Validation of the Brazilian Healthy Eating Index-Revised Using Biomarkers in Children and Adolescents.

Roseli Toffano,Elaine Hillesheim,Jim Kaput,Francois-Pierre Martin,Jacqueline Monteiro,Laeticia Silva,Sofia Moco,Laurence Goulet,Maria Almada,Roberta Salomão,Carolina Coelho-Landell,Sebastiano Collino,Tamiris Barros,Serge Rezzi,José Camelo-Junior,Maria Giner,Joyce Camarneiro,Mariana Mathias,Ivan Montoliu

doi:10.3390/nu10020154

Abstract

The Brazilian Healthy Eating Index-Revised (BHEI-R) can be used to determine overall dietary patterns. We assessed the BHEI-R scores in children and adolescents, aged from 9 to 13 years old, and associated its component scores with biomarkers of health and dietary exposure. Three 24-h recalls were used to generate BHEI-R. Biomarkers were analyzed in plasma and red blood cells. Correlation tests, agreement, and covariance analyses were used to associate BHEI-R components with biomarkers. Data from 167 subjects were used. The strongest correlations were between fruits, vegetables and legumes with omega-6 and omega-3 fatty acids, and β-carotene intakes. Milk and dairy correlated with plasma retinol and pyridoxine. All components rich in vegetable and animal protein sources correlated with plasma creatine. Total BHEI-R scores were positively associated with intakes of omega-6, omega-3, fiber and vitamin C, and inversely associated with energy and saturated fat intakes of individuals. Plasma β-carotene and riboflavin biomarkers were positively associated with total BHEI-R. An inadequate food consumption pattern was captured by both biomarkers of health and dietary exposure. BHEI-R was validated for the above dietary components and can be associated with metabolomics and nutritional epidemiological data in future pediatric studies.

Highlights

Associating individual foods with health outcomes does not account for the chemical complexity of foods and for widely varied eating habits
The results of this study demonstrated that in the cohort of Brazilian children and adolescents, aged 9 to 13 years, have poor diets, regardless of income level
The negative characteristics of food consumption patterns identified here, such as excessive content of sugar and lower amounts of whole grains, fruits, milk and dairy, and vegetables are consistent with other scientific studies

Summary

Introduction

Associating individual foods with health outcomes does not account for the chemical complexity of foods and for widely varied eating habits. Diet quality indices can be used to determine overall dietary patterns [1] The advantage of such indices is that they capture the complexity of human diets in a single value, Nutrients 2018, 10, 154; doi:10.3390/nu10020154 www.mdpi.com/journal/nutrients. Nutrients 2018, 10, 154 taking into account population food guides and the interactions between nutrients, food preparation methods, and eating patterns [1,2]. Guide 2006, with portion sizes for ages above 2 years [5]. This last version is called the Brazilian

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