Brazilian National Dietary Survey Research Articles

The global diet quality score as an indicator of adequate nutrient intake and dietary quality – a nation-wide representative study

BackgroundThe Global Diet Quality Score (GDQS) was developed to be a simple, timely and cost-effective tool to track, simultaneously, nutritional deficiency and non-communicable disease risks from diet in diverse settings. The objective was to investigate the performance of GDQS as an indicator of adequate nutrient intake and dietary quality in a national-representative sample of the Brazilian population.MethodsNationally-representative data from 44,744 men and non-pregnant and non-lactating women aging ≥ 10 years, from the Brazilian National Dietary Survey were used. Dietary data were collected through two 24-h recalls (24HR). The GDQS was calculated and compared to a proxy indicator of nutrient adequate intake (the Minimum Dietary Diversity for Women—MDD-W) and to an indicator of high-risk diet for non-communicable diseases (caloric contribution from ultra-processed foods—UPF). To estimate the odds for overall nutrient inadequacy across MDD-W and GDQS quintiles, a multiple logistic regression was applied, and the two metrics’ performances were compared using Wald’s post-test.ResultsThe mean GDQS for Brazilians was 14.5 (0–49 possible range), and only 1% of the population had a low-risk diet (GDQS ≥ 23). The GDQS mean was higher in women, elderly individuals and in higher-income households. An inverse correlation was found between the GDQS and UPF (rho (95% CI) = -0.20(-0.21;-0.19)). The odds for nutrient inadequacy were lower as quintiles of GDQS and MDD-W were higher (p-trend < 0.001), and MDD-W had a slightly better performance than GDQS (p-diff < 0.001). Having a low-risk GDQS (≥ 23) lowered the odds for nutrient inadequacy by 74% (95% CI:63%-81%).ConclusionThe GDQS is a good indicator of overall nutrient adequacy, and correlates well with UPF in a nationally representative sample of Brazil. Future studies must investigate the relationship between the GDQS and clinical endpoints, strengthening the recommendation to use this metric to surveillance dietary risks.

Intake of Table Sugar and Their Corresponding Food Sources in Adults from the 2017-2018 Brazilian National Dietary Survey.

Excessive intake of free sugars is associated with adverse health outcomes. Table sugar is one of the main dietary sources of free sugars; however, the amount added by Brazilian consumers in their culinary preparations is unknown. The aims were to estimate the daily intake of table sugar (g/day), its contribution to total energy intake (E%) and the main food groups that contribute to the intake of this sugar in a nationwide multi-ethnic sample of Brazilian adults (2017-2018 Brazilian National Dietary Survey). Based on two 24-h recalls adjusted for the within-person variation, the overall median table sugar intake was 14.3 g/day, corresponding to 3.2 E%. Males, individuals living in rural areas, with low income, low education and experiencing food insecurity had a higher intake of table sugar. The main food sources of table sugar were coffee (55.8%), juice (33.9%), milk-based preparations and smoothies (3.1%), powdered and processed juice (2.7%), whole milk (1.9%), and tea (1.6%). There are no recommendations regarding the limit of table sugar intake, but considering that the WHO limits the intake of free sugars to <10 E%, it is concluded that table sugar intake by Brazilians corresponds to about 30% of the upper recommended daily intake of free sugars.

100% Orange Juice Consumption is Associated with Socioeconomic Status, Improved Nutrient Adequacy, and Higher Bioactive Compounds Intake: Results from Brazilian National Dietary Survey 2017–2018

Objective The consumption of 100% orange juice (OJ) has been associated with nutrient adequacy and better diet quality. To date, there are few analyses exploring 100% OJ consumption patterns across populations, with no data from Brazil. We aimed to explore the associations between 100% OJ consumption, sociodemographic factors, and nutrient intake in a representative sample of the Brazilian general population aged 10 years or older. Methods Data were obtained from the National Dietary Survey 2017–2018, a cross-sectional study including data on individual food intake of 46,164 subjects aged ≥10 years collected using two 24-h dietary recalls. Results 100% OJ was consumed by 11% of the population, with a mean intake of 43.0 ml/d. Males were more frequent consumers compared to females, and the percentage of consumers increased with education and income. 100% OJ consumption was associated with higher intakes of energy, vitamin C, folate, calcium, magnesium, potassium, polyphenols, and carotenoids. There is no significant difference in fiber intake between consumers and non-consumers. 100% OJ consumers had a higher percentage of the population meeting the Estimated Average Requirement for vitamin A, vitamin C, vitamin D, folate, calcium, and magnesium. Conclusion Our results suggest that 100% OJ could be a component of a healthy diet, helping individuals to achieve nutrient recommendations.

How many meals and snacks do Brazilians eat a day? Findings from the 2017-2018 Brazilian National Dietary Survey.

The habit of eating specific meals has been addressed in several studies, but the evaluation of meal patterns has received less attention. This study aimed to describe the meal patterns of the Brazilian population. A complex sampling design was used to select the 46,164 ≥ 10-year-old individuals examined in the Brazilian National Dietary Survey. Food consumption was assessed by two non-consecutive 24-hour recalls applied throughout a one-week period. The exploratory data analysis approach was used to determine the meal patterns, i.e., how individuals combined the main meals (breakfast, lunch, dinner) and snacks (morning, afternoon, evening/night) throughout the day. The most common meal patterns were three main meals + one snack, reported by 25.1% of the individuals, and three main meals + two snacks (24.6%). Other meal patterns identified were: three main meals + three snacks (18.5%); three main meals and no snacks (10.9%); one or two main meals + two snacks (7.4%); one or two main meals + one snack (6.9%); one or two main meals + three snacks (4.2%); and one or two main meals and no snacks (2.3%). Meal patterns varied according to gender and age group, and on typical versus atypical food consumption days. We found that eight patterns characterized the daily meal consumption in Brazil. Furthermore, around 80% of the population had three main meals every day and about 13% did not report having any snacks. The characterization of meal habits is important for tailoring and targeting health promotion actions.

Carbon Footprint of Away-From-Home Food Consumption in Brazilian Diet

Environmentally unsustainable diets are often characterized by being high in calories, processed foods, and red meats, characteristics related to away-from-home food (AFHF). The aim of this study is to evaluate if AFHF consumption is related to environmental sustainability. Data of 20,780 adults from 24 h recalls collected in the 2017-2018 Brazilian National Dietary Survey (NDS) were used to estimate carbon footprint coefficients. The mean carbon footprint was estimated among individuals who consumed AFHF and non-consumers. Linear regression models were used to evaluate differences between away-from-home eating and the carbon footprint of the diet, adjusting for age and income. A total of 41% of Brazilians consumed AFHF during the previous day. The mean carbon footprint from foods consumed away from home represented 18% of the total carbon footprint. AFHF was positively associated with increased total carbon footprint (β: 204.1; p-value: 0.0145). In conclusion, the consumption of foods away from home in urban areas of Brazil was associated with atmospheric greenhouse gas emissions independently of age and income. Away-from-home food consumption should be considered to reinforce the influence of diet on individual and planet health.

Snacking habits of Brazilian adolescents: Brazilian National Dietary Survey, 2017-2018.

This study was aimed at describing the snack consumption among Brazilian adolescents. The Brazilian National Dietary Survey (2017-2018) is a nationwide representative cross-sectional study that collected food consumption data from 8264 adolescents (10 to 19 years old); data from one 24-h recall were used, in which all foods and beverages consumed throughout the day prior to the interview were described along with the amount, unit of measurement, time, place and occasion of consumption (breakfast, lunch, dinner or snack). Snacks were classified as follows: (a) Morning snack: "Snacks" consumed between 6AM and 12 PM; (b) Afternoon snack: "Snacks" consumed between 1PM and 5PM; (c) Evening snack: "Snacks" consumed between 6PM and 5AM. Individuals were categorised according to the number of "Snacks" per day (zero, one, two or three or more). Among the evaluated adolescents, 52.8% were female and 23.0% were overweight. The consumption of at least one snack per day was mentioned by 88.2% of the adolescents, with an average of 2.33 snacks per day. An afternoon snack was consumed by 70.0% of the adolescents. Snack consumption was related to higher mean daily energy intake and a greater contribution of carbohydrates, added sugar and trans fat to the total daily energy intake. 'Cookies & Crackers' and 'Fast Foods' were the groups that contributed the most to the energy intake provided by snacks, showing, therefore, that less healthy foods were relevant components of the snacks consumed. For their important contribution to food intake, snacking habits deserve attention among the topics covered in dietary guidelines.

Prevalence of Excess Sodium Intake and Their Corresponding Food Sources in Adults from the 2017–2018 Brazilian National Dietary Survey

Excessive sodium intake has been related to high blood pressure, a central risk factor for cardiovascular disease. In the present work, updated estimates of sodium intake, the main food sources, and the prevalence of excessive intakes in a nationwide multi-ethnic sample of Brazilian adults (2017–2018 Brazilian National Dietary Survey) were presented. Based on two 24-h recalls adjusted for the within-person variation, the overall median of sodium intake was 2432 mg. The prevalence of adults exceeding the recommended limits (tolerable upper limit, UL, and the chronic disease risk reduction cut-off point, CDRR) was 61% and 56%, respectively. The median sodium intake and proportion of individuals above the limits varied according to the subgroups evaluated. Males and adults (20–29 years) presented the highest excessive sodium intakes, and consequently, lowest adherence rates to UL and CDRR recommendations. The top food sources of sodium were white bread and toast (12.3%), beans (11.6%), white rice (10.6%), beef (7.7%), and poultry meat (5.5%). Given the health benefits of dietary sodium reduction, it would be advisable to enhance the current national initiatives of awareness and educational campaigns’ combined efforts to reduce sodium in processed foods to effectively decrease this micronutrient intake across the Brazilian population.

Breakfast patterns and weight status among adolescents: a study on the Brazilian National Dietary Survey 2008-2009.

Examining the composition of breakfast concerning weight status is essential for evaluating adolescent health and understanding this gap. This study aimed to identify breakfast patterns and investigate the relationship with weight status among Brazilian adolescents. We used a subsample of 7425 adolescents aged 10-19 years from the 2008-2009 Brazilian Household Budget Survey. Breakfast eaters were those with intake of at least 50 kcal (209·2 kJ) between 05.00 and 10.00 hours. Breakfast dietary patterns were derived by principal component factor analysis with varimax rotation. We performed logistic regression analyses between breakfast patterns and weight status, considering the complexity of the survey sample design. Three breakfast patterns were identified explaining 44·8 % of data variability: (1) the Cereal, protein, fruit beverages and Northern/Northeastern pattern, characterised by high consumption of cookies, meats, dairy products, preparations with maize, eggs, fruit juices/fruit drinks/soya-based drinks, tubers/roots/potatoes and cereals, and negative adherence to cold cut meat and savoury snacks/crackers; (2) the Protein-based pattern, characterised by positive loadings for cold cut meat, milk and cheese, and negative for cookies, fruit juices/fruit drinks/soya-based drinks, tubers/roots/potatoes and cereals; and (3) the Mixed pattern, with positive loadings for cakes, coffee/tea, bread, fruit juices/fruit drinks/soya-based drinks, chocolate/desserts and savoury snacks/crackers. No association was found between skipping and weight status. Overweight adolescents had lower adherence to the Cereal, protein, fruit beverages and Northern/Northeastern pattern (OR = 0·67; 95 % CI 0·47, 0·96). This is the first study to address dietary patterns at the meal level with adolescent population-based data, which requires further investigation.

Impact of sociodemographic factors on the consumption of tubers in Brazil

BackgroundAlthough tubers play a significant role in Brazilian agriculture, very little is known about the intake of tubers among the Brazilian population. The objective of this study was to characterize the intake of tubers across Brazil. The types of tubers consumed were quantified, and the impact of geographic and sociodemographic factors was assessed.MethodsThis cross-sectional study is based on dietary intake data of 33,504 subjects obtained from the Brazilian National Dietary Survey. All tuber containing foods were identified, and the contribution of different tubers to overall tuber consumption in Brazil was quantified. Descriptive analyses assessed the impact of macroregion and sociodemographic characteristics on tuber consumption, and differences in intake were assessed using statistical tests. Lastly, the dietary intakes of tuber consumers and non-consumers were compared after adjusting for energy and covariates to determine if there were any major differences in dietary intakes between the two groups.ResultsFifty-five percent of the Brazilian population consumed tubers, which differed by macroregion. The intake of tubers among consumers also differed between macroregions. Overall, rural areas reported significantly higher mean daily intakes of tubers (122 g/day) among tuber consumers than urban areas (95 g/day). Mandioca and potato were the most commonly consumed tubers (59 and 43% prevalence, respectively, on any of the 2 days), while the highest daily intakes amongst tuber consumers across Brazil were noted for sweet potato (156 g/day) and potato (95 g/day). On a macroregion level, among tuber consumers, mandioca had the highest prevalence of consumption in the North (94%), Northeast (83%), and Central-West (68%), while consumption of potatoes was most prevalent in the Southeast (63%) and South (62%). Compared to women, small but significantly higher tuber intakes were noted for males (108 vs. 85 g/day). There were no significant differences in intakes among income quintiles. After adjusting for energy and other covariates, nutrient intakes between tuber and non-tuber consumers were not meaningfully different, with the exception of sodium (+ 6.0% comparing non-tuber to tuber consumers), iron (+ 6.1%), zinc (+ 5.7%), vitamin C (+ 8.3%), riboflavin (+ 9.0%), and folate (+ 7.9%).ConclusionsTuber consumption is influenced by regional and sociodemographic characteristics of the Brazilian population. When looking at energy-adjusted nutrient intakes, diets of tuber consumers have resulted in somewhat lower intakes of some micronutrients, namely riboflavin, folate, vitamin C, iron, sodium, and zinc.

Carbohydrate and Lipid Dietary Quality Indexes: Trends in the Brazilian Population

ObjectivesOur aim was to evaluate the qualitative profile of carbohydrate (CHO) and fat intake and the modification in 10-year period according to demographic and socioeconomic variables. MethodsData from two Brazilian National Dietary Survey with nationally representative sample of individuals ≥10 years old. The dietary Carbohydrate Quality Index (CQI) is a score ranging from 4 to 20 calculated from dietary fiber intake, global glycemic index, solid CHO to total CHO ratio and CHO from wholegrains to CHO from total grains ratio. Lipid Quality Index (LQI) was estimated by dividing the sum of the dietary content of monounsaturated and polyunsaturated fatty acids by the sum of saturated with trans fatty acids. Both indexes were categorized in quintiles in ascending order for best quality. Information about sex, age (categorized in adolescents, adults and elderly), income (quartiles), urban and rural area and lastly body mass index (categorized in obesity, overweight and normal/underweight) was collected. The estimates were generated separately for each survey and their 95% confidence intervals were compared to identify changes in time. ResultsCQI reduced in the Brazilian population, but was not significant. There was a significant reduction in the quintile of greater CHO quality over time for adolescentes (2,8%), first quartile of income (3,3%) and people living in rural área (5,3%). Otherwise the frequency of people that have better dietary quality for CHO increased for the last quartile of income (3,2%) over time. It was observed an increase for the population and for several categories at the second quintile for CQI, including men, adolescents, people in lowest quartile for income and people living in rural area. >The LQI raised 1,6% across 10 years in Brazilian population. It also increased between women (3,2%), adults (2,1%), last quartile of income (4,2%), urban area (2,2%) and obese (4,1%). Additionally, the frequency of people in the lowest quartile for income that presented the best quality in their diet for fats decreased 3,7% in 10 years. ConclusionsStrategies to improve the dietary carbohydrate quality should be taken into consideration; particular attention should be given to dietary quality of carbohydrates and lipids of people with lowest income values in the Brazilian population. Funding SourcesNot applicable.

Intake of saturated fat, trans fat, and added sugars by the Brazilian population: an indicator to evaluate diet quality

In recent decades, changes in the diet of Brazilians have been characterized by increased consumption of high energy-dense foods, rich in fat and sugar. This study was aimed at assessing diet quality based on the intake of foods with high content of solid fat and added sugars (SoFAS). The first Brazilian National Dietary Survey (2008-2009) is a nationwide representative cross-sectional study that collected food records from 34,003 ≥ 10-year-old individuals. A receiver-operating characteristic curve was used to determine the limit that would identify diets with high SoFAS content. The limit of 45% of total dietary energy provided by SoFAS was adopted to classify diets with excessive content. The SoFAS provided 53% of daily energy intake to adolescents, 49% to adults, and 48% to the elderly. A high intake of SoFAS was found in 64.7% of adolescents, 59.1% of adults, and 57.8% of the elderly. The contribution of SoFAS to daily energy intake increased with income in all age groups. Those with high consumption of SoFAS had higher intakes of sugar-sweetened beverages, cookies and cakes, processed meats, chips, candy and chocolate, and sandwiches and snacks, when compared with those that had moderate SoFAS intake (<45% of daily energy). The 45% cutoff point for the contribution of SoFAS foods to total energy intake, utilized to classify low-quality diets, allowed to point out the high-risk profile of the Brazilian diet.

Adult food consumption by household composition: an analysis of the first National Dietary Survey, Brazil, 2008-2009.

To evaluate differences in food consumption of Brazilian adults according to the presence of children and adolescents in the household. Averages of two non-consecutive days of food records from the first Brazilian National Dietary Survey were analysed and classified into eighteen food groups according to nutritional characteristics and use in diet. We compared the mean percentage contribution to total daily energy intake of each food group according to three groups of household composition: adults living alone or with other adults (32·7 %), adults living with children (35·6 %) and adults living with adolescents (31·7 %). Brazilian nationwide survey, 2008-2009. Adults aged 20-59 years (n 6312; 52·1 % female). Women living alone or with other adults had higher consumption of vegetables, milk and other drinks, and lower consumption of beans and rice, compared with those living with children or adolescents. Men living alone or with other adults had higher consumption of sweets & desserts and vegetables, and lower consumption of beans, compared with those living with children or adolescents. According to household income, adults in the highest tertile who lived with children or adolescents presented a mixed consumption of healthy and unhealthy foods, whereas their counterparts in the first income tertile presented a marked consumption of foods considered traditional of the Brazilian population. There are differences in food consumption based on the presence of children and adolescents in the household, with greater variation according to gender and household income.

Are there differences in nutrient intake of Brazilian adults according to weight status?

It was assessed the intake and prevalence of inadequate nutrient intake according to weight status among Brazilian adults from urban areas (n=16,198) evaluated in the Brazilian National Dietary Survey (NDS - 2008-2009), that obtained food records from two non-consecutive days. The prevalence of inadequate nutrient intake according to weight status was estimated based on Brazilian and international recommendations, in which usual intake was estimated applying the National Cancer Institute method. From 14 nutrients evaluated, six differed according to weight status in men, and only two among women. For men, the mean proportion of energy derived from lipids and saturated fat and mean intake of cholesterol, zinc, and vitamin B12 were greater among those with excess weight compared to those with normal weight; the inverse was observed for dietary fiber. Mean sodium intake was greater and proportion of energy from added sugar intake was lower among obese women compared to overweight ones. Strategies to encourage food consumption with high micronutrient density should be targeted to adult population regardless of their weight status.

Prevalence of consumption and nutritional content of breakfast meal among adolescents from the Brazilian National Dietary Survey

ObjectiveTo estimate the prevalence of breakfast consumption and describe the foods and nutrients consumed at this meal and throughout the day by Brazilian adolescents. MethodA total of 7276 adolescents aged 10–19 years were evaluated in the Brazilian National Dietary Survey 2008–9, a population‐based cross‐sectional study. Individuals’ information was collected at home. Dietary data were obtained by two food records. Breakfast was defined as the first eating occasion of the day that occurred between 6 and 9:59am. Differences between breakfast consumers, occasional consumers, and skippers were tested through Pearson's chi‐squared test or F‐test of regression analysis. ResultsBreakfast was consumed by 93% of adolescents and it was associated with age, income, geographic region and household area. The most frequently consumed foods at breakfast were white bread, coffee, butter/margarine, refined cookies and crackers, and whole milk. The mean daily intakes of total energy, sugar, and calcium were higher among occasional consumers and skippers. Breakfast consumers had higher intake of vitamins B12, C, and D. Breakfast contributed more to total intake of calcium, phosphorus, thiamin, riboflavin, and vitamins A, B6, and D (17–32%), trans fat and sodium (about 30%) and less to folate, vitamin C, iron, zinc, and fiber (8–12%) and energy intake (16%). ConclusionsAlthough the prevalence of breakfast consumption among Brazilian adolescents was high, the overall nutritional quality of this meal is suboptimal, highlighting the need to support adolescents and their families to make more nutrient‐dense food choices.

Breakfast patterns and their association with body mass index in Brazilian adults.

The objective was to investigate the relationships between body mass index (BMI), skipping breakfast, and breakfast patterns in Brazilian adults. We analyzed data of 21,003 individuals aged between 20 to 59 from the Brazilian National Dietary Survey 2008-2009. Breakfast was defined as the eating occasion between 5 and 10a.m. with the highest usual food consumption (exceeding 50Kcal/209.2kJ). Dietary patterns were derived by the factor analysis of 18 food groups (usual intake). Controlling for confounders linear regressions of BMI were used to verify the associations considering the survey design. Skipping breakfast was not associated with BMI. Three breakfast patterns were observed (48% variability): Brazilian Northern (positive loading for meats, preparations with corn, eggs, tubers/roots/potatoes, dairy products, savory snacks/crackers, fruit juices/fruit drinks/soy-based drinks); Western (positive for fruit juices/fruit drinks/soy-based drinks, sandwiches/pizza, baked/deep-fried snacks, chocolate/desserts, cakes/cookies) and Brazilian Southeastern (cold cut meat, milk, cheese, coffee/tea, bread). The Brazilian Southeastern pattern was inversely associated with BMI, while the Brazilian Northern pattern was directly associated with it. Therefore, the results suggest a role for breakfast quality in the association with BMI. Thus, a Brazilian Southeastern breakfast usual intake may be inversely associated with BMI.

Lunch quality and sociodemographic conditions between Brazilian regions.

The objective of this study was to assess the quality of lunch consumed by adults in Brazil and its sociodemographic determinants in each Brazilian region. A cross-sectional study was carried out and a representative sample of regional populations was used. The sample comprised of 16,096 adults from the Brazilian National Dietary Survey, part of the Brazilian Household Budget Survey (POF). The lunch quality was evaluated by applying the main meal quality index (MMQI), comprised of 10 items of equal weights that resulted in a score that ranged from zero to 100 points. Linear regression models measured the association between lunch quality and sociodemographic factors. The average energy consumption at lunch was 704kcal (SD = 300), and the meal quality score mean was 57 points (SE = 0.30). The North Region had the worst MMQI score (56 points, SE = 0.07), while the Central had the best MMQI adjusted score (59 points, SE = 0.05). The MMQI final score was positively associated with male gender and ages between 20-39 years, and was inversely associated with having eight years or more of education, per capita income of at least three minimum wages, and with the consumption of meals prepared away from home. Despite differences among sociodemographic factors, all Brazilian regions had a lunch composed of foods rich in sugars and fats, with insufficient portions of fruits and vegetables, resulting in a low meal quality.

Use of Table Sugar and Artificial Sweeteners in Brazil: National Dietary Survey 2008-2009.

The study aimed to describe the use of table sugar and artificial sweeteners (AS) in Brazil. A representative sample (n = 32,749) of individuals aged > 10 years was examined from the Brazilian National Dietary Survey (2008–2009). Participants reported whether they use table sugar, AS, both, or none as sweeteners for their foods and beverages. Energy intake and the contribution of selected food groups to energy intake were evaluated according to the type of sweetener reported. Sample weights and design effects were considered in the analysis. The majority of the population (85.7%) used sugar to sweeten foods and beverages, 7.6% used AS, and 5.1% utilized both products. The use of AS was more frequent among the elderly (20%), women (10% versus 5.5%), overweight individuals (10% versus 6%), those who live in urban areas (8.5% versus 3%), and those who belong to the highest income quartile (14% versus 1.6%), compared with men, normal weight individuals, those who live in rural areas, and those who belong to the first income quartile, respectively. Overall, the mean daily energy intake of individuals using only sugar was approximately 16% higher than those who used AS exclusively. The contribution of staple foods to daily energy intake was higher in individuals who used sugar than those who used AS.

Prevalence of consumption and nutritional content of breakfast meal among adolescents from the Brazilian National Dietary Survey

ObjectiveTo estimate the prevalence of breakfast consumption and describe the foods and nutrients consumed at this meal and throughout the day by Brazilian adolescents. MethodA total of 7276 adolescents aged 10–19 years were evaluated in the Brazilian National Dietary Survey 2008–9, a population-based cross-sectional study. Individuals’ information was collected at home. Dietary data were obtained by two food records. Breakfast was defined as the first eating occasion of the day that occurred between 6 and 9:59am. Differences between breakfast consumers, occasional consumers, and skippers were tested through Pearson's chi-squared test or F-test of regression analysis. ResultsBreakfast was consumed by 93% of adolescents and it was associated with age, income, geographic region and household area. The most frequently consumed foods at breakfast were white bread, coffee, butter/margarine, refined cookies and crackers, and whole milk. The mean daily intakes of total energy, sugar, and calcium were higher among occasional consumers and skippers. Breakfast consumers had higher intake of vitamins B12, C, and D. Breakfast contributed more to total intake of calcium, phosphorus, thiamin, riboflavin, and vitamins A, B6, and D (17–32%), trans fat and sodium (about 30%) and less to folate, vitamin C, iron, zinc, and fiber (8–12%) and energy intake (16%). ConclusionsAlthough the prevalence of breakfast consumption among Brazilian adolescents was high, the overall nutritional quality of this meal is suboptimal, highlighting the need to support adolescents and their families to make more nutrient-dense food choices.

At-home and away-from-home dietary patterns and BMI z-scores in Brazilian adolescents

BackgroundAway-from-home food intake has been associated with high rates of overweight among children and adolescents. However, there are no studies comparing at-home and away-from-home eating patterns among adolescents. ObjectivesThe objective of this paper was to identify at-home and away-from-home dietary patterns among adolescents in Brazil, and to evaluate the relationship between these patterns and body mass index (BMI) z-scores. DesignData from the Brazilian National Dietary Survey 2008–2009 were analyzed in this cross-sectional study. Dietary intake was assessed by completion of written food records on two non-consecutive days. Participants/settingFive thousand two hundred sixty-six adolescents 10–19 years of age living in urban areas of Brazil were included in the analysis. Statistical analysisThirty-two food groups were examined by factor analysis, stratified by at-home and away-from-home eating. The associations between the food patterns and BMI z-scores were ascertained using linear regression analysis. ResultsIn general, mean at-home food intake was greater than away-from-home food intake, but the ratio of away-from-home/at-home was greater than 30% for baked and deep-fried snacks, soft drinks, sandwiches, pizza, and desserts, and was lower than 10% for rice and beans. Three main similar dietary patterns were identified both at-home and away-from-home: the “Traditional pattern”, the “Bread and Butter pattern” and the “Western pattern”; however, away-from-home patterns encompassed more overall food items. Only the at-home “Western pattern” was positively associated with BMI z-scores (β = 0.0006; p < 0.001). ConclusionOur results indicate that unhealthy dietary pattern consumed at home is associated to BMI z-score, while away-from-home food consumption is not associated.

Quality of food choices of Brazilian adolescents according to individual earnings.

To evaluate the quality of food choices according to adolescent individual earnings in Brazil. Adolescents were classified according to their individual earnings as having or not having spending power for their own expenses. Food records from two non-consecutive days of the Brazilian National Dietary Survey (NDS 2008-2009) were used to estimate food intake. Quality of food choices was based on two approaches: (i) the NOVA classification, which classifies processed and ultra-processed foods and drinks as unhealthy food groups; and (ii) traditional classification, with beans, milk, fruits and vegetables as healthy food groups, and soft drinks, sweets, snacks and crackers classified as unhealthy. We compared mean food intake (g/kJ or ml/kJ) according to per capita household income (tertiles) and adolescent individual earnings, with adolescent earnings adjusted for household income, using multiple linear regression. Brazilian households (n 13 569). Adolescents aged 14-18 years (n 3673). Males without individual earnings had higher per capita household income than those with individual earnings. Household income was associated with all three food groups of the NOVA classification and seven of the eight groups of the traditional classification. However, only beans and snacks were consumed in significantly greater quantities by adolescents with individual earnings compared with those without earnings. Adolescent individual earnings were not the main driver of food choices; however, per capita household income was associated with food choices. The consumption of both healthy and unhealthy items increased with increasing household income.