Child dietary and eating behaviour outcomes up to 3.5 years after an early feeding intervention: the NOURISH RCT

- Objective To evaluate dietary intake impact outcomes up to 3.5 years after the NOURISH early feeding intervention (concealed allocation, assessor masked RCT). - Methods 698 first-time mothers with healthy term infants were allocated to receive anticipatory guidance on protective feeding practices or usual care. Outcomes were assessed at 2, 3.7 and 5 years (3.5 years post-intervention). Dietary intake was assessed by 24-hour recall and Child Dietary Questionnaire. Mothers completed a food preference questionnaire and Children’s Eating Behaviour Questionnaire. Linear mixed models assessed group, time and time x group effects. - Results There were no group or time x group effects for fruit, vegetables, discretionary food and non-milk sweetened beverages intake. Intervention children showed a higher preference for fruits (74.6% vs 69.0% liked, P<.001), higher Child Dietary Questionnaire score for fruit and vegetables (15.3 vs 14.5, target>18, P=0.03), lower food responsiveness (2.3 vs 2.4, of maximum 5, P=.04) and higher satiety responsiveness (3.1 vs 3.0, of maximum 5, P=.04). - Conclusions Compared to usual care, an early feeding intervention providing anticipatory guidance regarding positive feeding practices led to small improvements in child dietary score, food preferences and eating behaviours up to 5 years of age, but not in dietary intake measured by 24-hour recall.

Efetividade de um ensaio randomizado de base escolar envolvendo familiares e professores para redução do ganho excessivo de peso em adolescentes

Esta tese é composta por três artigos que veiculam os resultados da realização e análise de uma intervenção de base escolar com o objetivo de reduzir o ganho de peso excessivo em adolescentes. O ensaio, denominado PAPPAS (Pais, Alunos e Professores Pela Alimentação Saudável), foi conduzido com alunos do 5 ano de vinte escolas públicas do município de Duque de Caxias, Rio de Janeiro. As atividades desenvolvidas durante o ano letivo de 2010 desencorajaram o consumo de bebidas adoçadas e biscoitos e estimularam o consumo de feijão e frutas. Pais/ responsáveis e professores receberam informação e material de divulgação sobre os mesmos temas abordados em sala de aula. O consumo de alimentos foi avaliado por meio de um questionário de frequência alimentar aplicado ao início e ao final do estudo. A aferição do peso e da estatura se deu em três momentos: na linha de base, na metade do ano letivo e ao fim do estudo. Para as análises longitudinais, empregou-se modelos generalizados lineares mistos, que levam em conta tanto os dados faltantes quanto o efeito de conglomerado. No primeiro artigo é apresentado o efeito da intervenção no Índice de Massa Corporal (IMC) dos estudantes. Análise por intenção de tratamento revelou que a alteração no IMC dos adolescentes ao longo do tempo não foi estatisticamente diferente entre os grupos intervenção e controle. Observou-se redução estatisticamente significativa no consumo de bebidas adoçadas e biscoitos e aumento no consumo de frutas nos participantes do grupo intervenção quando comparados aos do grupo controle. Pôde-se concluir que estratégias baseadas exclusivamente na qualidade da dieta podem não levar à alterações no peso corporal de adolescentes. No segundo artigo verificou-se a influência do estágio de prontidão para modificação dos hábitos alimentares dos adolescentes na alteração do consumo de refrigerantes, biscoitos e frutas. Observou-se maior alteração no consumo dentre os participantes do grupo intervenção que se encontravam nos estágios de ação na linha de base (relataram já ter alterado seus hábitos alimentares), sugerindo que essa estratégia pode auxiliar em estudos de intervenção visando à alteração do comportamento. O terceiro artigo revisou evidências do ajuste inadequado para características da linha de base, em análises de ensaios randomizados de base escolar que objetivaram alteração no estado nutricional de adolescentes. Foram avaliados 37 estudos e 35% apresentaram desbalanceamento estatisticamente significativo para o IMC na linha de base. Concluiu-se que o ajuste para o IMC na linha de base é frequente em ensaios comunitários randomizados, porém, esta prática força um balanço, que pode levar à resultados espúrios sobre o efeito do tratamento. Os resultados dos artigos 2 e 3 permitem explicar, ao menos em parte, as inconsistências nos resultados de estudos de intervenções voltadas para alteração de hábitos alimentares em escolares.

The Dietary Approaches to Stop Hypertension (DASH) eating pattern in special populations.

The Dietary Approaches to Stop Hypertension (DASH) trial showed that a diet rich in fruits, vegetables, low-fat dairy products with reduced total and saturated fat, cholesterol, and sugar-sweetened products effectively lowers blood pressure in individuals with prehypertension and stage I hypertension. Limited evidence is available on the safety and efficacy of the DASH eating pattern in special patient populations that were excluded from the trial. Caution should be exercised before initiating the DASH diet in patients with chronic kidney disease, chronic liver disease, and those who are prescribed renin-angiotensin-aldosterone system antagonist, but these conditions are not strict contraindications to DASH. Modifications to the DASH diet may be necessary to facilitate its use in patients with chronic heart failure, uncontrolled diabetes mellitus type II, lactose intolerance, and celiac disease. In general, the DASH diet can be adopted by most patient populations and initiated simultaneously with medication therapy and other lifestyle interventions.

Fructose toxicity: is the science ready for public health actions?

PURPOSE OF REVIEW: The assumption that fructose may be toxic and involved in the pathogenesis of noncommunicable diseases such as obesity, diabetes mellitus, dyslipidemia, and even cancer has resulted in the call for public health action, such as introducing taxes on sweetened beverages. This review evaluates the scientific basis for such action. RECENT FINDINGS: Although some studies hint towards some potential adverse effects of excessive fructose consumption especially when combined with excess energy intake, the results from clinical trials do not support a significant detrimental effect of fructose on metabolic health when consumed as part of a weight-maintaining diet in amounts consistent with the average-estimated fructose consumption in Western countries. However, definitive studies are missing. SUMMARY: Public health policies to eliminate or limit fructose in the diet should be considered premature. Instead, efforts should be made to promote a healthy lifestyle that includes physical activity and nutritious foods while avoiding intake of excess calories until solid evidence to support action against fructose is available. Public health is almost certainly to benefit more from policies that are aimed at promoting what is known to be good than from policies that are prohibiting what is not (yet) known to be bad.

High-sucrose effect on bone structure, hardness and biomechanics in an obesity model using Wistar male rats

Introduction: Excessive consumption of sugar-sweetened beverage is positively related to overweight. Despite the epidemic of childhood obesity, body mass can have a positive or negative effect on bone health. Material and methods: Wistar rats 8 weeks olds were randomly assigned to consume water (Control group, n = 10), sucrose 30% (HS group, n = 10) and water + sucrose 30% (WHS group, n = 14) for 8 weeks. All animals received standard laboratory chow ad libitum. Femur measurements included microhardness, bone mineral density (BMD) by DXA, mechanical compression test and microcomputed tomography (microCT) analysis. Results: We observed significant difference in final body weight in HS and WHS groups, significant increase in triacylglycerol/fructosamine in HS and WHS groups, significantly high BMD in WHS group, increased periosteal/endosteal cortical microhardness in WHS group. Compared with control, microCT parameters evidenced lower amount of connected trabecular bone, decreased bone volume, lower trabecular number with high trabecular separation in distal epiphysis in WHS animals. Conclusion: High-sucrose consumption causes obesity induced by a liquid diet with negative effects on cancellous bone.

Development of a synbiotic low-calorie beverage made from soy and yacon extracts

The objective of this study was to develop a new low-calorie symbiotic beverage made from yacon (prebiotic source) and soy extracts, containing probiotic Bifidobacterium animalis ssp. lactis BB-12. The synbiotic beverage was first produced with a range of sucrose concentrations in order to determine ideal sweetness by an acceptance test using a “just-about-right scale”. Sucrose was then replaced by sucralose or aspartame to produce sugar-free beverages. Characteristics including viable cell numbers, physicochemical properties, sensorial characteristics and fructooligosaccharides content were investigated. The ideal sweetness of the beverages with sucrose, aspartame and sucralose were 7.28%, 0.0486% and 0.0167%, respectively. Sucralose exhibited higher scores in acceptance test and was used to replace sucrose in the low-calorie symbiotic beverage. The synbiotic beverage exhibited counts of Bifidobacterium spp. of 108 CFU·mL-1 , sufficient condition to be considered probiotic. The chemical composition of the product was (g/100 g): 2.91 of protein, 1.41 of fat, 2.41 of total carbohydrate; 0.82 of FOS and 148.22 Kj of energy value. The synbiotic beverage developed in this study may be successful in health applications, due to their functional ingredients (soy, probiotic bacteria and yacon prebiotics) that can afford benefits to health or can present disease-preventing properties, beyond their inherent nutritional value. In addition this low-calorie beverage can be consumed by diabetic individuals and people concerned about the ingestion of calories.

Effects of a health advocacy program to promote physical activity and nutrition behaviors among adolescents: An evaluation of the Young Leaders for Healthy Change program

Background. This study was designed to evaluate the effects of the Young Leaders for Healthy Change program, an internet-delivered program in the school setting that emphasized health advocacy skills-development, on nutrition and physical activity behaviors among older adolescents (13–18 years). The program consisted of online curricular modules, training modules, social media, peer and parental support, and a community service project. Module content was developed based on Social Cognitive Theory and known determinants of behavior for older adolescents. ^ Methods. Of the 283 students who participated in the fall 2011 YL program, 38 students participated in at least ten of the 12 weeks and were eligible for this study. This study used a single group-only pretest/posttest evaluation design. Participants were 68% female, 58% white/Caucasian, 74% 10th or 11th graders, and 89% mostly A and/or B students. The primary behavioral outcomes for this analysis were participation in 60-minutes of physical activity per day, 20-minutes of vigorous- or moderate- intensity physical activity (MVPA) participation per day, television and computer time, fruit and vegetable (FV) intake, sugar-sweetened beverage intake, and consumption of breakfast, home-cooked meals, and fast food. Other outcomes included knowledge, beliefs, and attitudes related to healthy eating, physical activity, and advocacy skills. ^ Findings. Among the 38 participants, no significant changes in any variables were observed. However, among those who did not previously meet behavioral goals there was an 89% increase in students who participated in more than 20 minutes of MVPA per day and a 58% increase in students who ate home-cooked meals 5–7 days per week. The majority of participants met program goals related to knowledge, beliefs, and attitudes prior to the start of the program. Participants reported either maintaining or improving to the goal at posttest for all items except FV intake knowledge, taste and affordability of healthy foods, interest in teaching others about being healthy, and ease of finding ways to advocate in the community. ^ Conclusions. The results of this evaluation indicated that promoting healthy behaviors requires different strategies than maintaining healthy behaviors among high school students. In the school setting, programs need to target the promotion and maintenance of health behaviors to engage all students who participate in the program as part of a class or club activity. Tailoring the program using screening and modifying strategies to meet the needs of all students may increase the potential reach of the program. The Transtheoretical Model may provide information on how to develop a tailored program. Additional research on how to utilize the constructs of TTM effectively among high school students needs to be conducted. Further evaluation studies should employ a more expansive evaluation to assess the long-term effectiveness of health advocacy programming.^

Apparent dietary intake in remote Aboriginal communities

Apparent per capita food and nutrient intake in six remote Australian Aboriginal communities using the ‘store-turnover’ method is described. The method is based on the analysis of community-store food invoices. The face validity of the method supports the notion that, under the unique circumstances of remote Aboriginal communities, the turnover of foodstuffs from the community store is a useful measure of apparent dietary intake for the community as a whole. In all Aboriginal communities studied, the apparent intake of energy, sugars and fat was excessive, while the apparent intake of dietary fibre and several nutrients, including folic acid, was low. White sugar, flour, bread and meat provided in excess of 50 per cent of the apparent total energy intake. Of the apparent high fat intake, fatty meats contributed nearly 40 per cent in northern coastal communities and over 60 per cent in central desert communities. Sixty per cent of the apparent high intake of sugars was derived from sugar per se in both regions. Compared with national Australian apparent consumption data, intakes of sugar, white flour and sweetened carbonated beverages were much higher in Aboriginal communities, and intakes of wholemeal bread, fruit and vegetables were much lower. Results of the store-turnover method have important implications for community-based nutrition intervention programs.

Energy compensation following consumption of sugar-reduced products: a randomized controlled trial

PURPOSE: Consumption of sugar-reformulated products (commercially available foods and beverages that have been reduced in sugar content through reformulation) is a potential strategy for lowering sugar intake at a population level. The impact of sugar-reformulated products on body weight, energy balance (EB) dynamics and cardiovascular disease risk indicators has yet to be established. The REFORMulated foods (REFORM) study examined the impact of an 8-week sugar-reformulated product exchange on body weight, EB dynamics, blood pressure, arterial stiffness, glycemia and lipemia. METHODS: A randomized, controlled, double-blind, crossover dietary intervention study was performed with fifty healthy normal to overweight men and women (age 32.0 ± 9.8 year, BMI 23.5 ± 3.0 kg/m2) who were randomly assigned to consume either regular sugar or sugar-reduced foods and beverages for 8 weeks, separated by 4-week washout period. Body weight, energy intake (EI), energy expenditure and vascular markers were assessed at baseline and after both interventions. RESULTS: We found that carbohydrate (P < 0.001), total sugars (P < 0.001) and non-milk extrinsic sugars (P < 0.001) (% EI) were lower, whereas fat (P = 0.001) and protein (P = 0.038) intakes (% EI) were higher on the sugar-reduced than the regular diet. No effects on body weight, blood pressure, arterial stiffness, fasting glycemia or lipemia were observed. CONCLUSIONS: Consumption of sugar-reduced products, as part of a blinded dietary exchange for an 8-week period, resulted in a significant reduction in sugar intake. Body weight did not change significantly, which we propose was due to energy compensation.

Evaluation of monolithic columns for determination of formaldehyde and acetaldehyde in sugar cane spirits by High-Performance Liquid Chromatography

High-Performance Liquid Chromatography (HPLC) conditions are described for separation of 2,4-dinitrophenylhydrazone (2,4-DNPH) derivatives of carbonyl compounds in a 10 cm long C-18 reversed phase monolithic column. Using a linear gradient from 40 to 77% acetonitrile (acetonitrile-water system), the separation was achieved in about 10 min-a time significantly shorter than that obtained with a packed particles column. The method was applied for determination of formaldehyde and acetaldehyde in Brazilian sugar cane spirits. The linear dynamic range was between 30 and 600 mu g L-1, and the detection limits were 8 and 4 mu g L-1 for formaldehyde and acetaldehyde, respectively.

Amino acids profile of sugar cane spirit (cachaca), rum, and whisky

An analytical procedure for the separation and quantification of 20 amino acids in cachacas has been developed involving C18 solid phase cleanup, derivatization with o-phthalaldehyde/2-mercaptoethanol, and reverse phase liquid chromatography with fluorescence detection. The detection limit was between 0.0050 (Cys) and 0.25 (Ser) mg L-1, whereas the recovery index varies from 69.5 (Lys) to 100 (Tyr)%. Relative standard deviations vary from 1.39 (Trp) to 13.4 (Glu)% and from 3.08 (Glu) to 13.5 (His) for the repeatability and intermediate precision, respectively. From the quantitative profile of amino acids in 41 cachacas, 5 turns, and 12 whisky samples, the following order of amino acids in significant quantities is observed: Gly = Ser < Cys < Ile < His < Pro = Asp < Asn < Tyr for cachaca; Phe < Glu = Gln = Val = Ala < His = Gly Thr = Arg = Tyr < Asn Ser = Lys = Pro < Cys = Asp for rum; and Ala = Asn < Trp < Gln = His = Met = Ile = Cys < Thr < Asp Leu < Phe = Lys < Ser = Gly = Tyr = Val < Glu = Pro < Arg for whisky samples. (C) 2007 Elsevier Ltd. All rights reserved.

Evaluation of physicochemical, microbiological and sensorial characteristics of fermented milk beverages with buttermilk addition

This study evaluated three fermented milk beverages to which had been added sugar strawberry puree post-fermentation. The base was composed of 70% of milk, with whey and buttermilk in the concentrations of 30% and 0%, 15% and 15%, and 0% and 30%, respectively. The starter culture developed well with all formulations reaching pH 4.74.9 in 180 min of fermentation. Lactic acid bacteria in the products were above 8 log cfu/mL throughout the study. The beverages presented similar pH, acidity and viscosity. Buttermilk and whey can be interesting ingredients to be added into fermented milk beverages, because the consumers liked all the products equally, which had an average acceptance score exceeding liked moderately.

Determinação da razão isotópica delta13C em bebidas comerciais a base de laranja

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Carbon isotope analysis in apple nectar beverages

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Caracterização físico-química, energética e sensorial de refresco adoçado de jabuticaba

Pós-graduação em Agronomia (Energia na Agricultura) - FCA