Eating Patterns in the Brazilian Longitudinal Study of Adult Health
Total Page：16
File Type：pdf, Size：1020Kb
ARTIGO ARTICLE 1 Eating patterns in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): an exploratory analysis Letícia de Oliveira Cardoso 1 Padrões alimentares no Estudo Longitudinal de Marilia Sá Carvalho 2 Saúde do Adulto (ELSA-Brasil): Oswaldo Gonçalves Cruz 2 Cristiane Melere 3 uma análise exploratória Vivian Cristine Luft 3 Maria del Carmen Bisi Molina 4 Patrones alimenticios en el Estudio Longitudinal de Carolina Perim de Faria 4 Isabela M. Benseñor 5 Salud del Adulto (ELSA-Brasil): Sheila Maria Alvim Matos 6 un análisis exploratorio Maria de Jesus Mendes da Fonseca 1 Rosane Harter Griep 7 Dóra Chor 1 Abstract The food consumption of 15,071 public employees was analyzed in six 1 Escola Nacional de Saúde Correspondence Pública Sergio Arouca, L. O. Cardoso Brazilian cities participating in the baseline for Brazilian Longitudinal Fundação Oswaldo Cruz, Rio Escola Nacional de Saúde Study of Adult Health (ELSA-Brasil, 2008-2010) with the aim of identify- de Janeiro, Brasil. Pública Sergio Arouca, 2 Programa de Computação Fundação Oswaldo Cruz. ing eating patterns and their relationship to socio-demographic variables. Científica, Fundação Rua Leopoldo Bulhões 1480, Multiple correspondence and cluster analysis were applied. Four patterns Oswaldo Cruz, Rio de Janeiro, sala 813, Rio de Janeiro, RJ were identified, with their respective frequencies: “traditional” (48%); Brasil. 22763-195, Brasil. 3 Faculdade de Medicina, [email protected] “fruits and vegetables” (25%); “pastry shop” (24%); and “diet/light” (5%) The Universidade Federal do Rio “traditional” and “pastry shop” patterns were more frequent among men, Grande do Sul, Porto Alegre, Brasil. younger individuals, and those with less schooling. “Fruits and vegetables” 4 Centro de Ciências da and “diet/light” were more frequent in women, older individuals, and those Saúde, Universidade Federal with more schooling. Our findings show the inclusion of new items in the do Espírito Santo, Vitória, Brasil. “traditional” pattern and the appearance of the “low sugar/low fat” pat- 5 Hospital Universitário, tern among the eating habits of Brazilian workers, and signal socio-demo- Universidade de São Paulo, São Paulo, Brasil. graphic and regional differences. 6 Instituto de Saúde Coletiva, Universidade Federal da Feeding Behavior; Urban Population; Multivariate Analysis; Adult Bahia, Salvador, Brasil. 7 Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil. http://dx.doi.org/10.1590/0102-311X00066215 Cad. Saúde Pública, Rio de Janeiro, 32(5):e00066215, mai, 2016 2 Cardoso LO et al. Introduction particularly to explore the different patterns by socio-demographic characteristics. Obesity, a leading health problem in many coun- tries around the world, is very difficult to reverse. Dietary interventions based exclusively on en- Materials and methods ergy intake and nutrients may yield immediate success, but fail in the medium and long term 1. Study population The current proposed dietary guidelines for the Brazilian population 2, designed to promote a ELSA-Brasil is a multicenter cohort study that, healthy diet in the Brazilian context and encour- at baseline (2008-2010), examined 15,105 civil aging the consumption of “real food” (i.e. foods servants at teaching and research institutions in in their natural state or with minimal process- six cities in Brazil 14,15. Its main purpose was to ing), constitute a new strategy for future inter- estimate the incidence of cardiovascular diseases ventions. However, it is fundamentally important and diabetes and their social, environmental, oc- to verify what Brazilian adults are eating today cupational and biological determinants. All of the – not with a view to adjusting recommendations six institutions’ active and retired civil servants on nutrient intake in the strict sense, but to iden- aged 35 to 74 were eligible for the study. Baseline tify what foods are in fact being consumed, so as evaluation lasted about 7 hours and was divided to suit the proposals of the guide to the realities into two stages that included interviews and ex- of people’s actual diets. aminations conducted by a trained team. The in- International organizations have encouraged terviews addressed sets of risk factors for the dis- the study of dietary patterns 3 to evaluate a pop- eases of interest, as well as diet 16. Quality control ulation’s overall diet. Dietary patterns are pre- measures included direct team supervision, test- ferred over isolated nutrients, because studying retest studies and centralized interpretation of specific compounds can attenuate the strength laboratory and other test results 17. The study was or prevent the identification of possible associa- approved by the ethics committees of all six in- tions between overall diet and the risk of chronic stitutions and by the Brazilian National Research disease 4. Furthermore, identifying dietary pat- Ethics Committee and all participants signed a terns can help to establish new interventions, declaration of free and informed consent. because they show how foods are combined into This study included 15,071 (99.8%) ELSA-Bra- a dietary routine 5. sil participants for whom complete information Eating habits are changing in Brazil, as in was available from the food frequency question- other countries: consumption of ultra-processed naire (missing data n = 29) and on other study and ready-to-serve foods is increasing, while variables (missing data n = 34). consumption of minimally-processed and raw foods is decreasing, with adverse effects on Measuring food consumption health, as already indicated 6,7. There is evidence that patterns of food consumption vary with de- A Food Frequency Questionnaire (FFQ) of 114 mographic characteristics and socioeconomic food items, based on a previously validated levels. In Brazil, there are few studies relating to questionnaire 18, was applied by trained inter- these dietary patterns. They are expected to be viewers, in order to evaluate participants’ usual varied, given the country’s cultural and economic consumption in the previous 12 months. The list diversity 5,8,9,10,11,12. of foods was modified on the basis of a study per- A recent study, representative of Brazil’s pop- formed at the six research centers in which 100 ulation, revealed that household acquisition of 24-hour dietary recalls (R24h) were applied 19. food is characterized, at the same time, by foods Some foods (e.g. zucchini, chayote and eggplant) acknowledged to be beneficial to health (e.g. fruit were grouped into single items. When different and vegetables) and less healthy foods (e.g. con- types of the same food displayed different nu- fectionery, processed meats, ready meals), and tritional features (e.g. white or whole rice; full- also by a “traditional” pattern that includes rice, cream, semi-skimmed or skimmed milk), par- beans, eggs, roots and tubers 13. ticipants were asked to indicate which type they The Brazilian Longitudinal Study of Adult consumed most often, and only that one was Health (ELSA-Brasil) evaluated food consump- recorded. The results of the quality evaluation tion in six cities in three of Brazil’s macro-regions studies of the ELSA-Brasil food frequency ques- (Northeast, Southeast and South). It thus offers tionnaire demonstrated satisfactory reliability an excellent opportunity to pursue in-depth for all nutrients and acceptable relative validity knowledge of dietary patterns among Brazilian for energy, macronutrients, calcium, potassium working populations residing in large cities – and vitamin E and C 20. Cad. Saúde Pública, Rio de Janeiro, 32(5):e00066215, mai, 2016 EATING PATTERNS IN THE ELSA-BRASIL 3 The semi-quantitative food frequency ques- 2%) or not at all in some of the study centers, tionnaire of the ELSA-Brasil study was structured making it harder to establish patterns. Alcohol- as follows: (1) foods/preparations; (2) number of ic beverages were also eliminated as this study portions, expressed in household measures or aimed to identify dietary patterns. reference units; and (3) consumption frequen- cies (“more than 3 times a day”, “2-3 times a day”, • Definition of food subgroups “once a day”, “5-6 times a week”, “2-4 times a week”, “once a week”, “1-3 times a month” and a) Step 1 “never/almost never”). Participants were asked about their consumption of each food item in the In this stage, the MCA was used once again, by 12 months preceding the interview. In order to inspecting the graphs, to indicate how many sub- facilitate their choices, participants were offered groups were formed. a response card with consumption frequency op- tions, eliminating the need to memorize them 19. b) Step 2 Statistical analysis After identifying the number of possible sub- groups from the MCA graphs, the vectors of the • Definition of food groups and frequency first two axes, corresponding to the coordinates categories of the food frequency categories, were extracted. That procedure made it possible to define the The 114 food items were assembled into ten number of subgroups by cluster partition analy- groups by nutritional composition and by divi- sis (partitioning around medoids, PAM). At this sions used in previous studies in Brazil 18,21. stage, the cluster graphs were examined to as- Initial analyses using the original eight FFQ certain intragroup homogeneity and intergroup categories returned no interpretable results. heterogeneity, and the silhouette graphs were Therefore, the number of food frequency cate- used to assist in analyzing the cluster quality of gories was redefined using multiple correspon- the previously established k groups (the closer dence analysis (MCA) in each food group. In this to 1 the silhouette value, the better placed those procedure, the correspondence matrix derived items are in the group). In addition, the silhou- from the contingency table can be decomposed ette statistic was used as a parameter for defin- into eigenvalues and eigenvectors, from which ing the number of subgroups, the value desired the main coordinates of the table lines and col- being in excess of 0.523.