<p>Diet and physical activity (PA) are independent risk factors for obesity and chronic diseases including type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS). The temporal sequence of these exposures could be used to create patterns with potential links to health status indicators.</p> <p>The objectives were (1) to create clusters of joint temporal dietary and PA patterns (TDPAPs) and to determine their association with health status indicators including body mass index (BMI), waist circumference (WC), fasting plasma glucose, glycated hemoglobin, triglycerides, high density lipoprotein cholesterol, total cholesterol, blood pressure, and disease status including obesity, T2DM, and MetS; (2) compare the number and strength of association between clusters of daily temporal dietary patterns (TDPs), temporal PA patterns (TPAPs), and TDPAPs and health status indicators above; (3) determine the association between TDPs on weekday and weekend days and health indicators (diet quality, waist circumference, BMI, and obesity) and their overlap of membership; (4) assess concurrent validity of energy and time cut-offs describing the data-driven TDPs by determining their relationships to BMI and WC.</p> <p>A 24-h dietary recall and random day of accelerometer data of U.S. adults aged 20-65 years from the cross-sectional National Health and Nutrition Examination Survey 2003-2018 data were used to create data-driven TDPAP, TDP, TPAP clusters by constrained or modified dynamic time warping, coupled with a kernel k-means clustering algorithm. Multivariate regression models determined associations between the temporal pattern clusters and health status indicators, controlling for potential confounders and adjusting for multiple comparisons. The number of significant differences among clusters and adjusted R2/the Akaike information criterion compared the strength of associations between clusters of patterns and continuous/categorical health status indicators. The percentages of overlap in cluster membership between temporal patterns were also calculated.</p> <p>A TDPAP/TDP cluster with proportionally equivalent energy consumed at evenly spaced eating occasions, or a TDPAP/TPAP cluster with the highest PA counts among 4 clusters, </p> <p>was associated with significantly better health indicators including lower BMI, WC, and</p> <p>odds of obesity than other temporal lifestyle pattern clusters. TDPAPs and TDPs had stronger and more numerous associations with health indicators compared with TPAPs. Both a weekday and weekend day TDP of proportionally equivalent energy consumed throughout the day were significantly associated with better health indicators compared with the other TDP clusters but the TDPs of most adults were not consistent on weekdays and weekend days. The data-driven TDP was validated using descriptive cut-off generated TDP and holds promise for obesity interventions and translation to dietary guidance. </p> <p>Temporal lifestyle patterns are significantly associated with health indicators, providing evidence that incorporating time with lifestyle style behaviors comprehensively may provide insight into health. Further evaluation of temporal patterns linked to health holds potential for application to interventions to prevent chronic disease.</p>

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Yes / Background: stable isotope ratios of carbon (δ13C) and nitrogen (δ15N) in bone and dentine collagen have been used for over 30 years to estimate palaeodiet, subsistence strategy, breastfeeding duration and migration within burial populations. Recent developments in dentine microsampling allow improved temporal resolution for dietary patterns. Aim: We propose a simple method which could be applied to human teeth to estimate chronological age represented by dentine microsamples in the direction of tooth growth, allowing comparison of dietary patterns between individuals and populations. The method is tested using profiles from permanent and deciduous teeth of two individuals. Subjects and methods: using a diagrammatic representation of dentine development by approximate age for each human tooth (based on the Queen Mary University of London Atlas) (AlQahtani et al., 2010), we estimate the age represented by each dentine section. Two case studies are shown: comparison of M1 and M2 from a 19th century individual from London, England, and identification of an unknown tooth from an Iron Age female adult from Scotland. Results and conclusions: The isotopic profiles demonstrate that variations in consecutively-forming teeth can be aligned using this method to extend the dietary history of an individual, or identify an unknown tooth by matching the profiles.

Lifestyle modifications, including calorie deficit diets targeting weight loss, are the first line treatment and prevention measures for the development and progression of the emerging cardiometabolic disease, nonalcoholic fatty liver disease (NAFLD), particularly early in the disease course when interventions may alter the natural history. However, the optimal composition of eating patterns to protect liver health is still under debate. High-quality diets with anti-inflammatory, antioxidant, and anti-obesity effects have the potential to play an important role in NAFLD occurrence; however, evidence is still limited. Dietary Approaches to Stop Hypertension (DASH) and a Mediterranean-style diet are two major healthy dietary patterns that have been extensively reported to prevent cardiometabolic outcomes such as hypertension (HTN) and cardiovascular disease (CVD), major concomitant diseases of NAFLD. A few indexes have been developed to measure adherence to both of these dietary patterns in observational studies. However, none of the DASH indexes have been updated with current evidence in more than a decade. Research suggests that greater reductions in cardiometabolic disorders are possible with more updated guidance. In addition to the impact of overall diet quality, the effects of specific foods on liver fat are still unknown, and some, such as eggs, are controversial. Until recently, eggs have been considered unhealthy due to concerns about dietary cholesterol intake, but evidence suggests these concerns may have been influenced by confounding. Eggs are rich in many important nutrients and bioactive compounds, including dietary choline and carotenoids, that may benefit cardiometabolic outcomes, including NAFLD. Choline deficiency has been shown to cause liver steatosis in preclinical studies, but little is known about the relations between egg consumption, egg-rich nutrients, and liver fat in humans. The objectives of this dissertation are to evaluate the association between adherence to different healthy dietary patterns, including a Mediterranean-style diet and the DASH diet, and NAFLD risk. To account for updated evidence, we also developed and tested the reliability and validity of a newly modified DASH (mDASH) eating pattern and evaluated its association with incident NAFLD risk as well as changes in liver fat over a 6-year follow-up period. Lastly, we evaluated the associations between eggs and selected egg-rich nutrients (i.e., choline, lutein, and zeaxanthin) and NAFLD risk and prevalence alone and in combination with other dietary habits. We used data from several cohorts in the Framingham Heart Study, including the Offspring, Third Generation, Omni Generation Cohort 1, and Omni Generation Cohort 2. Liver fat was assessed using a computed tomography (CT) scan using the average liver fat attenuation relative to a control phantom to create the liver phantom ratio (LPR) at two sequential CT scans (2002–2005 and 2008–2011) in the Offspring and Third Generation cohorts; measures were available at a single CT scan (2008–2011) in Omni cohorts. NAFLD was defined as a LPR ≤0.33 in the absence of heavy alcohol use (>14 drinks per week for females and >21 drinks per week for males). Prevalent NAFLD was determined on the follow-up CT scan, which all cohorts had available. Among those with no NAFLD at the first CT scan, incident NAFLD was determined on the follow-up CT scan. To determine changes in liver fat, we calculated the difference in LPR from one exam to the next by subtracting the 1st CT scan LPR measure from the 2nd CT LPR measure. Next, we calculated annualized changes by dividing LPR change values by the year difference between the 1st and 2nd CT scan dates for each participant. For the assessment of incident NAFLD and liver fat change, dietary data were derived from food frequency questionnaires (FFQs) administered as close as possible in time to the first liver fat measurement. For the analysis of prevalent liver fat, we used the FFQ as close as possible in time to the second liver fat measurement. The first specific aim of this dissertation is to evaluate whether adherence to the Mediterranean diet (MeDiet Index) or a DASH eating pattern (Fung DASH index) was associated with NAFLD risk. Modified Poisson regression models were used to compute incident NAFLD risk ratios (RR) and 95% confidence intervals (CI) associated with three score categories (low, moderate, and high) on each index adjusting for confounding in 1413 Framingham Offspring and Third Generation participants. Multivariable linear regression models were used to compute adjusted annualized means of liver fat change over a median of 6 years of median follow-up in 1691 participants. In the second specific aim, we aimed to evaluate the adherence to a mDASH eating pattern on NAFLD risk and changes in liver fat using a newly developed mDASH index. Firstly, we developed and evaluated the psychometric properties (reliability and validity) of the new mDASH index. To develop the index, we started with the components included in the original DASH eating pattern (fruits, vegetables, and low-fat dairy), and then proceeded to add components, one at a time, that have been suggested in the literature to protect against known DASH-related outcomes. The selection of the components included in the final mDASH index (total vegetables (including potatoes), total fruit, total dairy (including full-fat dairy), red and processed meat, whole grains, legumes, nuts and seeds, sugar-sweetened beverages, and fish) was based on two criteria: 1) factors found in previous literature to be associated with blood pressure and cardiovascular outcomes, and 2) the ability of possible components in the new mDASH to predict the risk of known DASH-related outcomes (i.e., HTN and atherosclerotic CVD (ASCVD)). Test-retest reliability analyses of the proposed mDASH index were performed with Pearson correlation coefficients over four sequential examination visits in 1339 Offspring Cohort individuals. To assess construct validity, we computed cross-sectional linear regression and correlation analyses between the proposed mDASH index against key DASH nutrients such as calcium, potassium, magnesium, and fiber in 2763 Offspring Cohort individuals. Next, we used Cox regression models to evaluate the predictive validity of the mDASH index, with one modification at a time, for incident HTN (n=1714) and then for ASCVD (n=2700) risks over 11 and 25 medians years of follow-up, respectively. Once the mDASH index was finalized, we used Cox models to determine whether our final mDASH index represents an improvement over three previously established DASH indexes (Fung, Dixon, and Günther) for predicting HTN and ASCVD in two Framingham cohorts, the Offspring and the younger Third Generation cohorts. Lastly, we aimed to evaluate the association between mDASH (vs. earlier DASH indexes) and the risk of incident NAFLD. Multivariable modified Poisson regression and general linear models were used to compute incident NAFLD RR (n=1406) and adjusted means of annualized liver fat change (n=1692) associated with the mDASH index and other prior DASH indexes in a combined sample from the Offspring and Third Generation cohorts. In the third specific aim, we evaluated the impact of egg and egg-rich nutrients (choline, lutein, and zeaxanthin) on NAFLD risk. Egg intake was classified into three categories based on the food frequency questionnaire categories (<1, 1, and ≥2 per week). Dietary choline was body weight adjusted based on the residual method while lutein and zeaxanthin were classified into tertiles, respectively. Multivariable logistic regression models were used to compute prevalent NAFLD odds ratios (OR) associated with egg intakes in 2644 participants from the Offspring, Third Generation, Omni 1, and Omni 2 cohorts. Multivariable modified Poisson regression and general linear models were used to compute NAFLD incident RR (n=1414) and adjusted means of annualized liver fat change (n=1690) associated with egg, choline, and lutein and zeaxanthin intakes in a combined sample from the Offspring and Third Generation cohorts which had repeated measures of liver fat. In our analyses related to the comparison of the DASH eating pattern with a Mediterranean-style diet (Aim 1, Chapter 2), in a combined sample from the Offspring and Third Generation cohorts 19% of participants (n=1413, mean age 51 years, 53% female) developed new onset of NAFLD during follow-up and liver fat increased for most participants. High score category (>28 vs. ≤23 scores) on the Fung DASH index were associated with a 40% lower risk of incident NAFLD (95% CI: 0.42–0.84) after adjusting for age, sex, alcohol intake, education status, current smoking status, multivitamin use, moderate-to-vigorous physical activity, and annualized waist-to-height ratio changes. These findings were stronger in women than men (RR for higher (vs. lower) DASH scores: 0.46, 95% CI: 0.26–0.84 in women; 0.69, 95% CI: 0.45–1.05 in men). DASH scores were also associated with statistically significantly less acquisition of liver fat over study follow-up (p-value<0.05). Further, the DASH diet was protective against NAFLD risk even among individuals with prevalent HTN or an elevated triglyceride:high density lipoprotein cholesterol (TG:HDL-C) ratio. We observed no association between adherence to a MeDiet index and NAFLD risk or liver fat change. The development and testing of the mDASH index are shown in Chapter 3. We found in the analyses for this second specific aim that there was strong evidence of test-retest reliability for the newly-developed mDASH index as supported by moderate to high correlations (r=0.59–0.71) in total mDASH scores between four sequential exams. The construct validity of the mDASH index was supported by its associations with selected nutrients in expected directions. Total mDASH scores were strongly positively associated with intakes of calcium, potassium, magnesium, and fiber (p-values<0.05). These associations were similar to or stronger than those observed with previous DASH indexes. The predictive validity of the new mDASH index was supported by the statistically significant 31% and 29% lower risks of incident HTN and ASCVD associated with score quintile 5 (vs. quintile 1) on the new index in the older Offspring Cohort. Similarly, strong inverse associations between the mDASH index and both HTN and ASCVD were also observed in the younger Third Generation Cohort. These associations were of a similar magnitude to those observed with the Fung index for both HTN and ASCVD but stronger than those seen with the Dixon or Günther indexes. In Chapter 3, we also examined the association between the new mDASH index and risk of incident NAFLD. We found that score tertile 3 (vs. tertile 1) on the mDASH index was associated with a 29% lower NAFLD risk (95% CI: 0.53–0.95) after adjusting for age, sex, energy, sodium intake, current smoking status, education level, multivitamin use, and alcohol intake. In addition, the highest scores on all DASH indexes (mDASH, Fung, Dixon, and Günther) were associated with substantially smaller annualized increases in liver fat over the study follow-up (p-value <0.05). In Chapter 4 of this dissertation, we first examined the association between egg consumption and prevalent and incident NAFLD. NAFLD prevalence was 29% among participants (n=2644) in a combined sample from the Offspring, Third Generation, Omni 1, and Omni 2 cohorts. In a sample from the Offspring and Third Generation cohorts with two measures of liver fat (n=1414), the cumulative incidence of NAFLD was 19% and liver fat was found to increase for most participants during follow-up. After adjusting for confounding by age, sex, energy, red meat and alcohol intakes, prevalent HTN, and body mass index (BMI), we found no association between egg intake and prevalent NAFLD (OR for ≥2 vs. <1 eggs per week (referent): 1.15, 95% CI: 0.92–1.45). Similarly, we observed no associations between egg intake and incident NAFLD risk (RR for ≥2 vs. <1 eggs per week (referent): 1.00, 95% CI: 0.77–1.30) or annualized change in liver fat. Our final specific aim in Chapter 4 was to examine the associations between selected egg-rich nutrients and NAFLD risk. Here, we found that dietary choline intake was strongly associated with a 31% lower risk of incident NAFLD (RR for highest vs. lowest tertile: 0.69, 95% CI: 0.51-0.94) after adjusting for age, sex, education level, and waist-to-height ratio. No associations were found between lutein and zeaxanthin intakes and NAFLD. In summary, the findings of this dissertation suggested that adherence to a DASH eating pattern is beneficially associated with a lower risk of incident NAFLD. Our new mDASH index supports other evidence suggesting that the DASH eating pattern should no longer be limited to the consumption of low-fat dairy and that total vegetable intake does not need to exclude white or sweet potatoes from the diet. The new mDASH is associated with a lower risk of traditional DASH-related outcomes, including HTN and ASCVD, as well as with the emerging cardiometabolic risk factor, NAFLD. Lastly, higher egg intake alone or combined with other eating patterns was not associated with NAFLD, while dietary choline intakes were inversely associated with NAFLD risk.

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Dans les pays en voie de développement, les évolutions prévues par les organismes internationaux montrent une progression beaucoup plus importante des maladies chroniques non transmissibles, comme le cancer, que des maladies transmissibles. Actuellement, la majorité des études montre que la tendance à l'augmentation de l'incidence et de la mortalité par cancer colorectal est plus marquée dans les sociétés riches que dans les sociétés pauvres. Dans les pays développés le cancer colorectal est au deuxième rang en ce qui concerne la mortalité par cancer et les changements dans les habitudes alimentaires et le mode de vie sont souvent mis en cause dans son développement. Bien que les données épidémiologiques soient rares, les populations de la plupart des pays asiatiques ne sont pas conscientes du risque grandissant que peut constituer pour eux le cancer colorectal. Comme les autres pays en développement, le Cambodge n'a pas de système d'enquête de consommation alimentaire, ni de système de surveillance ou de contrôle des substances chimiques, ni de système d'enregistrement, de contrôle ou de dépistage des cancers. L'objectif de cette recherche était de débuter la première observation d'une relation entre régime alimentaire et cancer colorectal au Cambodge. L'idée générale était d'identifier les aliments grands contributeurs des régimes alimentaires de la population cambodgienne, et de les traduire en calories, nutriments et composés bioactifs en se fondant sur les bases de données existantes. Une étude a également été menée sur les comportements de cette population, en ce qui concerne ses habitudes alimentaires et les modes de préparation des aliments susceptibles de produire des substances cancérigènes telles que des amines hétérocycliques (AH) et du benzo[a]pyrene (BaP). Pour réaliser ce travail de recherche, une enquête de consommation alimentaire a été effectuée à l'aide d'un rappel sur 24 heures et d'un questionnaire de fréquence alimentaire, afin de créer une base de données dédiée pour servir à l'évaluation des risques. Ensuite, une évaluation de l'exposition aux AH et BaP a été effectuée, afin d'établir une hiérarchie du risque que ces substances posent pour cette population d'étude ; celle-ci a été réalisée en croisant les données de consommation alimentaire, obtenues par le biais d'une enquête de consommation alimentaire individuelle exécutée dans ce travail, avec les données de contamination rassemblées à partir des analyses chimiques reportées dans la littérature scientifique récente. Les résultats ont été comparés avec les valeurs toxicologiques de référence. Ils ont montré que les habitudes alimentaires au Cambodge n'ont pas encore changé pour s'adapter à l'alimentation occidentale, et qu'elles offrent plus de composés protecteurs. L'exposition aux contaminants néoformés (AH et BaP) a été plus faible par rapport aux pays régionaux ainsi qu'aux pays développés. La présence de composés endogènes tels que glucides, fibres alimentaires, calcium et vitamine C semble protéger la population cambodgienne du cancer colorectal. Des recherches supplémentaires sont nécessaires pour étudier les interactions entre l'alimentation, le mode de vie et les facteurs génétiques, ainsi que d'autres facteurs également. / From the projection in the future of international bodies, non-communicable diseases such as cancer may increase more than communicable diseases in developing countries. The highlight of this burden may be due to the changing of dietary patterns and lifestyle. Currently, the evolution of food consumption, consumption pattern and colorectal cancer is very worrying worldwide. It is a disease in economically ‘developed' populations, and it is the second killer among other cancers; however, its incidence seems lower in poor countries. As the other developing countries, Cambodia has no system of food survey, no monitoring and control system of chemical substances, and also, there is no control and registration system for cancer. Thus, the objective of this research was to start the first observation of the relationship between dietary pattern and colorectal cancer in Cambodia. The general idea of the study was to identify the dietary patterns, and larger contributors to colorectal cancer in Cambodia, then to translate them into calories, nutrients and bioactive compounds, based on the existing database. Another goal was to assess the difference of dietary habit and cooking methods in the studied population that could lead to the production of colorectal carcinogens such as heterocyclic amines (HAs) and benzo[a]pyrene (BaP). In order to create the food consumption database needed for food risk assessment, a food consumption survey was conducted using 24-hour recall and food frequency questionnaire. A dietary assessment of HAs and BaP has been done, in order to establish a hierarchy of the importance of the risk that these substances represent to the health of this population. Dietary exposures to HAs and BaP were obtained by combining food consumption data, obtained from the individual food survey specially designed and carried out during this research, with the contamination data gathered from chemical analysis reported in the recent literature. The observation results have been compared with the toxicological reference values. The results show that dietary patterns in Cambodia have not changed yet to adapt to the Western diet, and contain higher levels of protected nutrients. The exposure to neoformed contaminants (HAs and BaP) was lower than the values reported among other Asian countries, and lowest as compared to the developed countries. The presence of endogenous compounds such as carbohydrates, dietary fibers, calcium and vitamin C, seems to protect the Cambodian population from colorectal cancer. Further research is needed to study the interaction of diet, lifestyle and the genetic background, and other factors as well.

INTRODUÇÃO: As recomendações alimentares na infância são a exclusividade do leite materno (LM) até o 6º mês, sua extensão mínima até o 24º mês e introdução programada de alimentos semissólidos e sólidos até os dois anos. O padrão alimentar na infância influencia preferências sensoriais e indicadores de saúde nos ciclos de vida subsequentes. OBJETIVO: Analisar a tendência secular da alimentação de crianças brasileiras menores de cinco anos nas três últimas décadas. MÉTODOS: Os dados foram provenientes da amostra de crianças menores de cinco anos das três Pesquisas de Demografia e Saúde realizadas no Brasil em 1986, 1996 e 2006. O aleitamento materno (AM) foi descrito segundo indicadores propostos pela Organização Mundial da Saúde (2008). As medianas do AM e do aleitamento materno exclusivo (AME) e os seus fatores preditores foram estimadas por modelo de regressão de Cox. Os padrões alimentares (PA) foram identificados por análise de componentes principais (ACP) e, em seguida, foram calculados os escores de cada PA. Estes PA foram incluídos como desfechos em modelos de efeitos mistos cujos fatores preditores associados foram aqueles referentes à saúde materno-infantil e sociodemográficos. RESULTADOS: Entre 1986 e 2006, o percentual de crianças expostas ao LM foi de 91 para 97 por cento e a duração mediana, de 6 para 12 meses. Entre 1996 e 2006 a mediana do AME aumentou de 0,7 para 2 meses. A amamentação na 1ª hora de vida foi fator protetor para a duração do AME e do AM. A duração mediana do AME foi homogênea entre as regiões, associada de forma direta com relação de pré-natal, escolaridade materna e índice de riqueza. A duração mediana do AM foi associada de forma inversa com nascimento por parto cesáreo em hospital privado, intervalo interpartal inferior a 24 meses e difere segundo região geográfica, sendo superior no Norte brasileiro. Foram identificados quatro padrões alimentares para as crianças com idade entre 6 e 59 meses: PA1(iogurte, carnes, tubérculos, hortaliças, frutas), PA2(líquidos, leites não-maternos, carnes e carga fatorial negativa para leite materno e papas à base de farinhas enriquecidas), PA3(líquidos, sucos de frutas, papas à base de amido industrializado, papas à base de farinha enriquecida, iogurte e carga fatorial negativa para carnes vermelhas) e PA4(leite não-materno, fórmulas e carga fatorial negativa papas à base de farinhas enriquecidas e ovopeixefrango). A prática dos padrões PA1 e PA3 foi superior entre crianças que recebiam leite materno. O padrão PA1 foi distribuído de forma homogênea entre as regiões enquanto os outros padrões alimentares apresentaram comportamento distinto entre as regiões. A mudança mais expressiva no período analisado foi a virtual substituição do PA4 pelo PA3, cuja composição de alimentos se aproxima mais das recomendações para faixa etária. CONCLUSÃO: O quadro pró-aleitamento materno é centrado principalmente na exposição universal ao LM e na sustentação desta exposição, refletida no incremento da sua duração mediana. Entretanto, o avanço na duração do AME é menos expressivo no período. O aumento da exposição aos alimentos sólidos entre as crianças menores de 12 meses representa a principal alteração dos padrões alimentares entre 1996 e 2006. Três padrões alimentares das crianças menores de cinco anos são influenciados regionalmente e um deles socialmente. / INTRODUCTION: The infant and recommendations are exclusive breastfeeding (EBF) at six months, breastfeeding at least 24th months and the programmed introduction of solid, semi-solid or soft foods with breast milk until 24 months. Early dietary patterns can explain the sensory preferences and the health indicators throughout the life course. OBJECTIVE: To analyze the secular trend of Brazilian young child feeding practices in last three decades. METHODS: The under five children sample was from three probabilistic Brazilian Demographic Health Surveys carried out in 1986, 1996 and 2006. The breastfeeding (BF) was described according to the indicators from World Health Organization (WHO, 2008). The BF and exclusive breastfeeding (EBF) medians and the predictor factors were estimated using Cox regression model. The dietary patterns (DP) were identified by principal component analysis (PCA) and the dietary pattern scores were included as outcome variables in logistic mixed model. The predictive variables were sociodemographic, maternal and infant health. The complex design sample was considered in statistical analysis. RESULTS: In the period between 1986 and 2006, the percentage of children exposed to breast milk increased from 91 to 97 per cent and the BF median increased from 6 to 12 months and the EBF increased from 0.7 to 2.0 months. Early initiation of breastfeeding was a protective factor for BF and EBF length. The EBF length was uniform among geographic regions and it was directly associated with antenatal care, maternal schooling and wealth index. The EF median was inversely associated with cesarean delivery in private hospital, birth interval less than 24 months and it was different among regions (higher in North). Four DP were identified for children age 6 to 59 months: PA1(composed of yogurt, red meat, chicken, eggs, tubers, vegetables and fruits), PA2(composed of liquids, non-breast milk, red meat, chicken, eggs and negative loadings for breast milk and enriched starch porridge), PA3(composed of liquids, fruit juices, industrialized starch porridge, yogurt and negative factor loadings for red meat) and PA4( composed of non-breast milk, formula and negative factor loadings for enriched starch porridge and egg/fish/chicken). The PA1 and PA3 practices were higher among breastfed children. The PA1 dietary pattern was uniform among geographic regions otherwise, another patterns were differently distribute. The most important DP change was the virtual replacement PA4 for PA3, that was more appropriated for children aged higher than 12 months. CONCLUSION: The pro-breastfeeding scenarium is focused mainly in children universally exposed to BF and the upkeeping of BF, assessed by BF median duration. However, in this survey periods, the increase of EBF duration is lower than the BF duration. The increased solids exposure in children under 12 months expresses the main dietary pattern change between 1996 and 2006. Three dietary patterns of under five children are predicted by geographic region factors and one of them by socioeconomic factors.

Introdução: Índices dietéticos (ID) têm sido utilizados para estudar associações entre alimentação e doenças cardiovasculares (DCV). Um ID combina e resume aspectos de uma recomendação ou guia alimentar. Esses aspectos geralmente são a quantidade de nutrientes, alimentos ou grupos de alimentos a serem consumidos em um período de tempo (dia / semana / mês). A dieta do Programa Alimentar Brasileiro Cardioprotetor (DICA Br) classificou os alimentos em quatro grupos e definiu a quantidade diária a ser consumida. Uma vez que os aspectos nutricionais do DICA Br são diferentes de outras recomendações alimentares, não é possível utilizar os ID existentes para associar essa dieta com as DCV. Por isso, faz-se necessário o desenvolvimento de ID que considere as características da DICA Br. Objetivo: Descrever o desenvolvimento do ID DICA Br, avaliar a sua consistência interna, validade de constructo e as características da população associadas ao índice. Métodos: Foram utilizados dados de baseline do ensaio clínico randomizado DICA Br (www.clinicaltrials.gov; NCT01620398). Os quatro grupos alimentares da dieta estudada foram adotados como componentes do índice. Os critérios para atribuir pontos foram definidos a priori com base nos princípios e recomendações da DICA Br. Cada componente do índice recebeu pontos que variam de 0 a 10, portanto a pontuação total variou de 0 a 40. A consistência interna foi avaliada por meio dos coeficientes de correlação entre a pontuação total e de cada componente do índice, assim como pelo alpha de Cronbach. A validade de constructo foi avaliada verificando como nutrientes se associam com o índice por meio de testes para tendência linear. Análises de regressão linear bruta e ajustada foram realizadas para avaliar as características da população associadas ao índice. Resultados: A análise incluiu 2044 indivíduos (58,6 por cento homens). A média do índice total foi maior entre as mulheres. Os componentes do índice apresentaram baixas correlações entre si e as correlações entre cada componente isolado e o índice total foram >0,40. O alpha de Cronbach foi 0,66. Maiores pontuações no índice estiveram inversamente associadas com o consumo de energia, gordura total, gordura monoinsaturada, colesterol e diretamente associadas com a ingestão de carboidratos e fibras. Homens hipertensos e mulheres diabéticas apresentaram maiores pontuações, enquanto homens fumantes apresentaram menores pontuações. Conclusões: O ID DICA Br apresentou confiabilidade e validade de constructo satisfatórias, refletiu a ingestão de nutrientes chaves e detectou características dos indivíduos que se associam com a DICA Br. / Background: The diet of the Brazilian Cardioprotective Nutritional Programme (BALANCE) classified food into four groups and set the daily amount to be consumed. The nutritional aspects of BALANCE are different from other dietary recommendations, therefore it is not possible to use existing diet indexes (DI) to associate this diet with cardiovascular disease. Objective: To describe the development of BALANCE DI, evaluate its internal consistency, construct validity and population characteristics associated with the index. Methods: We analyzed baseline data from BALANCE randomized clinical trial (www.clinicaltrials.gov, NCT01620398). The four food groups of the studied diet were adopted as index components. Each index component received points ranging from 0 to 10 and the total score ranged from 0 to 40. The internal consistency was evaluated by means of correlation coefficients between total and each component index score, as well as the Cronbach´s alpha coefficient. The construct validity was assessed by checking how nutrients are associated with the index. Crude and adjusted linear regression analyses were performed to evaluate the characteristics of the population that are associated with the index. Results: The analysis included 2044 subjects (58.6 per cent men). The average of the total index was higher among women. The components of the index showed low correlations with each other and the correlations between each individual component and the total index were > 0.40. Cronbach\'s alpha coefficient was 0.66. High scores in the index were inversely associated with the intake of energy, total fat, monounsaturated fat, cholesterol and directly associated with the intake of carbohydrates and fiber. Hypertensive men and diabetic women had higher scores, while male smokers had lower scores. Conclusions: The BALANCE DI showed satisfactory reliability and construct validity, reflected the intake of key nutrients and detected characteristics of individuals that are associated with the BALANCE diet.