Given the high disease burden associated with the low intake of whole grains, modelling studies that estimate the impact of dietary strategies to increase more healthful grain foods consumption are essential to inform evidence-based and culturally specific policies. The current study investigated the potential nutritional impact of replacing staple grain foods with more healthful options.

Based on the 2015 Health Survey of São Paulo, a cross-sectional, population-based study, we modelled the substitution of white rice and white bread with brown rice and whole-wheat bread. Outcomes included changes in more healthful grain foods, energy and nutrient intakes.

Urban area of São Paulo, Brazil.

Participants aged over 12 years who completed a semi-structured questionnaire and one 24-h recall (n 1741).

The substitution of all white rice and white bread with brown rice and whole-wheat bread, respectively, would result in more than 5 % increases in Zn (+9·1 %), Ca (+9·3 %), vitamin E (+18·8 %), dietary fibre (+27·0 %) and Mg (+52·9 %) intake, while more than a 5 % decrease would be seen for total carbohydrate (–6·1 %), folate (–6·6 %), available carbohydrate (–8·5 %), Fe (–8·6 %), vitamin B6 (–12·5 %), vitamin B2 (–17·4 %), and vitamin B1 (–20·7 %). A substantial increase in the amount of more healthful grain foods consumed would be seen (10 g/d to 220 g/d, or from 4 % to 69 % of total grain intake).

Replacing white rice and white bread with their whole-grain versions has the potential to improve diet quality, suggesting they are prime targets for policy actions aiming at increasing intake of more healthful grain foods.

To quantify the energy, nutrients-to-limit and total gram amount consumed and identify their top food sources consumed by Latin Americans.

Data from the Latin American Study of Nutrition and Health (ELANS).

ELANS is a cross-sectional study representative of eight Latin American countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru and Venezuela.

Two 24-h dietary recalls on non-consecutive days were used to estimate usual dietary intake of 9218 participants with ages between 15–65 years. ‘What We Eat in America’ food classification system developed by United States Department of Agriculture was adapted and used to classify all food items consumed by the ELANS population. Food sources of energy, added sugars, SFA, Na and total gram amount consumed were identified and ranked based on percentage of contribution to intake of total amount.

Three-highest ranked food categories of total energy consumed were: rice (10·3%), yeast breads (6·9%), and turnovers and other grain-based items (6·8 %). Highest ranked food sources of total gram amount consumed were fruit drinks (9·6%), other 100% juice (9·3%) and rice (8·3%). Three highest ranked sources for added sugars were other 100% juice (24·1 %), fruit drinks (16·5%), and sugar and honey (12·4%). SFA ranked foods were turnovers and other grain-based (12·6 %), cheese (11·9%), and pizza (10·3%). Three top sources of Na were rice (13·9%), soups (9·1 %) and rice mixed dishes (7·3 %).

Identification of top sources of energy and nutrients-to-limit among Latin Americans is critical for designing strategies to help them meet nutrient recommendations within energy needs.

To evaluate associations between selected dietary concerns and eating practices and determine the association of these concerns/practices with demographic and socio-economic characteristics in a population from a large Brazilian city.

Population-based cross-sectional study. We investigated concerns regarding salt intake, the use of highly processed seasoning and the custom of reading the Na content on food labels. We also analysed concerns regarding the use of pesticides on food products and the practice of consuming organic foods. These variables were analysed according to sex, age group, schooling and income. Multivariate Poisson regression analysis was performed for the estimation of prevalence ratios.

Campinas, state of São Paulo, Brazil.

The representative sample consisted of 1710 adults and seniors.

A total 62·3 % of the population were concerned with salt intake, 34·7 % did not use highly processed seasoning and 10·6 % checked the Na content on food labels; 27·5 % were concerned with pesticides and 26·5 % consumed organic foods. The practices analysed were associated with the respective concerns. Women and seniors had a better profile, except for reading Na content in both groups and the consumption of organic foods among seniors. The frequency of checking the Na content and consuming organic foods increased with the level of schooling. The higher income group had a better profile, except for concern with salt intake.

Considerable social differences were found regarding the dietary practices, and the practices were associated with concerns. The present findings underscore the need for different dietary counseling strategies targeting specific groups.

To evaluate the association between nutritional quality of breakfast and cardiometabolic risk factors.

Cross-sectional study, 2015 Health Survey of São Paulo (2015 ISA-Capital) with Focus on Nutrition Study (2015 ISA-Nutrition).

Population-based study, with a representative sample of adults and elderlies living in São Paulo, Brazil.

The sample included 606 adults (aged 20–59 years) and 537 elderlies (aged ≥60 years) from the 2015 Health Survey of São Paulo. Dietary intake was assessed by at least one 24-h recall. Breakfast quality was evaluated using the proposed Brazilian Breakfast Quality Index (BQI), ranging scores from 0 to 10. BQI associations with sociodemographic, lifestyle, dietetic and cardiometabolic variables were estimated using survey-weighted multiple logistic regression models.

Being ≥60 years of age, self-identifying as White or Asian, having a per capita family income with ≥1 minimum wage, being sufficiently active at leisure time and non-smoker were associated with better scores of BQI. A higher BQI score was inversely associated with elevated blood pressure (OR 0·81, 95 % CI 0·70, 0·94), fasting glucose (OR 0·85, 95 % CI 0·73, 0·98), HOMA-IR (OR 0·86, 95 % CI 0·74, 0·98), total cholesterol (OR 0·87, 95 % CI 0·76, 0·99), LDL-C (OR 0·85, 95 % CI 0·74, 0·97), metabolic syndrome (OR 0·82, 95 % CI 0·72, 0·93) and being overweight (OR 0·87, 95 % CI 0·76, 0·99).

Breakfast quality of Brazilian adults needs improvement with disparities across some sociodemographic factors. BQI was associated with lower odds of cardiometabolic risk factors, suggesting a beneficial effect in this population and emphasising the role of breakfast in reducing the risk of CVD.

Misreporting in adults has been associated with socioeconomic and anthropometric characteristics, such as sex, age and weight status. Body Mass Index (BMI) is an important factor that has been associated with underreporting of energy intake. Many epidemiological studies often use self-reported values of height and weight, in order to reduce the cost and viability of population-base studies. Therefore, it is important to test the reliability of self-reported against measured values of height, weight and BMI in individuals who tend to underestimate their energy consumption.

To compare self-reported and measured anthropometric data of individuals who are underreporting their energy intake.

The sample included forty-six men and women who participated on the Health Survey of São Paulo, Brazil and had their total energy expenditure (TEE) measured by the doubly labelled water technique. Self-reported data were obtained from questionnaires and trained professional conducted the measurements of height and weight. BMI was classified based on the World Health Organization cutoff points for adults and the Pan-American Health Organization for elderlies. Correlation analysis and paired t test was used to test the differences between both values. Energy intake (EI) was assessed using two 24-hours dietary recall. The ratio of EI:TEE was used to identify misreporting considering the 95% confidence intervals. Respondents were classified in under-reporters, plausible reporters and over-reporters.

Twenty-six (57.8%) were classified as under-reporters, thirteen (28.9%) as plausible reporters, and six (13.3%) as over-reporters. Significant differences were found comparing measured vs. self-reported anthropometric values of under-reporters with height (1.60 m vs. 1.62 m, p < 0.00) and BMI (29.1kg/m2 vs. 27.9kg/m2, p < 0.02), but no significant differences for weight (74.6 kg vs. 75.7 kg, p = 0.28). Overweight and obesity were higher in under-reporters comparing self-reported (11.5% and 30.8%) and measured (15.4% and 46.2%) anthropometric values. Pearson correlation coefficient between measured and self-reported values was 0.95 (p < 0.00) for weight, 0.96 (p < 0.00) for height and 0.92 (p < 0.00) for BMI.

Although results showed a strong and significant correlation between self-reported and measured anthropometric values in under-reporters, it is important to consider BMI and obesity are important factors related to underreporting. Therefore, it recommends to measure anthropometric data in studies that aim to characterize misreporting based on nutritional status, since the classification and prevalence of BMI and obesity can be affected by the chosen approach.

Although evidence shows some decrease in energy intake, consumption of added sugars, solid fat acids (SFA), and sodium are still high among Latin Americans. This study evaluated top food sources contributing to the percentage of energy and nutrients-to-limit among Latin Americans.

Latin American Study of Nutrition and Health (ELANS) cross-sectional included 9,218 adults from Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela. 24h-recalls were used and foods were identified via adaptation of “What We Eat in America” system. Food sources of energy and nutrient-to-limit were ranked based on the percentage of intake contribution.

Argentina energy food sources were pizza (11.8%), and meats (5.7%); added sugars were sweetened beverages (14.3%), and quick breads (12.4%); SFA was pizza (22.2%) and meats (7.8%); and sodium was pizza (15.5%), and soup (7.6%). Brazil energy sources were alcoholic beverages (9.3%), and pizza (6.9%); added sugars were sweetened beverages (14.7%) and desserts (14.3%); SFA and sodium were pizza (9.0% and 9.9%) and sandwiches (9.4%). Chile energy sources were pizza (11.9%) and grain-based dishes (5.6%); added sugars were sweet bakeries (16.6%) and sweetened beverages (13.8%); SFA and sodium were pizza (19.6% and 21.2%) and sandwiches (7.4% and 7.7%). Colombia energy sources were pizza (6.6%) and alcoholic beverages (5.6%); added sugars were snacks (15.2%) and desserts (12.9%); SFA were desserts (9.7%) and pizza (7.6%); and sodium were soups (11.8%) and pizza (10.5%). Costa Rica energy sources were pizza (8.7%) and alcoholic beverages (6.9%), added sugars were sweetened beverages (13.0%) and candy (10.5%); SFA was pizza (12.0%) and Mexican dishes (8.9%); and sodium was pizza (13.5%) and sandwiches (8.8%). Ecuador energy sources were grain dishes (7.7%) and alcoholic beverages (6.8%), added sugars were sweetened beverages (14.6%) and desserts (12.6%), SFA was pizza (8.8%) and grain-based dishes (7.5%), and sodium were Asian dishes (10.4%) and grain-based dishes (9.2%). Peru energy sources were grain-based dishes (8.9%) and alcoholic beverages (8.2%), added sugars were yogurts (18.6%) and sweetened beverages (14.3%), SFA was pizza (8.6%) and sandwiches (8.1%), and sodium were grain-based dishes (17.2%) and cooked grains (14.9%). Venezuela energy sources were grain-based dishes (6.9%) and alcoholic beverages (6.1%), added sugars were sweetened beverages (13.5%) and desserts (11.3%), SFA were grain-based dishes (11.3%) and meats (7.7%), and sodium were sandwiches (9.0%) and grain-based dishes (7.9%).

Awareness of food sources is critical for designing strategies to help Latin Americans meet nutrient recommendations within energy needs.

Introduction: Overweight has become a very important issue in the epidemiological scenario of nutrition due to its increasing rates and association with several chronic noncommunicable diseases. The etiology of overweight is complex, but diet is one of the modifiable factors that may interfere in the nutritional status of individuals and consequently on overweight and obesity. One aspect of the diet that has been related to overweight is the increase of energy intake, and related to that, the increase on food portion size.

Objective: To evaluate differences in food portions size and its energy contribution in adolescents from São Paulo, Brazil between 2003, 2008 and 2015.

Materials and Methods: Cross-sectional population-based study with a representative sample of 1711 adolescents aged 12 to 19 years who participated in the Health Survey of São Paulo (HS-SP). The HS-SP was conducted in 2003, 2008 and 2015. Overweight was defined according to the cutoff points of the World Health Organization (WHO) for adolescents (BMI ≥ p85). Dietary data were obtained from two 24-hour recalls.Reported foods were classified into groups and the prevalence of consumers, the percentage of energy contribution, and the mean and median of portion sizes in each food group were calculated.

Results: Over the years, the prevalence of overweight in adolescents increased from 13.8% to 29.4%. The prevalence of consumers of salty snacks, fruits, industrialized juices, red meats, rice, sweets/desserts and toast/cookies has increased; while the number of consumers of coffee/tea, fruit juice, milk, artisan/non-packaged snacks and sugar decreased. The food groups with the highest energy contribution were: rice (14%), red meat (12%) and bread (9%) in all the years evaluated. The groups with the greatest increase in the energy contribution from 2003 to 2015 were: toast / cookies, sweets / desserts, white and red meats, and industrialized juices. The consumption portion size of eggs has increased, while those of cold cuts, fruits, industrialized juices, rice and tubers/roots decreased.

Discussion: There was a diverse variation in the frequency of intake, the energy contribution and the food portion size over time with increase in some groups and decrease in others. These findings provide useful data to support future interventions and public policies focused on adolescent feeding.

To investigate the association among social determinants, lifestyle variables and diet quality in São Paulo, Brazil.

Cross-sectional study, 2015 Health Survey of São Paulo (Inquérito de Saúde de São Paulo (2015 ISA-Capital)) with Focus on Nutrition Study (2015 ISA-Nutrition).

Population-based study, with a representative sample of adults living in São Paulo, Brazil.

Adults (aged 20–59 years, n 643) and older adults (aged ≥60 years, n 545).

We observed differences in the Brazilian Healthy Eating Index-Revised (BHEI-R) by education, income, occupation, sex and race. Whole grains (0·63 points, 12·6 % of the maximum score), sodium (2·50 points, 25·0 %) and solid fat, alcohol and added sugars (9·28 points, 46·4 %) components had the lowest BHEI-R scores. Factors positively associated with diet quality included the presence of one disease or more (e.g. diabetes mellitus, hypertension, cancer, hypercholesterolaemia: β = 0·636, P < 0·001), income (middle income: β = 0·478, P < 0·001; high income: β = 0·966, P < 0·001) and occupation (other: β = 1·418, P < 0·001). Energy (β = –0·001, P < 0·001), alcohol consumption (β = –0·207, P = 0·027), education level (middle education: β = –0·975, P < 0·001; high education: β = –1·376, P < 0·001), races other than white (β = –0·366, P < 0·001) and being unemployed (β = –0·369, P < 0·046) were negatively associated with diet quality.

Groups affected by socio-economic inequalities need better diet quality. Governmental actions should be implemented to reduce the consumption of energy-dense and sodium-rich foods, facilitate access and information on healthy eating, and conduct nutritional education.

To assess Fe intake, calculate the prevalence of inadequate Fe intake and identify food contributors to Fe intake during 2003 and 2008 in a population-based study, reflecting before and after the mandatory fortification of flour with Fe.

Two cross-sectional population-based studies conducted in 2003 and 2008. Dietary intake was evaluated by 24 h recall and the Software for Intake Distribution Estimation (PC-SIDE) was used to estimate within-person variance and prevalence of inadequate Fe intake. The statistical analysis was conducted considering the complex survey design.

São Paulo, Brazil.

Adolescents, adults and elderly adults of both sexes, interviewed in 2003 (n 2386) and 2008 (n 1661).

The Fe intake mean increased in all populations in the post-fortification period. A reduction of over 90 % was observed in the prevalence of inadequate Fe intake among men for all age groups analysed. When evaluating women, despite the substantial reduction (over 63 %), prevalence of inadequate Fe intake remained high (34 %) in those aged 19–50 years. Major food contributors to Fe intake before fortification were beans, beef, vegetables and dairy. There was an alteration in the contributors in the post-fortification period, with bread, beef, beans and biscuits as main contributors.

The mandatory fortification with Fe significantly furthered the reduction in the prevalence of inadequacy, except among women of reproductive age, and changed the main contributors to this nutrient in the studied population. Therefore, monitoring of Fe addition in flour is essential to assess compliance to the fortified flour policy and to guarantee a safe Fe intake for all the population.

To evaluate red and processed meat intake, and the impact meat consumption has on diet quality and the environment.

A large cross-sectional health survey performed in São Paulo, Brazil.

Diet was assessed by two 24 h dietary recalls. Usual intakes were calculated using the Multiple Source Method. The World Cancer Research Fund recommendation of an average of 71·4 g/d was used as the cut-off point to estimate excessive red and processed meat consumption. To investigate the relationship between meat consumption and diet quality we used the Brazilian Healthy Eating Index Revised. The environmental impact was analysed according to estimates of CO2 equivalent emissions from meat consumption.

Brazilians (n 1677) aged 19 years and older were studied.

The mean red and processed meat intake was 138 g/d for men and 81 g/d for women. About 81 % of men and 58 % of women consumed more meat than recommended. Diet quality was inversely associated with excessive meat intake in men. In Brazil alone, greenhouse gas emissions from meat consumption, in 2003, were estimated at approximately 18 071 988 tonnes of CO2 equivalents, representing about 4 % of the total CO2 emitted by agriculture.

The excessive meat intake, associated with poorer diet quality observed, support initiatives and policies advising to reduce red and processed meat intake to within the recommended amounts, as part of a healthy and environmentally sustainable diet.

To estimate the prevalence of inadequate nutrient intake among adolescents and the association between socio-economic variables and nutritional status.

Cross-sectional study with a population-based sample.

The usual nutrient intake distribution was estimated using the Iowa State University method. The Estimated Average Requirement cut-off point method was used to determine the proportion of adolescents with inadequate intake for each nutrient, according to sex, income, parental educational level and nutritional status.

Twenty-four-hour dietary recalls were applied in 525 male and female Brazilian adolescents aged 14–18 years.

The highest prevalence of inadequate nutrient intake was observed for vitamin E (99 % in both sexes). For male and female adolescents, the prevalence of inadequate intake was: Mg, 89 % and 84 %; vitamin A, 78 % and 71 %; vitamin C, 79 % and 53 %; and vitamin B6, 21 % and 33 %, respectively. The prevalence of inadequate intake for niacin, thiamin, riboflavin, Se, Cu and vitamin B12 was <15 %. Individuals in the lower income and lower parental educational level strata had the highest risk of having inadequate intake for P, riboflavin and vitamins A, B6 and B12. Compared with non-overweight individuals, overweight individuals had a higher risk of inadequate intake for Mg, vitamin A, P, thiamin and riboflavin.

The present study found a high prevalence of inadequate intake of nutrients that are recognised as being protective against chronic diseases. Adolescents in the lower income and lower parental educational level strata were less likely to have their nutrient intake requirements met.