear regression analysis was performed, with calories from added sugars as the dependent continuous variable and the remaining factors (socioeconomic, demographic, lifestyle, household condition, and food intake) as independent variables.
The average contribution of added sugars to total energy value was 12.28% (95% confidence interval [CI]: 11.87-12.70) with no statistically significant sex difference (p > 0.05). Soft drinks were a major source of added sugars among the adolescents (34.2% among males and 32.0% among females), followed by sugars (sucrose and honey) and chocolate powder (around 11%). In the multiple linear regression analysis, the head of household's education level and calories from protein, fats, and carbohydrates other than sugars had an independent effect on added sugars intake.
This study showed that the percentage contribution of added sugars to energy intake among adolescents in the city of São Paulo, Brazil, was above the current recommended levels. Socioeconomic condition (represented by the head of the household's education level) and macronutrient intake were shown to be determinants of sugars intake.
Journal of the American College of Nutrition 08/2012; 31(4):259-67. · 1.68 Impact Factor
[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. · 0.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe the occurrence of self-reported problems of accessibility to health services used by persons with disabilities in terms of social and health services variables.
We performed a cross-sectional household survey designed to assess problems with accessibility to health services faced by persons with disabilities. We interviewed 333 persons in São Paulo city, in 2007. Variables related to the presence of accessibility problems, disabilities, gender, age, family head income, ethnicity, use of health services and others were analysed using frequencies, percentages, χ(2)-test, ANOVA and Poisson regression models.
15.92% of the interviewed persons reported problems with accessibility to health services. Persons having multiple (prevalence ratios; PR = 2.91) or mobility disability (PR = 6.46) had more problems with accessibility than persons with hearing disability. Persons younger than 78 years old had more problems with accessibility; those who needed help to go to the health service (PR = 3.01) also.
Persons with multiple or mobility disability, younger than 78 years, and those who needed help of others to go to the health service were more likely to have problems with accessibility to health services. This information could be one of the first steps to the management and/or planning of appropriate health services for persons with disabilities.
Disability and Rehabilitation 08/2011; 33(17-18):1693-8. · 1.84 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. · 0.35 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: To investigate health self-assessment and to estimate the prevalence of chronic diseases and recent illnesses in people with and without physical disabilities (PD) in the state of São Paulo, southeastern Brazil.
A cross-sectional study comprising two population-based health surveys conducted in 2002 and 2003.
A total of 8317 persons (165 with PD) were interviewed in the two studies. Variables concerning to health self-assessment; chronic disease and recent illness were compared in the people with and without PD. Negative binomial regression was used in the analysis.
Subjects with PD more often assessed their health as poor/very poor compared to non-disabled ones. They reported more illnesses in the 15 days prior to interview as well as more chronic diseases (skin conditions, anaemia, chronic kidney disease, stroke, depression/anxiety, migraine/headache, pulmonary diseases, hypertension, diabetes, arthritis/arthrosis/rheumatic conditions and heart disease). This higher disease prevalence can be either attributed to disability itself or be associated to gender, age and schooling.
Subjects with PD had more recent illnesses and chronic diseases and poorer health self-assessment than non-disabled ones. Age, gender, schooling and disability have individual roles in disease development among disabled people.
Disability and Rehabilitation 02/2010; 32(19):1612-5. · 1.84 Impact Factor