nutrient intakes according to eating patterns and nutritional status for older people josé eduardo...

4rd International Conference on Obesity and Weight Management

Nutrient intakes according to eating patterns and nutritional status for

older people

José Eduardo Corrente – Patrícia Moraes FerreiraBiostatistics Department - UNESP – Botucatu

São Paulo - Brazil

4th International Conference and Exhibition on Obesity and Weight Management

1. Introduction

• The feeding plays a fundamental role in the promotion, maintenance and recover of health (FERREIRA; MARUCCI, 2004).

• With aging, the food security becomes more frequent due to factors which limit the consumption of food and nutrients.


• Among them are physiological, oral cavity changes, economic, psychosocial, mobility restriction and other factors. (CAMPOS et al., 2000).

• Added to these factors, the nutritional transition, due to changes in dietary patterns and physical inactivity, brought great impact on health and nutritional status of the elderly (SILVEIRA et al., 2007).



• The main focus of nutritional epidemiology at the present moment has been the study of chronic diseases as obesity, diabetes and heart disease associated with the conditions of development and modernity (FRANGELLA et al., 2009).

• In Brazil, epidemiological studies on food consumption of the elderly are increasing, due to concern about the change in dietary pattern and the high prevalence of chronic non-communicable diseases in this age group.


• In order to evaluate the consumption, FFQ is an instrument that can evaluate the usual intake using a long time information from a list of food.

• It is usual to get data from FFQ to obtain eating patterns of a population but e we also can get information about nutrient intakes.


• In the literature, there is a lack of studies that make these two approaches: nutrient intakes and eating patterns.


2. Objective

The aim of this study was to analyze the nutrient intakes according to the dietary pattern and nutritional status of older people registered in the Basic Health Units and Family Health Strategies of Botucatu-SP - Brazil.


3. Methodology

• Cross-sectional epidemiologic study carried over in Botucatu city – São Paulo – Brazil, using 172 older people registered in then Basic Health Units.

• This is a subsample of a previous research carried out with 355 older people in order to evaluate obesity in the population.


São Paulo State

Botucatu

http://pt.wikipedia.org/wiki/Ficheiro:Brazil_location_map.svg

http://pt.wikipedia.org/wiki/Ficheiro:SaoPaulo_Municip_Botucatu.svg


• The subsample was randomly selected and a validated FFQ for older people was applied and information about food, frequency and quantity (portion size) was recorded.


• Data collection took place at households and at the basic health units from March to June of 2011.

• Also it was applied a sociodemographic and lifestyle identification questionnaire and anthropometric evaluation was made.


• Other variables analyzed: - consumption of alcoholic beverages; - gender; - education level; - marital status; - physical activity. - income per member

• FFQ - was analyzed and interpreted using factor analysis

(principal component analysis - PCA) with varimax rotation in order to obtain eating patterns.


Consumption scores were calculated in order to obtain participants’ adherence, which were divided into tertiles classified as:

1st tertile – low adherence of the pattern;2nd tertile – moderate adherence to the pattern3rd tertile – high adherence to the pattern.


• Obesity was evaluated as “general obesity” or “abdominal obesity”. • General obesity: - Body Mass Index (BMI) defined as ≥ 30 kg/m2; - Abdominal obesity:

WC ≥ 88cm for women WC ≥102cm for men • Both criteria are in agreement with

recommendations from the WHO.


Data from FFQ were transformed in nutrient intake.

FFQ contain information about:

- Frequency of food consumption = daily, weekly, monthly, annually

- Number of times consumption- Portion size: small, medium, large, extra-large

With these information we calculate:

Food intake daily= frequency * portion size/number of days


This calculation transform the information from FFQ in daily consumption for each food.

Then, we calculate the amount of nutrient based on 100g of each food as:

Nutrient in the food = Food intake * amount of nutrient /100


Example:

Soup consumption 2 times a week in a small portion

To calculate the amount of energy:

Small portion of soup = 75.85g

Food intake = 2 * 75.85/7 = 21.67g a day

Amount of energy in 100g of soup = 46.71kcal

Energy of soup = 21,67 * 46.71/100 = 10.12 kcal


This calculation was made for each food in the FFQ list considering all the information about frequency, number of days, portion size and amount of nutrients in 100g of each specific food.

Adding all nutrient information from the list of food, we get the consumption of that nutrient.

All the information about the size of the portions and the amount of nutrient in 100g of food was developed by the Nutrition Department – Public Health School at University of São Paulo (ISA – Capital Project) – São Paulo - Brazil.


A routine in SAS for windows software, v.9.4, was developed in order to transform the information from FFQ in nutrient intakes.

In this work we analyze only some macro and micronutrients considered important for older people.


• Mean intakes of the nutrients were compared using a generalized linear model with gamma distribution (asymmetric data) considering: sex, general obesity, central obesity and tertiles of eating patterns.

• Total energy was included in analysis as a confounding variable.

• All analysis were made using SAS for Windows software, v.9.4.


• Ethics

• The study was approved by the Committee of Ethics in Research of the Botucatu Medical School - São Paulo State University (UNESP).


3. Results and Discussion

• Sample characteristics

- 80 male (46.5%) and 92 female (53.5%),- Mean age: 69.5 7.9 yo (60 to 92 yo);- Mean Per capita family income was 1.89

minimum wages (approximately 500 U.S. dollars).


• Prevalence of general obesity:- 21.25% in men and 25% in women

• Prevalence of abdominal obesity:- 60% in men and 66.3% in women.


• The six patterns identified through factor analysis were:

1. Healthy foods: raw endive/chicory; beetroot/chayote/zucchini; broccoli/cauliflower/cabbage; cooked endive/kale; carrots; extra virgin olive oil; tomatoes; lettuce; fish; oats.


2. Snacks and weekend meals: processed meat; mozzarella/cheddar cheese; pizza/pancakes; baked snacks; bacon/jerky; hamburger/chicken nuggets/meatballs; fried snacks; regular butter; regular soda; bread rolls; pasta with meat; cooked potatoes with mayonnaise; desserts/candies; fried potatoes/manioc.


3. Fruits: avocado; guava; papaya; apple/pears; melon/watermelon; oranges/tangerines/pineapples; bananas.

4. Light and whole food: low-fat/non-fat milk; whole wheat bread; natural juice without added sugar; oats; extra virgin olive oil.

5. Mild diet: cooked potatoes/manioc; soup; bread rolls; whole milk; carrots; polenta.

6. Traditional diet: white rice; beans; lettuce; tomatoes.


• Distribution of eating pattern adherence Consumption scores were obtained from the

factorial analysis and were divided in tertiles where:

1º. Tertile – low adherence to the pattern2º. Tertile – moderate adherence to the pattern3º. Tertile – high adherence to the pattern


Nutrients Female (Mean (SD)) Male (Mean (SD)) p-value Total fat (g) 81,58 (35,92) 79,62 (43,00) 0,5368Saturated fat (g) 27,01 (13,77) 26,10 (16,73) 0,4717Carbohydrates (g) 264,70 (116,37) 267,36 (112,51) 0,7644Protein (g) 70,66 (28,48) 75,27 (36,58) 0,1245Total fiber (g) 26,19 (10,76) 27,06 (10,86) 0,5095Vitamin D (μg) 3,8032 (2,48) 3,33 (1,83) 0,1193Vitamin C (mg) 196,15 (137,47) 174,38 (149,92) 0,3409Retinol (μg) 1102,72 (664,37) 922,53 (582,43) 0,0459Folate (μg) 421,74 (160,85) 450,56 (170,79) 0,1034Vitamin E (mg) 10,22 (3,74) 9,44 (3,71) 0,0600Vitamin B12 (μg) 29,70 (36,49) 41,08 (62,38) 0,0904Calcium (mg) 817,79 (371,80) 772,72 (374,78) 0,3277Phosphorus (mg) 1134,47 (437,35) 1155,73 (503,25) 0,6355Magnesium (mg) 301,51 (113,42) 321,42 (128,92) 0,0661Iron (mg) 11,97 (5,16) 12,96 (6,01) 0,0477Sodium (mg) 2870,64 (1215,50) 3061,33 (1407,94) 0,1190Potassium (mg) 2890,63 (1098,71) 2891,34 (1078,69) 0,9952Selenium(μg) 94,92 (40,87) 102,05 (46,81) 0,0560Cuprum (mg) 1,23 (0,51) 1,27 (0,51) 0,3367Manganese(mg) 3,68 (1,59) 4,10 (1,73) 0,0173Added sugar (g) 65,54 (61,82) 59,19 (79,62) 0,2679Alcohol (g) 0,70 (2,07) 5,96 (39,84) <0,0001

Table 1. Macro and micronutrients mean intake (adjusted for energy) according to sex of older people registered in the Basic Health Units of Botucatu city – 2011.


From table 1 we found:

Women: greater intake mean of retinol

Men: greater intake mean of iron, manganese and

alcohol


Female MaleNutrients Obese Non obese Obese Non obese

Mean(SD) Mean(SD) p-value* Mean(SD) Mean(SD) p-value*Total fat (g) 79,6859(4,56) 73,2493(2,64) 0,1966 95,2933(6,22) 86,0602(2,93) 0,1338Saturated fat (g) 26,39(1,87) 23,99(1,07) 0,2352 32,94(2,65) 28,08(1,21) 0,0517Carbohydrates (g) 232,89(10,99) 242,97(7,17) 0,4457 287,02(15,10) 301,06(7,89) 0,4105Protein (g) 68,64(4,12) 64,09(2,40) 0,3191 90,59(5,51) 80,96(2,52) 0,0757Total fiber (g) 22,51(1,50) 24,99(1,03) 0,1931 28,52(2,25) 29,581,11) 0,6753Vitamin D (μg) 3,58(0,46) 3,60(0,28) 0,9677 3,73(0,47) 3,480,21) 0,6054Vitamin C (mg) 179,78(26,69) 195,41(17,66) 0,6398 204,29(45,10) 173,55(17,72) 0,4801Retinol (μg) 948,67(81,69) 1099,19(115,20) 0,3197 943,15(140,08) 964,81(153,47) 0,8893Folate (μg) 380,74(21,63) 396,62(13,95) 0,5421 474,68(29,82) 494,00(15,11) 0,5651Vitamin E (mg) 9,41(0,56) 9,65(0,35) 0,7151 9,67(0,67) 10,23(0,34) 0,4641Vitamin B12 (μg) 38,63(9,18) 26,07(3,74) 0,1334 52,35(16,76) 39,35(5,82) 0,3784Calcium (mg) 747,71(37,70) 774,02(37,70) 0,7234 898,85(37,70) 816,22(37,70) 0,3288Phosphorus (mg) 1086,77(73,87) 1040,36(73,87) 0,5349 1384,40(73,87) 1235,39(66,67) 0,0402Magnesium (mg) 268,42(8,63) 281,98(8,63) 0,4204 353,16(8,63) 353,51(8,63) 0,9855Iron (mg) 11,03(0,58) 10,83(0,36) 0,7646 14,04(0,91) 14,56(13,61) 0,6117Sodium (mg) 2831,69(161,69) 2566,35(91,79) 0,1291 3708,62(235,93) 3306,89(0,54) 0,0836Potassium (mg) 2582,77(154,27) 2738,48(101,21) 0,4083 3196,36(195,48) 3120,76(93,57) 0,7168Selenium(μg) 94,17(4,89) 83,83(2,74) 0,0474 124,49(7,11) 111,07(3,24) 0,0550Cuprum (mg) 1,11(0,05) 1,12(0,03) 0,7672 1,39(0,07) 1,41(0,03) 0,7979Manganese(mg) 3,25(0,19) 3,38(0,12) 0,5609 4,16(0,30) 4,64(0,16 ) 0,1823Added sugar (g) 55,32(8,53) 59,98(5,72) 0,6567 79,25(19,22) 127,60(15,63) **Alcohol (g) 3,30(0,39) 3,06(0,47) 0,5145 8,70(2,35) 5,38(1,33) 0,0269

Table 2. Macro and micronutrients mean intake (adjusted for energy) according to sex and general obesity of older people registered in the Basic Health Units of Botucatu city – 2011.



General obese men – greater intake mean of

- phosphorus (some cereals, foods of animal origin and

soft drinks)

- alcohol

General obese women – greater intake mean of

selenium


Table 3. Macro and micronutrients mean intake (adjusted for energy) according to sex and central obesity of older people registered in the Basic Health Units of Botucatu city – 2011.

Female MaleNutrients Obese Non obese Obese Non obese

Mean(SD) Mean(SD) p-value* Mean(SD) Mean(SD) p-value*Total fat (g) 77,84(2,80) 69,85(3,12) 0,0382 84,84(3,59) 90,45(3,70) 0,2388Saturated fat (g) 25,58(1,14) 22,92(1,25) 0,0795 29,20(1,61) 28,84(1,52) 0,8598Carbohydrates (g) 40,07(7,11) 240,43(9,04) 0,9700

288,45(9,40) 307,85(9,74) 0,1307

Protein (g) 68,06(2,56) 60,42(2,86) 0,0300 80,96(3,21) 84,36(3,24) 0,4291Total fiber (g) 24,18(1,03) 24,54(1,34) 0,8205 27,46(1,30) 31,22(1,44) 0,0490Vitamin D (μg) 3,97(0,32) 2,94(0,30) 0,0228 3,49(0,28) 3,56(0,27) 0,8527Vitamin C (mg) 186,18(17,86) 199,67(24,97) 0,6514 189,48(25,34) 168,94(22,00) 0,5409Retinol (μg) 1059,15(82,91) 1056,20(107,20) 0,9822 989,49(91,65) 934,13(83,85) 0,6490Folate (μg) 393,24(14,21) 390,56(18,12) 0,9015 467,86(17,90) 511,79(19,08) 0,0827Vitamin E (mg) 9,68(0,36) 9,42(0,45) 0,6367 9,44(0,39) 10,78(0,43) 0,0190Vitamin B12 (μg) 32,32(4,99) 24,58(4,96) 0,3047 52,47(10,05) 31,41(5,84) 0,0672Calcium (mg) 790,62(37,70) 724,56(37,70) 0,2824 887,11(37,70) 778,52(37,70) 0,1054Phosphorus (mg) 1090,12(47,83) 986,48(47,83) 0,0845 1281,49(73,87) 1245,45 (73,87 0,5409Magnesium (mg) 282,48(10,73) 270,69(10,73) 0,3856 341,95(10,73) 364,10(10,73) 0,1193Iron (mg) 10,96(0,45) 10,73(0,45) 0,6660 13,22(0,58) 15,61(0,58) 0,0009Sodium (mg) 2686,61(98,65) 2554,05(161,69)

0,3549 3339,66(161,69)

3417,91(161,69 0,6726

Potassium (mg) 2783,67(104,58) 2539,32(121,41)

0,1113 3044,25(115,57)

3218,49(118,79) 0,2767

Selenium(μg) 89,62(2,97) 81,30(3,37) 0,0452 114,51(4,32) 112,64(4,10) 0,7403Cuprum (mg) 1,11(0,03) 1,13(0,04) 0,7865 1,35(0,04) 1,47(0,04) 0,0393Manganese(mg) 3,31(0,12) 3,41(0,16) 0,6052 4,15(0,175) 4,93(0,20) 0,0027Added sugar (g) 56,44(5,29) 62,96(7,59) 0,4069 63,24(7,37) 69,99(7,89) 0,4817Alcohol (g) 1,27(0,17) 4,07(0,55) ** 10,37(3,39) 2,70(0,90) 0,0320



Central obese men

– greater intake mean of alcohol

– lower mean intake of total fiber, vitamin E, iron,

cuprum and manganese

Central obese women – greater intake mean of total fat,

protein, vitamin D and selenium


Female Male

Nutrients Low Moderate High Low Moderate High

Mean(SD) Mean(SD) Mean(SD) p-value* Mean(SD) Mean(SD) Mean(SD) p-value*

Total fat (g) 73,47 (3,49) 76,87(3,57) 74,50(4,13) 0,7301 85,42(3,99) 86,60(4,30) 91,89(4,61) 0,4889Saturated fat (g) 24,11(1,39) 24,46(1,39) 25,48(1,74) 0,8197 28,62(1,70) 29,23(1,84) 29,29(1,86) 0,9520Carbohydrates (g) 240,98(9,20) 232,25(8,57) 248,83(11,03) 0,4515 306,31(11,14) 293,48(11,51) 293,70(11,65) 0,6358Protein (g) 57,53b(2,73) 66,80a(3,10) 72,18a(3,90) 0,0045 76,26a(3,22) 82,55a(3,71) 91,01b(4,13) 0,0148Total fiber (g) 21,05a(1,10) 24,34b(1,24) 27,88c(1,64) 0,0021 27,88a(1,43) 26,91a(1,51) 33,85b(1,93) 0,0075Vitamin D (μg) 3,82(0,42) 3,54(0,37) 3,42(0,41) 0,7690 3,57(0,31) 3,34(0,32) 3,65(0,35) 0,7805Vitamin C (mg) 158,20(20,25) 190,87(23,36) 229,13(31,81) 0,1495 173,71(26,00) 165,58(27,40) 199,59(33,79) 0,7086Retinol (μg) 716,75a(64,68) 958,92b(82,54) 1559,25c(151,29) <0,0001 686,12a(60,43) 840,54a(80,53) 1432,67b(142,08) <0,0001Folate (μg) 355,59a (16,18) 389,91ab(17,16) 435,87b(22,26) 0,0129 480,87a (19,65) 446,80a (19,83) 546,69b(24,57) 0,0044Vitamin E (mg) 8,64b(0,41) 10,11a(0,47) 9,99a(0,54) 0,0325 9,40a(0,40) 9,14a(0,42) 12,05b(0,56) <,0001Vitamin B12 (μg) 13,07b(2,60) 40,42a(7,72) 34,44a(7,40) 0,0004 28,53a(5,98) 34,37ab(8,01) 66,41b(15,95) 0,0219Calcium (mg) 723,24(49,96) 744,43(49,96) 842,90(49,96) 0,3020 820,64(37,70)

774,02(54,63) 901,45(64,36) 0,2769

Phosphorus (mg) 957,38a(55,22) 1059,84ab(50,84) 1150,84b(64,38) 0,0423 1198,73a(47,83) 1218,13a(48,02) 1386,85b(55,22) 0,0106

Magnesium (mg) 252,62a(13,27) 277,29ab(10,97) 307,81b(10,97) 0,0062 338,21a(10,73) 330,90a(10,73) 394,86b(13,27) 0,0002Iron (mg) 9,78b(0,39) 10,89a(0,43) 12,09a(0,43) 0,0029 14,00ab(0,61) 13,68a(0,64) 15,83b(0,75) 0,0477Sodium (mg) 2330,22a(104,35) 2628,43b(104,35) 2993,01c(104,35) 0,0013 3149,13a (137,11) 3264,94a(152,33) 3784,00b(152,33) 0,0087Potassium (mg) 2423,62a(115,86)

2683,39ab(124,17)

3013,01b(161,56) 0,0109 2913,75a(119,38) 3111,76ab(137,98 3436,43b(154,10) 0,0237

Selenium(μg) 80,81a(3,42) 85,13ab(3,52) 95,02b(4,64) 0,0430 109,09 (4,39) 110,01(4,73) 122,59(5,33) 0,0759Cuprum (mg) 1,02a(0,03) 1,11b (0,03) 1,24c(0,05) 0,0015 1,39ab(0,04) 1,33a(0,05) 1,52b (0,05) 0,0287Manganese(mg) 3,17(0,15) 3,28(0,15) 3,63(0,19) 0,1607 4,34a(0,21) 4,31a(0,22) 5,07b(0,27) 0,0393Added sugar (g) 62,26(7,30) 57,75(6,64) 55,75(8,03) 0,7597 126,36(75,12) 140,03(77,45) 62,89(25,35) **Alcohol (g) 2,71(0,36) 4,96(0,63) 1,97(0,26) ** 19,39(2,94) 16,81(2,55) 40,20(6,07) **

Table 4. Macro and micronutrients mean intake (adjusted for energy) according to sex and adherence to “Healthy Pattern” pattern for older people registered in the Basic Health Units of Botucatu city – 2011.


From table 4 we found:Men and women with high adherence to the “Healthy Pattern” had greater intake mean of:- Protein- Fiber- Phosphorus- Magnesium- Sodium- Potassium- Retinol- Folate- Cuprum- Vitamin B12 - Vitamin E

compared to the ones with low and moderate adherence


This result is expected once the foods in this pattern are the

ones of animal (protein) and plant (greens and legumes)

origin.


Female Male

NutrientsLow Moderate High Low Moderate High

Mean(SD) Mean(SD) Mean(SD) p-value* Mean(SD) Mean(SD) Mean(SD) p-

value*Total fat (g) 75,52(3,54) 79,19(4,48) 70,23(3,83) 0,2967 90,93(4,75) 84,51(3,92) 88,63(4,20) 0,5129

Saturated fat (g) 25,87(1,48) 25,39(1,76) 22,12(1,45) 0,1665 31,98(2,04) 27,91(1,60) 27,75(1,63) 0,1308Carbohydrates (g) 244,08(9,35) 227,32(10,65) 247,04(11,34) 0,3827 287,96(11,87) 292,65(10,56) 313,38(11,62) 0,2164

Protein (g) 64,30(3,19) 65,81(3,98) 66,40(3,96) 0,9086 84,94(4,19) 79,98(3,48) 83,83(3,74) 0,5822

Total fiber (g) 24,94(1,33) 21,68(1,42) 25,96(1,70) 0,1301 29,62(1,80) 26,88(1,43) 31,94 (1,77) 0,0777Vitamin D (μg) 3,27(0,34) 3,89(0,49)

3,79(0,48) 0,5172 3,79(0,38) 3,45(0,30) 3,38(0,31) 0,6668

Vitamin C (mg) 244,48b(27,94) 153,49a(21,61)

152,17a(20,51) 0,0093 273,20b(44,28) 152,29a(21,63) 128,46a(19,09) 0,0017

Retinol (μg) 1254,5b(119,14)

904,26a(105,89)

925,42a(104,21) 0,0445 1161,09a(130,41)

969,77ab(95,92) 781,51b(80,43) 0,0322Folate (μg) 389,53(17,79) 366,10(20,46)

421,88(23,65) 0,2023 469,70a(22,58) 463,23a(19,45) 537,28b(23,39) 0,0248Vitamin E (mg) 10,12(0,47) 9,54(0,55) 8,87(0,49) 0,2068 10,08(0,55) 9,77(0,47) 10,57(0,52) 0,5029

Vitamin B12 (μg) 33,75(6,51) 22,46(5,23) 30,02(7,31) 0,4093 47,13a(11,28) 56,60a(11,82) 20,25b(4,44) 0,0045Calcium (mg) 807,20(69,78) 742,85(60,77) 731,52(58,22) 0,5820 984,07b (69,78) 779,91a(69,78) 758,09a(69,78) 0,0106

Phosphorus (mg) 1068,86(49,02)

1026,27(62,71)

1056,13(62,71) 0,8746 1325,24(64,38) 1224,89(64,38) 1251,73(49,02) 0,3459

Magnesium (mg) 271,23(11,30) 265,41(13,52) 301,16(13,52) 0,1604 325,96a(12,07) 348,54a(12,07) 381,13b(12,07) 0,0056Iron (mg) 10,25(0,59) 10,72(0,55) 11,97(0,55) 0,0686 13,33a(0,43) 13,83a(0,59) 16,06b(0,59) 0,0067

Sodium (mg) 2671,68(164,95)

2569,07(164,95)

2660,23(151,65) 0,8607 3295,50(170,72)

3298,72(170,72) 3536,01(164,95) 0,4416

Potassium (mg) 2796,74(135,00)

2538,43(150,06)

2701,53(157,16) 0,4513 3234,59(156,58)

3027,94(128,65) 3165,81(138,87) 0,5520

Selenium(μg) 85,06(3,73) 86,47(4,62) 89,24(4,70) 0,7792 116,00(5,41) 111,89(4,60) 113,280(4,78) 0,8288

Cuprum (mg) 1,13(0,04) 1,08(0,05) 1,14(0,05) 0,6300 1,38(0,05) 1,37(0,05) 1,48(0,05) 0,2352Manganese(mg) 3,23(0,15) 3,13(0,18 )

3,75(0,21) 0,0551 3,93a(0,20 ) 4,39a(0,20) 5,23b(0,25) 0,0003Added sugar (g) 66,00(7,90) 53,34(7,92) 53,43(7,31) 0,3870 99,56(15,51) 146,66(21,74) 103,15(14,60) **

Alcohol (g) 1,24(0,19) 5,62(1,17) 1,85(0,39) ** 4,52(1,78) 6,99(2,00) 7,56(2,11) 0,3922

Table 5. Macro and micronutrients mean intake (adjusted for energy) according to sex and adherence to “Snacks and Weekend Meals ” pattern for older people registered in the Basic Health Units of Botucatu city – 2011.



Men and women with high adherence of “Snacks and

Weekend Meals pattern” had lower intake mean of vitamin C

and retinol.

No foods are expected have these nutrients in this pattern.


Men with high adherence to this pattern had lower

intake mean of calcium and vitamin B12.

Even this pattern is represented for food of animal

origin, they may not a good source of calcium and vitamin

B12.


Men with high adherence to this pattern have greater

intake mean of magnesium, iron, folate and manganese.

Probably this happen due to the consumption of food

like cereal and pasta (made of wheat flour that is fortified

with folate in Brazil) and characterize this pattern.


Table 6. Macro and micronutrients mean intake (adjusted for energy) according to sex and adherence of “Fruits” pattern for older people registered in the Basic Health Units of Botucatu city – 2011.

Female Male


Mean(SD) Mean(SD) Mean(SD) p-value Mean(SD) Mean(SD) Mean(SD) p-value

Total fat (g) 68,04(3,70) 80,52(3,73) 76,43(4,13) 0,0760 79,93(5,32) 89,00(4,12) 91,08(4,34) 0,2785Saturated fat (g) 20,05b(1,29) 27,50a(1,52) 26,79a(1,75) 0,0020 24,13(2,02) 29,84(1,72) 31,01(1,86) 0,0557Carbohydrates (g) 240,83(11,01) 241,24(9,19) 237,92(10,63) 0,9623 305,28(15,64) 294,32(10,69) 299,03(11,14) 0,8395Protein (g) 60,66(3,45) 66,59(3,29) 69,78(4,16) 0,2677 81,20(5,01) 80,85(3,52) 85,62(3,85) 0,5886Total fiber (g) 26,24(1,66) 24,11(1,29) 22,16(1,37) 0,1959 33,62a(2,41) 29,72ab(1,52) 26,61b(1,39) 0,0348Vitamin D (μg) 3,46(0,41) 3,72(0,39) 3,61(0,46) 0,9029 3,45(0,43) 3,47(0,30) 3,64(0,33) 0,9092Vitamin C (mg) 192,41(26,47) 185,79(23,24) 196,80(30,38) 0,9528 163,31(33,04) 189,30(28,00) 177,28(27,91) 0,8376Retinol (μg)

988,41(111,40) 1089,55(111,01) 1108,10(137,95) 0,7753 832,77(116,69) 897,48(90,57) 1108,20(119,81) 0,2026

Folate (μg) 413,10(22,35) 386,57(17,82) 373,65 (20,27) 0,4587 537,39(31,60) 487,23(20,46) 466,86(20,02) 0,1616Vitamin E (mg) 10,23(0,57) 9,49(0,45) 8,90(0,50) 0,2540 10,27(0,68) 10,27(0,49) 9,90(0,48) 0,8352Vitamin B12 (μg) 22,37(4,62) 31,37(6,30) 36,93(9,37) 0,3124 41,96(12,27) 36,10(7,72) 47,43(11,03) 0,6917Calcium (mg) 712,30(61,56) 783,49(61,56) 816,21(61,56) 0,5081 758,92(69,12) 806,87(69,12) 900,16(61,56) 0,2786Phosphorus (mg) 992,65(47,53) 1069,17(47,53) 1110,26(47,53) 0,4396 1220,25(62,71) 1240,73(47,53) 1311,04(47,53) 0,4458Magnesium (mg) 295,92(14,58) 275,31(14,58) 260,06(14,58) 0,2075 390,16a(17,55) 351,01ab(11,30) 334,77b(10,89) 0,0250Iron (mg) 10,61(0,97) 11,17(0,97) 10,83(0,97) 0,7198 15,88(0,97) 14,16(0,97) 13,98(0,97) 0,2160Sodium (mg)

2443,74(133,11) 2667,86(126,25) 2857,81(163,65) 0,1707 3153,41a(196,59) 3214,68a(142,18)

3690,86b(171,35) 0,0416

Potassium (mg)2831,00(161,32) 2662,11129,36) 2570,31(146,97) 0,5238 3417,72(196,87) 3113,43(128,04) 2991,68(125,51)

0,1809

Selenium(μg) 74,91b(3,56) 89,97a(3,74) 97,86a(4,94) 0,0015 106,41(6,03) 109,01(4,37) 122,55(5,13) 0,0508Cuprum (mg) 1,12(0,05) 1,13(0,04) 1,10(0,04) 0,8527 1,51(0,07) 1,41(0,05) 1,35(0,04) 0,2274Manganese(mg) 3,56(0,20) 3,31(0,15) 3,14(0,17) 0,3309 5,26b(0,34) 4,39a(0,20) 4,31a(0,20) 0,0429Added sugar (g) 53,92(8,02) 59,95(7,20) 63,022(9,03) 0,7691 49,75(9,37) 68,93(8,91) 74,78(10,15) 0,2291Alcohol (g) 8,82a(1,94) 1,28b(0,24) 1,39b(0,30) ** 0,63a(0,37) 7,98b(2,09) 7,28b(1,90) 0,0161


From table 6:

Women with high or moderate adherence to the “Fruits

pattern” had greater intake mean of saturated fat and

selenium compared with the ones with low adherence.

Men with high adherence to this pattern had greater

mean intake of sodium a lower intake mean of fiber,

magnesium and manganese compared with the low

adherence


This is a non expected result for a “Fruits pattern”.

In a previous work we found an association between

this pattern and general obesity.

Then we can suppose that exists preference for fruits

but also exists the consumption of another type of caloric

and fatty food.


Besides, we can not discard the possibility of underreport

of these caloric and fatty food once FFQ is susceptible to this

sort of bias.


Table 7. Macro and micronutrients mean intake (adjusted for energy) according to sex and adherence to “Light and Whole Food” pattern for older people registered in the Basic Health Units of Botucatu city – 2011.

Female Male


Mean(DP) Mean(DP) Mean(DP) p-value Mean(DP) Mean(DP) Mean(DP) p-value

Total fat (g) 75,83(4,26) 74,24(3,35) 75,19(3,82) 0,9506 87,09(3,93) 87,20(5,34) 89,20(4,49) 0,9124Saturated fat (g) 23,69(1,66) 25,08(1,40) 25,11(1,55) 0,7976 29,02(1,65) 28,09(2,20) 29,82(1,89) 0,8311Carbohydrates (g) 238,57(10,86)

238,85(8,70) 243,79(9,97) 0,8900 288,32(10,01) 310,98(14,39) 300,98(11,74) 0,3876

Protein (g) 67,18(3,90) 64,86(3,07) 63,98(3,44) 0,8262 81,15(3,41) 83,11(4,68) 84,47(3,98) 0,7731Total fiber (g) 21,07a(1,27) 24,13a(1,20) 28,20b(1,67) 0,0032 25,98a(1,24) 29,32a(1,82) 33,88b(1,86) 0,0012Vitamin D (μg) 3,60(0,44) 3,68(0,37) 3,48(0,41) 0,9300 3,27(0,27) 3,50(0,39) 3,89(0,37) 0,3382Vitamin C (mg)

97,00a(11,32) 196,19b(20,19) 294,44c(36,99) <,0001 91,92b(11,28) 194,10a(30,12) 279,23a(39,86) <0,0001

Retinol (μg) 823,51a(90,51)

1056,78ab(99,54)

1327,82b(150,91) 0,0137 925,52(91,24)

968,55(124,23) 1000,61(111,74) 0,8551

Folate (μg) 379,75(20,42) 384,70(17,03) 416,74(21,52) 0,3391 461,01a(18,35)

478,36ab(24,98)

539,63b(24,46)

0,0205

Vitamin E (mg) 9,03(0,50) 9,45(0,43) 10,39(0,56) 0,1693 9,53(0,43) 10,19(0,60) 10,86(0,55) 0,1306Vitamin B12 (μg) 16,33b(3,47) 37,48a (7,06) 32,93a(7,51) 0,0182 26,63b(5,39) 58,17a(15,17) 47,17ab(11,00) 0,0459Calcium (mg) 679,00(62,29)

818,43(62,29) 792,52(59,29) 0,1879 746,86a(44,39)

794,04ab(62,29)

972,02b(62,29) 0,0076

Phosphorus (mg) 1010,83(47,53) 1085,40(52,20) 1054,82(52,20)

0,6447 1219,24(47,53) 1266,47(47,53) 1316,52(47,538)

0,2984

Magnesium (mg) 274,61(14,58) 273,42(14,58) 289,00(14,58) 0,5695 346,46(14,58) 350,97(14,58) 364,76(14,58) 0,5085

Iron (mg) 11,80(0,69) 10,36(0,69) 10,59(0,47) 0,1273 14,72(0,64) 14,36(0,83) 14,23(0,69) 0,8424Sodium (mg) 2730(152,18) 2637(119,63) 2541(129,69) 0,6309 3421(151,21) 3377(197,18) 3327(163,92) 0,8981Potassium (mg) 2365a(125,84)

2654a(117,04) 3122b(163,23) 0,0011 2834a(101,90) 3045a(144,48) 3599b(148,44)

<0,0001

Selenium(μg) 87,31(4,48) 88,73(3,69) 83,14(3,85) 0,4791 109,82(4,30) 118,45(6,23) 114,11(5,01) 0,4905Cuprum (mg) 1,10(0,04) 1,10(0,03) 1,16(0,04) 0,5549 1,39(0,04) 1,40(0,06) 1,44(0,05) 0,7694Manganese(mg) 3,55(0,19) 3,26(0,14) 3,25(0,16) 0,4456 4,55(0,22) 4,63(0,29) 4,487(0,24) 0,9254Added sugar (g) 66,83(9,63) 56,01(6,33) 53,62(6,37) 0,4965 132,36(27,94) 131,36(31,62) 68,78(13,38) **Alcohol (g) 5,96a(1,10) 1,31b(0,21) 3,30c(0,57) ** 7,86 (2,24) 2,52(1,23) 7,06(2,00) 0,1242


From table 7:

Men and women with high adherence to the “Light add

Whole Meal pattern” had greater intake mean of total fiber,

vitamin C and potassium.

Women with high adherence to this pattern had greater

intake mean of retinol and vitamin B12.


Men with high adherence of this pattern had greater

intake mean of calcium and folate

This is expected once light and whole meal are good

source of fiber , vitamin C and potassium.


Table 8. Macro and micronutrients means intake according to sex and adherence to “Mild Diet” pattern for older people registered in the Basic Health Units of Botucatu city – 2011.

Female Male



Total fat (g) 78,98(4,33) 76,26(4,13) 70,82(3,49) 0,2931 83,62(3,64) 94,25(4,77) 86,68(4,76) 0,1562Saturated fat (g) 27,41(1,82) 24,08(1,61) 22,99(1,38) 0,1142 27,79(1,56) 30,45(1,97 29,19(2,05) 0,5031Carbohydrates (g)

230,10(10,47) 245,24(10,84) 243,42(9,94) 0,5344 276,71a(8,88) 302,48ab(11,49) 327,72b(13,20) 0,0034

Protein (g) 72,24a(3,98) 66,28ab(3,61) 59,14b(2,91) 0,0213 81,56(3,39) 85,17(4,15) 81,77(4,28) 0,7521Total fiber (g) 22,85(1,43) 27,16(1,65) 22,89(1,28) 0,0765 30,81(1,55) 29,22(1,76) 27,28(1,76) 0,3282Vitamin D (μg) 3,94(0,48) 3,12(0,36) 3,78(0,41) 0,3620 3,21(0,26) 3,66(0,35) 3,87(0,40) 0,3108Vitamin C (mg) 175,70(24,95) 231,72(31,19) 167,39(20,78) 0,1811 186,12(26,12) 168,34(28,52) 179,09(32,39) 0,9016Retinol (μg)

937,62(109,94) 1184,07(131,62) 1036,50(107,46) 0,3534 967,36(93,32) 906,41(104,50) 1012,44(123,93)

0,7991

Folate (μg) 362,07(19,40) 428,58(22,08) 382,75(18,24) 0,0740 493,61(20,28) 488,94(23,89) 487,50(25,43) 0,9779Vitamin E (mg) 8,91(0,49) 10,60(0,57) 9,20(0,45) 0,0620 10,12(0,45) 10,70(0,57) 9,50(0,54) 0,3119Vitamin B12 (μg) 28,47(6,64) 32,11(6,98) 27,87(5,72) 0,8832 39,77(8,09) 46,22(11,35) 39,47(10,35) 0,8704Calcium (mg) 820,20(66,99) 756,01(66,99) 735,87(51,78) 0,5581 824,58 (51,28) 822,89(60,83) 850,70(66,99) 0,9389Phosphorus (mg)

1154,62(58,49) 1044,20(58,49) 982,74(58,49) 0,0938 1259,08(52,20) 1268,17(52,20) 1262,41(58,49) 0,9911

Magnesium (mg) 273,53(13,55) 291,99(13,55) 269,56(13,55) 0,4582 364,17(14,58) 347,61(13,21) 343,09(13,95) 0,4206Iron (mg) 10,89(0,54) 11,52(0,54) 10,30 (0,54) 0,2600 14,33(0,47) 14,97(0,75) 14,10(0,75) 0,6832Sodium (mg) 2713,08(150,58)

2709,16(147,04) 2519,71(125,06) 0,5037 3285,00(141,29)

3459,52(175,41)

3439,14(186,51)

0,6586

Potassium (mg) 2650,58(151,93) 2832,68(156,78) 2607,73(133,02)

0,5345 3158,28(126,23) 3013,99(143,30) 3232,13(163,36)

0,5771

Selenium(μg) 91,50(4,61) 87,85(4,36) 81,88(3,70) 0,2285 108,09 (4,13) 119,65(5,36) 115,01(5,54) 0,1791Cuprum (mg) 1,11(0,04) 1,19(0,05) 1,06(0,04) 0,1637 1,43(0,05) 1,41(0,05) 1,39(0,06) 0,8980Manganese(mg) 3,29 (0,18) 3,46(0,19) 3,29(0,16) 0,7606 4,54(0,21) 4,61(0,25) 4,50(0,27) 0,9593Added sugar (g) 60,19(8,88) 54,68(7,84) 61,30(8,06) 0,8352 86,48(11,05) 98,40(14,77 151,61(24,30) **

Alcohol (g) 1,02a(0,18) 4,54b(0,64) 3,04c(0,42) ** 7,56(2,61) 2,8709(1,18) 9,59(4,04) 0,1076


From table 8:

Women with high adherence of “Mild Diet” pattern had

lower intake mean of protein.


intake mean of carbohydrates.

This is expected as a pattern like this one.


Table 9. Macro and micronutrients means intake according to sex and adherence to “Traditional” pattern for older people registered in the Basic Health Units of Botucatu city – 2011.

Female Male



Total fat (g) 72,51(3,77) 75,47(3,69) 77,44(4,04) 0,6649 88,83 (4,58) 78,66(4,26) 91,37(3,71) 0,0575Saturated fat (g) 22,98(1,48) 25,08(1,50) 26,11(1,67) 0,3629 29,65(1,91) 25,21(1,71) 30,33(1,56 ) 0,0539Carbohydrates (g) 250,92(10,40) 231,87(9,03) 237,32(9,77) 0,3746 292,22ab(11,84) 275,48a (11,76) 313,32b(9,87) 0,0367Protein (g) 64,93(3,50) 63,14(3,26) 68,44(3,83) 0,5241 86,78(4,26) 77,40(4,02) 82,90(3,19) 0,2462Total fiber (g) 24,82(1,47) 23,40(1,34) 24,79(1,53) 0,7044 25,15a(1,48) 27,87a(1,74) 32,61b(1,48) 0,0021Vitamin D (μg) 2,93a(0,32) 3,53ab(0,38) 4,50b(0,56) 0,0379 3,45(0,35) 3,03(0,32) 3,81(0,30) 0,2108Vitamin C (mg) 230,43(29,78) 172,11(21,85) 168,32(23,41) 0,1669 180,86(31,86) 153,04(28,50) 191,49(25,74) 0,6302Retinol (μg)

905,04(96,08) 1048,90(109,30)

1255,87(149,84) 0,1264 901,94(106,27) 835,92(104,80) 1058,20(96,27)

0,2537

Folate (μg) 391,68(19,60) 373,41(18,07) 415,58(22,02) 0,2984 439,54a(21,15) 480,60ab(24,32) 524,84b(19,40) 0,0133Vitamin E (mg) 10,14(0,52) 9,06(0,45) 9,56(0,52) 0,3031 9,60(0,52) 9,47(0,54) 10,77(0,45) 0,0971Vitamin B12 (μg) 41,41(**) 23,23(**) 23,20(**) 0,0767 66,44a (**) 47,55a(**) 24,06b (**) 0,0033Calcium (mg) 676,55(51,04) 779,49(51,04) 859,37(66,67) 0,0795 827,93(51,78) 734,91(58,49) 880,85(51,04) 0,1744Phosphorus (mg) 1000,40(58,49)

1036,74(53,88) 1135,00(53,88) 0,2359 1281,30(58,49) 1193,08(58,49) 1285,37(58,49) 0,3513

Magnesium (mg) 280,43(12,88) 269,07(11,83) 286,61(13,61) 0,5715 331,03(13,55) 353,91(14,24) 366,14(10,86) 0,1085Iron (mg) 10,74(0,54) 10,32(0,54) 11,71(0,54) 0,1104 13,29a(0,54) 13,60a(0,54) 15,56b(0,54) 0,0162Sodium (mg) 2473,10(126,02)

2584,97(126,24)

2900,99(155,27)

0,0734 3339,69(173,15) 3177,02(173,44)

3502,21(141,02) 0,3119

Potassium (mg) 2704,10(143,61)

2627,86(134,36)

2767,21(153,47) 0,7701 3013,67(144,01) 2912,09(147,30)

3314,66(122,36)

0,0704

Selenium(μg) 86,40(4,13) 84,69(3,83) 89,35(4,34) 0,6777 120,94(5,58) 109,16(5,32) 111,30(4,02) 0,2164Cuprum (mg) 1,14(0,04) 1,05(0,04) 1,17(0,04) 0,1187 1,29a(0,05) 1,34a(0,05) 1,51b(0,04) 0,0029Manganese(mg) 3,36(0,17) 3,29(0,16) 3,40(0,18) 0,8738 4,02a(0,22) 4,52ab(0,26) 4,87b(0,20) 0,0260Added sugar (g) 72,33(8,75) 51,10(5,85) 50,41(5,78) 0,0582 78,80a (10,70) 45,72b(7,12) 68,94a(7,69) 0,0197Alcohol (g) 6,25a(0,96) 2,61a(0,37) 1,30c(0,29) ** 43,86a(7,55) 21,92b(4,18) 8,74c(1,58) **


From table 9:

Women with high adherence of the “Traditional

pattern” had greater intake mean of vitamin D.


intake mean of fiber, iron, folate, cuprum, manganese and

lower mean intake of vitamin B12.


Men with high and low adherence to this pattern had

greater intake mean of carbohydrates and added sugar then

to the moderate adherence.

Adherence to this pattern may provide higher supply of

nutrients that are important for adequate nutritional status

of elderly people.


4. Final considerations

In the present work, the proposal of detail each nutritional component of each eating pattern, expanded the observed impact sense of these patterns in obesity.

In a general way, the expected results corroborate with the characteristic of each pattern.


It was observed that the majority of evaluated nutrients,

after adjustment for energy, no significant difference was

found between men and women, obese and non-obese.

This suggest that, for these outcomes, another factors are

influencing the nutrient intake.


Related to the differences of nutrient intake for each level of

pattern adherence, a coherent analysis was observed

enabling a better characterization of the feeding behavior.

The results found here added to the heterogeneity of eating

patterns became possible the use of this work in future

researches in order to evaluate the level of nutrient intake

and the tendencies of risk for obesity in older people.


References

ALVES, A.L.S. et al. Padrões alimentares de mulheres adultas residentes em área urbana no sul do Brasil Rev. Saúde Pública, v.40, n.5, p.865-873, 2006.

ATWATER, W.O., BENEDICT, F.G. 1902. Experiments on the metabolism of matter and energy in the human body, 1898–1900. US Office of Experiment Stations Bulletin No. 109, Government Printing Office, Washington, DC.

BEATON, G.H. Approaches to analysis of dietary data: relationship between planned analyses and choice of methodology. Am J Clin Nutr. V, 59, n.1, p. 253-261. 1994.

BRASIL. Ministério da Saúde. Vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico – VIGITEL 2009. Brasília, DF: Ministério da Saúde, 2010. Disponível em: <http://bvsms.saude.gov.br/bvs/publicacoes/ vigilancia_risco_doencas_inquerito_telefonico_2009.pdf >. Acesso em: 4 maio 2010.

BRASIL. Resolução RDC nº 344, de 13 de dezembro de 2002. Áreas de atuação. Alimentos. Legislação específica da área por assunto. Regulamentos técnicos por assunto. Farinhas de trigo e/ou milho fortificadas com ferro. Disponível em: <http://e-legis.bvs.br>

BRASIL. Ministério da Saúde. Vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico – VIGITEL 2013. Brasília, DF: Ministério da Saúde, 20103. Disponível em: http://biavati.files.wordpress.com/2014/05/vigitel-2013.pdf Acesso em: 18 novembro de 2014.

CAMPOS, M.T.F.S; MONTEIRO, J.B.R. & ORNELAS, A.P.R.C. Fatores que afetam o consumo alimentar e a nutrição do idoso. Revista de Nutrição, 13 (3): 157-165, 2000.

http://e-legis.bvs.br/

http://biavati.files.wordpress.com/2014/05/vigitel-2013.pdf


CHUMLEA, W.C.; ROCHE, A.F.; MUKHEYEE, D. Nutritional assessment of elderly through anthropometry. Ohio: Woright State University School of Medicine, 1987.

CORRENTE, J.E., MARCHIONI D.M.L, FISBERG, R.M. Validation of a FFQ (Food Frequency Questionaire) for older people. J Life Sic, v.7, n.8, p 878-882. 2013.

FERREIRA, L.S.; MARUCCI, M.F.N. Atenção ao estado nutricional de idosos institucionalizados. Revista Report, v.10, n.2, p. 61-66. 2004.

FERREIRA, P.M. Padrões alimentares e a associação com a obesidade em idosos cadastrados na rede básica de saúde de botucatu, São Paulo. 2012. Dissertação (mestrado) – Faculdade de Medicina de Botucatu, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Botucatu, 2012.

FISBERG, R.M., MARCHIONI, D.M.L., SLATER, B. Recomendações nutricionais. In: FISBERG, R.M.; SLATER, B.; MARCHIONI, D.M.L.; MARTINI, L.A. Inquéritos alimentares. Métodos e bases científicos. Barueri: Manole, 2005. 334 p.

FOOD AND AGRICULTURE ORGANIZATION - FAO. 2003. Food energy – methods of analysis and conversion factors. Report of a technical workshop. Food and Nutrition Paper, n. 77. Rome, 2003.

FRANGELLA, V.S; MARUCCI, M.F.N; TCHAKMAKIAN, L.A. Idosos. In: ROSSI, L., CARUSO, L., GALENTE, A.P. Avaliação Nutricional: Novas Perspectivas. 2009.

GALANTE, A.P, SCHWARTZMAN, F., VOCI, S.M. Aplicações práticas da Ingestão Dietética de Referência. In: ROSSI,L, CARUSO, L., GALANTE, A.P. Avaliação Nutricional: Novas perspectivas. São Paulo: Roca, 2009.

GIBSON, R.S. Principles of Nutritional Assessment. New York: Oxford University Press, 1990.

INSTITUTE OF MEDICINE. Dietary Reference Intakes. Applications in Dietary Assessment. Washington: National Academy Prees, 2001. Disponível em: www.nap.edu.

http://www.nap.edu/


INSTITUTO BRASILEIRO DE GEOGRAFIA E ESTATÍSTICA - IBGE. Análise do consumo alimentar pessoal no Brasil. POF 2008/2009. Rio de Janeiro: IBGE, 2011b. Disponível em: <http://www.ibge.gov.br/home/estatistica/populacaocondicaodevida /pof/2008_2009_analise_consumo/pofanalise_2008_2009.pdf>. Acesso em: 14 nov. 2011.

JACOBS, D.R.J.; STEFFEN, L.M. Nutrients, foods and dietary patterns as exposures in research: a framework for food synergy. Am. J. Clin. Nutr., v.78, suppl.3, p.508-513, 2003.

JACQUES, P.F.; TUCKER, K.L. Are dietary patterns useful for understanding the role of diet in chronic disease? Am. J. Clin. Nutr., v.73, p.1-2, 2001.

KAAKS, R., RIBOLI, E. Validation and calibration of dietary intake measurements in the EPIC Project: methodological considerations. Int J Epidemiol, v.26, n. 1, p. 15-24. 1997.

KIPNIS, V., SUBAR, A.F., MIDTHUNE, D., FREEDMAN, L.S., BALLARD-BARBASH, R., TROIANO, R.P., et al. Structure of dietary measurement error: results of the OPEN Biomarker Study. Am J Epidemiol, n. 158, p. 14-21. 2003.

LOPES, A. C. S. et al. Consumo de nutrientes em adultos e idosos em estudo de base populacional: Projeto Bambuí. Cad. Saúde Pública, Rio de Janeiro , v. 21, n. 4. 2005.

MARCHIONI, D.M.L. Estudos epidemiológicos em exposições nutricionais. In: FISBERG, R.M.; SLATER, B.; MARCHIONI, D.M.L.; MARTINI, L.A. Inquéritos alimentares. Métodos e bases científicos. Barueri: Manole, 2005. 334 p.

MARGETTS, B.M, NELSON, M. Design concepts in nutritional epidemiology. 2nd ed. Oxford: University Press, 1997.

MARUCCI, M.F.N., ALVES, R.P., GOMES, M.M.B.C. Nutrição na geriatria. In: SILVA, S.M.C.S., MURA, J.D.P. Tratado de alimentação, nutrição e dietoterapia. São Paulo: Roca. 2007. p. 391-416.


MICHAELSSON, K., MELHUS, H., BELLOCCO, R., WOLK, A. Dietary calcium and vitamin D intake in relation to osteoporotic fracture risk. Bone, n. 32, p. 694-703. 2003.

MONTILLA, R.N.G., ALDRIGHI, J.M., MARUCCI, M.F.N. Relação cálcio/proteína da dieta de mulheres no climatério. AMB Rev Assoc Méd Bras, n.50, p. 52- 54. 2004.

NETTLETON, J.A. et al. Dietary patterns are associated with biochemical markers of inflammation and endothelial activation in the Multi-Ethnic Study of Atherosclerosis (MESA). Am. J. Clin. Nutr., v.83, p.1369-1379, 2006.

ORGANIZAÇÃO MUNDIAL DE SAÚDE - OMS. Diet, nutrition and the prevention of chronic diseases. Geneva: WHO, FAO, Expert Consulation on Diet, Nutrition and Prevention of Chronic Diseases, 2002.

PEREIRA, C.A. Avaliação nutricional na terceira idade. In: MAGNONI,D.; CUKIER,C. & OLIVEIRA, P.A. Nutrição na Terceira idade. São Paulo: Sarvier, 2005.

POMERLEAU, J.; OSTBYE, T.; BRIGHT-SEE, E. Potential underreporting of energy intake in the Ontario Health Survey and its relationship with nutrient and food intakes. Eur. J. Epidemiol., v.15, p.553-557, 1999.

SICHIERI, R. Dietary Patterns and Their Associations with Obesity in the Brazilian City of Rio de Janeiro. Obes. Res., v.10, n.1, p.1-7, 2002.

SCAGLIUSI, F.B.; LANCHA JUNIOR, A.H. Subnotificação da ingestão energética na avaliação do consumo alimentar. Rev. Nutr., v.16, p.471-481, 2003.

SICHIERI, R., EVERHART, M.D. Validity of a brazilian food frequency questionnaire against dietary recalls and estimated energy intake. Nutr Res, n. 18, p. 1649-59. 1998.

SICHIERI, R.; GIGANTE, D.P. (Orgs.). Epidemiologia nutricional. Rio de Janeiro: Fiocruz, Atheneu, 2007. p.107.


SILVEIRA, E.A; LOPES, A.C.S; CAIAFFA, W.T. Avaliação Nutricional de Idosos. In: KAC, G.;

SPIEGELMAN, D., MCDERMOTT, A., ROSNER, B. Regression calibration method for correcting measurementerror bias nutritional epidemiology. Am J Clin Nutr, n. 65, p.1179-1786. 1997.

TOLEDO, A.L.A. et al. Dietary patterns and risk of oral and pharyngeal cancer: a case-control study in Rio de Janeiro, Brazil. Cad. Saúde Pública, v.26, n.1, p.135-142, 2010. Disponível em: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2010000100014&lng=pt&nrm=iso>. Acesso em: 2 set. 2010.

TUCKER, L.K. Micronutrient status and aging. Nutr Ver, n.53, p. 9-15. 1995.

WILLETT W. Nutritional epidemiology. 2nd ed. New York: Oxford University Press, 1998.

WILLETT, W.; STAMPFER M. Implications of total energy intake for epidemiologic analyses. In: WILLETT W. Nutritional epidemiology. 2nded. New York: Oxford University Press, 1998. 514p.

WORLD HEALTH ORGANIZATION - WHO. Encuesta multicêntrica: salud, bien estar y envejecimiento (SABE) em America Latina y el Caribe. In: REUNIÓN DEL COMITÉ ASESOR DE INVESTIGACIONES EM SALUD, 36., 2001, Washington. Anales... Washington, 2001.

WORLD HEALTH ORGANIZATION - WHO. Obesity: preventing and managing the global epidemic. Geneva, 1997. (Technical Report Series, 894).

ZABOTTO, C.B. Registro fotográfico para inquéritos dietéticos: utensílio e porções. Ed Meta Goiânia Nepa – Unicamp, 1996.


Thanks for your attention

JEC

nutrient intakes according to eating patterns and nutritional status for older people josé eduardo...

Documents