Orientador: Maria Antonieta de Barros Leite Carvalhaes / Resumo: Objetivos: Identificar padrões alimentares de duas coortes de gestantes e diferenças na adesão a estes padrões segundo trimestres gestacionais e características das gestantes: de escolaridade, idade, nível socioeconômico, trabalhar fora, morar com companheiro, fumar antes da gestação, ingerir bebida alcóolica antes da gestação, paridade, ser da cor branca e estado nutricional pré-gestacional. Métodos: A fonte dos dados foi o estudo “Impacto de intervenção para promoção de caminhada no lazer e alimentação saudável em gestantes atendidas pela Estratégia de Saúde da Família: um estudo de coorte controlado”. Em cada trimestre gestacional foram realizados dois recordatórios alimentares de 24 horas: um por entrevista presencial e outro por telefone, um referente a final de semana/feriado. Os inquéritos foram digitados no software Nutrition Data System for Research. Os alimentos com características semelhantes foram agrupados em 39 grupos, sendo a identificação dos padrões realizada por análise de componentes principais, utilizando a média de consumo de cada grupo nos dois recordatórios de cada trimestre. Foi realizada rotação ortogonal varimax, considerando cargas fatoriais rotacionadas acima de |0,30|. Foram calculados os escores de adesão das gestantes a cada padrão identificado e posteriormente divididos em tercis. As diferenças relativas aos trimestres gestacionais foram testadas pelo teste de diferença de proporções; associação entre os padrões e as características maternas re... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Objectives: To identify dietary patterns of two cohorts of pregnant women and differences in adherence to these patterns by gestational trimesters and characteristics of pregnant women: years of schooling, age, socioeconomic status, work outside the home, living with a partner, smoking before pregnancy, eat drink alcoholic before pregnancy, parity, be of white color and pre-gestational nutritional status. Methods: The data source was the study "Impact of an intervention to promote walking during leisure time and healthy eating in pregnant women attending the Family Health Strategy: a controlled cohort study”. At each trimester, there were two dietary recalls of 24 hours: one by personal interview and another by telephone, one referring to weekend/holiday. The surveys form entered in the software Nutrition Data System for Research. Foods with similar characteristics were grouped into 39 groups, with the identification of patterns performed by factorial principal component analysis using the average consumption of each food group in both recalls obtained in each trimester. Varimax orthogonal rotation was carried out, considering the significant food groups rotated factor loadings above |0.30|. The adhesion scores were calculated for pregnant women for each dietary pattern identified and subsequently divided into tertiles. The differences related to gestational trimesters were tested by the proportions difference test; association between the patterns and maternal characteristic... (Complete abstract click electronic access below) / Mestre

Made available in DSpace on 2015-07-22T20:49:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-03-31 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Objetivo: Identificar os padrões alimentares de adolescentes eutróficos e com excesso de peso. Métodos: Estudo transversal envolvendo 239 adolescentes de uma escola pública da cidade de São Paulo/SP, Brasil, de ambos os sexos, na faixa etária de 14 a 19 anos. Foram coletados dados antropométricos e registro alimentar de 4 dias. O estado nutricional foi avaliado pelo IMC, de acordo com os critérios de Must et al. Foi aplicada análise fatorial para a identificação dos padrões alimentares. Resultados: Foram identificados 4 padrões alimentares: Tradicional, Urbano, Saudável e Junk Food. O estado nutricional de eutrofia teve associação positiva com os padrões Tradicional e Urbano, o sobrepeso com os padrões Saudável e Junk Food e a obesidade associou-se negativamente com os Padrões Urbano, Saudável e Junk Food. Conclusão: O padrão saudável foi encontrado entre os adolescentes com sobrepeso, evidenciando preocupação com o controle do peso e tentativa de mudança do hábito alimentar. Entre os obesos, a ocorrência do subrelato, provavelmente, influenciou o resultado das associações. / Objective: Identify the dietary patterns of adolescents, both normal and overweight. Method: cross-sectional study of 239 adolescents from a public school in São Paulo/SP, Brazil; of both sexes, aged 14 to 19 years. Anthropometric data was collected and 4-day dietary records were collected. Nutritional status was assessed by BMI, according to the criteria of Must et al. A factor analysis was applied to identify dietary patterns. Results: Out of this assessment, four dietary patterns were identified: Traditional, Urban, Healthy, and Junk Food. The nutritional status of normal weight was positively associated with the Traditional and Urban patterns, the overweight was positively associated with the Healthy and Junk Food patterns, and, lastly, obesity was negatively associated with the Urban, Healthy and Junk Food patterns. Conclusion: The Healthy pattern was found among overweight adolescents, showing concern for weight control and an attempt to change eating habits. Among the obese, the occurrence of underreporting probably influenced the outcome of the associations. / FAPESP: 03/00415-4 / TEDE / BV UNIFESP: Teses e dissertações

Essa tese teve como objetivo avaliar a associação do consumo de padrões alimentares e produtos alimentícios ultraprocessados (UP) sobre indicadores antropométricos e sua variação entre adolescentes. Para tal, foram analisados os dados de 1.031 estudantes de quatro escolas privadas e duas escolas públicas da região metropolitana do Rio de Janeiro que foram acompanhados por três anos consecutivos (2010 a 2012) no Estudo Longitudinal de Avaliação Nutricional de adolescentes (ELANA). Os resultados estão apresentados em três manuscritos que compõem a tese. O primeiro manuscrito identificou três padrões alimentares: Ocidental, composto por massas, embutidos e bacon, carnes, doces, bebidas açucaradas, salgados e fast food, biscoito, pães e cereais, leite e derivados e ovos, o Saudável, caracterizado por peixes, hortaliças, verduras, raízes e feculentos, frutas e sucos e o Arroz/Feijão, composto pelo consumo de arroz, feijão e café. Na análise dos dados na linha de base o padrão Ocidental associou-se a um menor índice de massa corporal (IMC) e não foi observada associação estatisticamente significativa em relação ao percentual de gordura corpórea (%GC) e o padrão em questão. Adicionalmente, foi verificada uma associação negativa entre o padrão Arroz/Feijão e ambos os indicadores antropométricos sugerindo que esse padrão de consumo tradicional possa ser protetor para a obesidade. No segundo manuscrito avaliou-se a relação entre o consumo de UP e indicadores de qualidade da dieta. O consumo de UP foi avaliado em gramas por dia e em gramas/total de calorias. Observou-se um aumento das variáveis marcadoras de alimentação não saudável e saudável com o aumento do consumo de UP. No entanto, quando relacionados ao aumento de consumo de UP/energia observou-se um aumento de marcadores de alimentação não saudável e, com exceção da vitamina C, uma redução de marcadores de alimentação saudável. Assim, a densidade do consumo de UP mostrou-se um bom indicador de qualidade da dieta entre adolescentes. No terceiro manuscrito avaliou-se a associação entre o consumo de UP e a evolução temporal do IMC e %GC. A análise longitudinal por modelos lineares mistos, que levam em conta todas as observações ao longo do tempo, indicou que nas análises não ajustados havia uma associação negativa entre consumo de UP e o IMC e %GC, porém nas análises de UP/energia e nas análises ajustadas por atividade física e uma variável de controle para a qualidade do relato não mais foram observadas associações com o consumo de UP e as medidas antropométricas de adiposidade. Pode-se concluir que não evidenciamos associação do consumo de UP com medidas antropométricas de obesidade uma vez que o consumo elevado de UP associado ao crescimento do %GC nas análises transversais, não se manteve nas análises longitudinais. A discrepância entre os achados dos estudos seccionais e os longitudinais pode decorrer de confundimento residual nos estudos seccionais. Conclui-se, que para redução do ganho excessivo de peso, orientações relativas exclusivamente a um padrão de alimentação saudável que incorpora a ideia de UP, devem ser acompanhadas de redução da quantidade de alimentos consumidos. / This thesis had as an objective to evaluate the association of the consumption of dietary patterns and ultra-processed food products (UP) on anthropometrics indicators and its variation among adolescents. Thus, the data of 1,031 students of four private schools and two public schools of the metropolitan region of Rio de Janeiro were analyzed during three consecutive years (2010 through 2012) at the Adolescent Nutritional Assessment Longitudinal Study (ELANA). The results are presented in three manuscripts that compose the thesis. The first manuscript identified three dietary patterns: Western, compounding pasta, processed meat and bacon, meat, sweets, sugar sweetened beverages, savoury snacks and fast-food, cookies, bread and cereals, milk and dairy products and eggs, the Healthy, characterized by fish, vegetables, greens, roots and starchy, fruits and juices and the Rice/ Beans, compounded by the consumption of rice, beans and coffee. In the data analyses of baseline the Western pattern was associated to a lower body mass index (BMI) and a statistically significant association regarding the percentage of body fat (%BF) and the related pattern was not noticed. Additionally, a negative association between the Rice and Beans pattern and both anthropometric indicators could be verified suggesting that this traditional dietary pattern could be protective for obesity. On the second manuscript, the relationship between the UP consumption and the diet quality markers was estimated. The UP consumption was reported in grams per day and in grams per total calories. An increase of not only of non-healthy diet quality markers but also healthy markers ones were observed with UP consumption increases. However, when related to the growth of UP/energy consumption, an increase on the non-healthy diet quality markers and, with the exception of vitamin C, a reduction of healthy markers could be observed. The UP consumption density proved to be a good marker of diet quality among adolescents. On the third manuscript, were evaluated the association between UP consumption and temporal evolution of BMI and %BF. The longitudinal analyses by linear mixed models, which take into account all the observations during the time, indicated that on crude analyses there was a negative association between the UP consumption, BMI and %BF, however in the UP/energy analyses and adjusted analyses for physical activity and a control variable for the reporting quality no more associations were observed with the UP consumption and anthropometric adiposity measures. It is possible to conclude that there was no association of UP consumption and anthropometric adiposity measures since the high UP associated with the increase of %BF in the cross sectional analyses no remained in the longitudinal analyses. The discrepancy between the findings of cross-sectional studies and longitudinal may be due to residual confounding in cross-sectional studies. It could be concluded that, for reduction of excessive weight gain, guidelines exclusively related to the healthy eating pattern that incorporates an idea of UP, must be accompanied by reduction of consumed foods quantity.

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No. of bitstreams: 1 gomes_cb_me_bot.pdf: 1246184 bytes, checksum: 7b2e1fd7ffd21a1608fdda569ac3ece3 (MD5) Previous issue date: 2016-02-19 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Objetivos: Identificar padrões alimentares de duas coortes de gestantes e diferenças na adesão a estes padrões segundo trimestres gestacionais e características das gestantes: de escolaridade, idade, nível socioeconômico, trabalhar fora, morar com companheiro, fumar antes da gestação, ingerir bebida alcóolica antes da gestação, paridade, ser da cor branca e estado nutricional pré-gestacional. Métodos: A fonte dos dados foi o estudo “Impacto de intervenção para promoção de caminhada no lazer e alimentação saudável em gestantes atendidas pela Estratégia de Saúde da Família: um estudo de coorte controlado”. Em cada trimestre gestacional foram realizados dois recordatórios alimentares de 24 horas: um por entrevista presencial e outro por telefone, um referente a final de semana/feriado. Os inquéritos foram digitados no software Nutrition Data System for Research. Os alimentos com características semelhantes foram agrupados em 39 grupos, sendo a identificação dos padrões realizada por análise de componentes principais, utilizando a média de consumo de cada grupo nos dois recordatórios de cada trimestre. Foi realizada rotação ortogonal varimax, considerando cargas fatoriais rotacionadas acima de |0,30|. Foram calculados os escores de adesão das gestantes a cada padrão identificado e posteriormente divididos em tercis. As diferenças relativas aos trimestres gestacionais foram testadas pelo teste de diferença de proporções; associação entre os padrões e as características maternas realizada através de regressão logística multivariada, ajustada por coorte. Todos os testes foram realizados considerando p<0,05 como nível de significância. Resultados: Foram identificados três padrões: Brasileiro Tradicional; Predominantemente Ultraprocessado e Carne Bovina; Integral, Frutas, Legumes e Leite com baixo teor de gordura e derivados. Houve redução na frequência de gestantes no primeiro tercil e aumento no terceiro tercil do padrão Brasileiro Tradicional com o avançar da gestação e aumento na frequência no tercil de maior adesão do padrão Predominantemente Ultraprocessado e Carne Bovina. Um quarto das gestantes apresentaram-se nos mesmos tercis de adesão dos padrões durante os três trimestres. Dentre as variáveis investigadas, trabalhar fora de casa (p=0,041) e ser da cor não branca (p=0,046) aumentaram as chances de estar no tercil de maior adesão do padrão Brasileiro Tradicional. As gestantes mais novas mostraram maior adesão ao padrão Predominantemente Ultraprocessado e Carne Bovina (p=0,002). Não morar com companheiro (p=0,003), ingerir bebida alcóolica pré-gestacional (p=0,006) e o avançar dos trimestres gestacionais (p=0,002) também aumentaram as chances de maior adesão a este padrão. Gestantes não brancas e com excesso de peso (versus eutróficas) apresentaram menos chances de estarem no tercil de maior adesão deste padrão (p<0,001; p=0,05). Gestantes com escolaridade intermediária, frente àquelas com 11 ou mais anos de estudo, apresentaram menos chances de estarem no terceiro tercil do padrão Integral, Frutas, Legumes e Leite com baixo teor de gordura e derivados (p=0,007), assim como as das classes C e D/E frente às da classe B (p=0,05). Conclusão: Foram identificados três padrões alimentares dentre as gestantes estudadas, sendo observado um aumento significativo na adesão aos padrões Brasileiro Tradicional e Predominantemente Ultraprocessado e Carne Bovina com o avançar da gestação e diferentes características sociodemográficas, comportamentais, obstétricas e nutricionais associadas a adesão de cada padrão. / Objectives: To identify dietary patterns of two cohorts of pregnant women and differences in adherence to these patterns by gestational trimesters and characteristics of pregnant women: years of schooling, age, socioeconomic status, work outside the home, living with a partner, smoking before pregnancy, eat drink alcoholic before pregnancy, parity, be of white color and pre-gestational nutritional status. Methods: The data source was the study "Impact of an intervention to promote walking during leisure time and healthy eating in pregnant women attending the Family Health Strategy: a controlled cohort study”. At each trimester, there were two dietary recalls of 24 hours: one by personal interview and another by telephone, one referring to weekend/holiday. The surveys form entered in the software Nutrition Data System for Research. Foods with similar characteristics were grouped into 39 groups, with the identification of patterns performed by factorial principal component analysis using the average consumption of each food group in both recalls obtained in each trimester. Varimax orthogonal rotation was carried out, considering the significant food groups rotated factor loadings above |0.30|. The adhesion scores were calculated for pregnant women for each dietary pattern identified and subsequently divided into tertiles. The differences related to gestational trimesters were tested by the proportions difference test; association between the patterns and maternal characteristics was performed using multivariate logistic regression, adjusted for cohort. All tests were performed considering p <0.05 as level of significance. Results: Three patterns were identified: Traditional Brazilian; Predominantly Ultra-processed and beef; Integral, fruits, legumes, low fat milk and derivatives. There was a reduction in the frequency of pregnant women in the first tertile and an increase in the third tertile in Traditional Brazilian pattern with the advancing gestation, and an increased on frequency in greater adherence tertile of the Predominantly Ultra-processed and beef pattern. A quarter of the women presented in the same patterns adherence tertiles during the three trimesters. Among the variables investigated, work outside the home (p=0.041) and be nonwhite (p=0.046) increased the odds of being in the highest tertile of adherence Traditional Brazilian pattern. Younger pregnant women showed greater adherence to Predominantly Ultra-processed and beef pattern (p=0.002). Not living with a partner (p=0.002), drink alcoholic beverages before pregnancy (p=0.006) and the advance of gestational trimesters (p=0.002) also increased the chances of greater adherence to this pattern. Nonwhite pregnant women and overweight (versus normal weight) were less likely to be in greater adherence tertile of the same pattern (p<0.001; p=0.05. Pregnant women with intermediate education, compared to those with 11 or more years of study, had fewer chances of being in the third tertile of Integral, fruits, legumes, low fat milk and derivatives pattern (p=0.007), as well those from class C and D / E, compared to class B (p=0,05). Conclusion: Three dietary patterns were identified among pregnant women from Botucatu. A significant increase was observed in adherence to Traditional Brazilian and Ultra-processed patterns with advancing gestation and different socio demographic, behavioral, obstetric and nutritional characteristics associated with adhesion of each pattern. / FAPESP: 2014/06865-6

Essa tese teve como objetivo avaliar a associação do consumo de padrões alimentares e produtos alimentícios ultraprocessados (UP) sobre indicadores antropométricos e sua variação entre adolescentes. Para tal, foram analisados os dados de 1.031 estudantes de quatro escolas privadas e duas escolas públicas da região metropolitana do Rio de Janeiro que foram acompanhados por três anos consecutivos (2010 a 2012) no Estudo Longitudinal de Avaliação Nutricional de adolescentes (ELANA). Os resultados estão apresentados em três manuscritos que compõem a tese. O primeiro manuscrito identificou três padrões alimentares: Ocidental, composto por massas, embutidos e bacon, carnes, doces, bebidas açucaradas, salgados e fast food, biscoito, pães e cereais, leite e derivados e ovos, o Saudável, caracterizado por peixes, hortaliças, verduras, raízes e feculentos, frutas e sucos e o Arroz/Feijão, composto pelo consumo de arroz, feijão e café. Na análise dos dados na linha de base o padrão Ocidental associou-se a um menor índice de massa corporal (IMC) e não foi observada associação estatisticamente significativa em relação ao percentual de gordura corpórea (%GC) e o padrão em questão. Adicionalmente, foi verificada uma associação negativa entre o padrão Arroz/Feijão e ambos os indicadores antropométricos sugerindo que esse padrão de consumo tradicional possa ser protetor para a obesidade. No segundo manuscrito avaliou-se a relação entre o consumo de UP e indicadores de qualidade da dieta. O consumo de UP foi avaliado em gramas por dia e em gramas/total de calorias. Observou-se um aumento das variáveis marcadoras de alimentação não saudável e saudável com o aumento do consumo de UP. No entanto, quando relacionados ao aumento de consumo de UP/energia observou-se um aumento de marcadores de alimentação não saudável e, com exceção da vitamina C, uma redução de marcadores de alimentação saudável. Assim, a densidade do consumo de UP mostrou-se um bom indicador de qualidade da dieta entre adolescentes. No terceiro manuscrito avaliou-se a associação entre o consumo de UP e a evolução temporal do IMC e %GC. A análise longitudinal por modelos lineares mistos, que levam em conta todas as observações ao longo do tempo, indicou que nas análises não ajustados havia uma associação negativa entre consumo de UP e o IMC e %GC, porém nas análises de UP/energia e nas análises ajustadas por atividade física e uma variável de controle para a qualidade do relato não mais foram observadas associações com o consumo de UP e as medidas antropométricas de adiposidade. Pode-se concluir que não evidenciamos associação do consumo de UP com medidas antropométricas de obesidade uma vez que o consumo elevado de UP associado ao crescimento do %GC nas análises transversais, não se manteve nas análises longitudinais. A discrepância entre os achados dos estudos seccionais e os longitudinais pode decorrer de confundimento residual nos estudos seccionais. Conclui-se, que para redução do ganho excessivo de peso, orientações relativas exclusivamente a um padrão de alimentação saudável que incorpora a ideia de UP, devem ser acompanhadas de redução da quantidade de alimentos consumidos. / This thesis had as an objective to evaluate the association of the consumption of dietary patterns and ultra-processed food products (UP) on anthropometrics indicators and its variation among adolescents. Thus, the data of 1,031 students of four private schools and two public schools of the metropolitan region of Rio de Janeiro were analyzed during three consecutive years (2010 through 2012) at the Adolescent Nutritional Assessment Longitudinal Study (ELANA). The results are presented in three manuscripts that compose the thesis. The first manuscript identified three dietary patterns: Western, compounding pasta, processed meat and bacon, meat, sweets, sugar sweetened beverages, savoury snacks and fast-food, cookies, bread and cereals, milk and dairy products and eggs, the Healthy, characterized by fish, vegetables, greens, roots and starchy, fruits and juices and the Rice/ Beans, compounded by the consumption of rice, beans and coffee. In the data analyses of baseline the Western pattern was associated to a lower body mass index (BMI) and a statistically significant association regarding the percentage of body fat (%BF) and the related pattern was not noticed. Additionally, a negative association between the Rice and Beans pattern and both anthropometric indicators could be verified suggesting that this traditional dietary pattern could be protective for obesity. On the second manuscript, the relationship between the UP consumption and the diet quality markers was estimated. The UP consumption was reported in grams per day and in grams per total calories. An increase of not only of non-healthy diet quality markers but also healthy markers ones were observed with UP consumption increases. However, when related to the growth of UP/energy consumption, an increase on the non-healthy diet quality markers and, with the exception of vitamin C, a reduction of healthy markers could be observed. The UP consumption density proved to be a good marker of diet quality among adolescents. On the third manuscript, were evaluated the association between UP consumption and temporal evolution of BMI and %BF. The longitudinal analyses by linear mixed models, which take into account all the observations during the time, indicated that on crude analyses there was a negative association between the UP consumption, BMI and %BF, however in the UP/energy analyses and adjusted analyses for physical activity and a control variable for the reporting quality no more associations were observed with the UP consumption and anthropometric adiposity measures. It is possible to conclude that there was no association of UP consumption and anthropometric adiposity measures since the high UP associated with the increase of %BF in the cross sectional analyses no remained in the longitudinal analyses. The discrepancy between the findings of cross-sectional studies and longitudinal may be due to residual confounding in cross-sectional studies. It could be concluded that, for reduction of excessive weight gain, guidelines exclusively related to the healthy eating pattern that incorporates an idea of UP, must be accompanied by reduction of consumed foods quantity.

abstract: Background: Hispanic women are at high risk for Type 2 Diabetes (T2D), in part due to their high prevalence of obesity, which may influence the development of insulin resistance and disease onset. Unhealthy eating contributes to T2D risk. Dietary patterns are the combination of total foods and beverages among individual’s over time, but there is limited information regarding its role on T2D risk factors among Hispanic women. Objective: To identify a posteriori dietary patterns and their associations with diabetes risk factors (age, BMI, abdominal obesity, elevated fasting blood glucose, and hemoglobin A1c) among overweight/obese Hispanic women. Design: Cross-sectional dietary data were collected among 191 women with or at risk for T2D using the Southwestern Food Frequency Questionnaire capturing the prior three months of intake. Dietary patterns were derived using exploratory factor analysis. Regression scores were used to explore associations between dietary patterns and diabetes risk factors. Results: The patterns derived were: 1) “sugar and fat-laden”, with high loads of sweets, drinks, pastries, and fats; 2) “plant foods and fish”, with high loads of vegetables, fruits, fish, and beans; 3) “soups and starchy dishes”, with high loads of soups, starchy foods, and mixed dishes; 4) “meats and snacks”, with high loads of red meat, salty snacks, and condiments; 5) “beans and grains”, with high loads of beans and seeds, whole-wheat and refined grain foods, fish, and alcohol; and 6) “eggs and dairy”, with high loads of eggs, dairy, and fats. The “sugar and fat-laden” and “meats and snacks” patterns were negatively associated with age (r= -0.230, p= 0.001 and r= -0.298, p<0.001, respectively). Scores for “plant foods and fish” were associated with fasting blood glucose (r= 0.152, p= 0.037). There were no other statistically significant relationships between the dietary patterns and risk factors for T2D. Conclusions: A variety of patterns with healthy and unhealthy traits among Hispanic women were observed. Being younger may play an important role in adhering to a dietary pattern rich in sugary and high-fat foods and highlights the importance of assessing dietary patterns among young women to early identify dietary traits detrimental for their health. / Dissertation/Thesis / Doctoral Dissertation Exercise and Nutritional Sciences 2018

Abstract Proper nutrition and optimal weight status in pregnancy are important for both the mother and her child. The present study was aimed at assessment of maternal food and nutrient intake, dietary supplement use, dietary patterns, and weight during pregnancy. Additionally, associations between maternal weight, socio-demographic and perinatal factors and advanced beta cell autoimmunity in the offspring were examined. The results from a one-year cohort of mothers entering the ongoing Type 1 Diabetes Prediction and Prevention (DIPP) study in 1998–99 (n =  797) suggested that healthy food choices were positively correlated with maternal age and education. Dietary supplements were used by 85% of the women. However, the intake of vitamin D did not meet the recommendation and folic acid intake was inadequate in 44% of the pregnant women when both food and supplementation intakes were taken into account. Seven dietary patterns were identified in 3730 pregnant women who entered the DIPP study between 1997 and 2002. The ‘healthy’, the ‘low-fat foods’ and the ‘alcohol and butter’ dietary patterns were positively associated with maternal age and education. The ‘fast food’ dietary pattern was positively associated and the ‘alcohol and butter’ pattern was inversely associated with the rate of maternal weight gain during pregnancy. Altogether, 4093 children and their mothers comprised the study population in which the relationships between maternal initial body mass index, weight gain rate, and the development of beta cell autoimmunity in the offspring were examined. Maternal weight status during pregnancy was not related to the risk of advanced beta cell autoimmunity. A higher level of maternal education was significantly associated with a decreased risk of advanced beta cell autoimmunity in children. More attention should be paid to nutritional guidance among Finnish pregnant women, especially as regards young and less well educated women. Dietary patterns may be useful for risk group identification and they may offer a framework for further research concerning diet and health outcomes among mothers and their children.

Increasing rates of overweight, obesity, and related cardiovascular diseases among older adults in the United States present unique public health challenges. Cross-cultural research has shown marked variation in health across the world’s elder populations because aging is a biological process rooted in sociocultural context. The sociocultural environment contributes to complex negotiations of food and physical activity patterns for older adults. It is well established in the literature that urban residents report low levels of physical activity and have easy access to fast food outlets, which tend to be concentrated in lower-income neighborhoods. I utilize a biocultural framework, integrating nutritional anthropology with healthy aging perspectives to recognize the role of the social determinants of health throughout the lifespan. This anthropological study integrates qualitative and quantitative methods to answer the following research question: What is the relationship between the sociocultural factors that shape diet, physical activity, and nutritional status among Alaskan elders in Anchorage? The results indicate that diet and physical activity practices in this sample do not meet national recommendations and that diet differs adversely from national reference samples. Statistical analyses indicate that the media and friends positively influenced older adults to increase their energy expenditure. Family influences increased fruit consumption, while participation in cultural and social events increased intake of fats and sweets. Cultural identity was an important factor for Alaska Native participants’ dietary selections. Social supports increased access to healthy foods and safe physical activities. This research suggests that trying to reach older adults with diverse needs through a variety of channels, including the media, social networks, and social events, can help alleviate some of the barriers to healthy diet and exercise patterns. These data indicate a need for culturally-responsive programs that maintain relationships with family members and make connections between elders with similar healthy aging goals in order to improve diet and physical activity practices.

Les maladies inflammatoires chroniques de l'intestin (MICI) désignent deux affections, la maladie de Crohn (MC) et la rectocolite hémorragique (RCH). Ces maladies sont caractérisées par une grande disparité de répartition dans le monde et une forte augmentation de leur incidence depuis 50 ans. Leur physiopathologie fait intervenir une composition anormale du microbiote intestinal (appelée dysbiose), une dysfonction de la barrière épithéliale, un déficit de l'immunité innée et une dérégulation de l'immunité adaptative. Plus de 163 gènes de prédisposition ont été identifiés, mais la plupart d'entre eux ne sont associés qu'à une augmentation modeste du risque de MICI (Odds Ratios compris entre 1,02 et 1,2). Les facteurs d'environnement semblent jouer un rôle important dans la survenue de ces maladies. Le tabagisme a un effet démontré, favorable dans la RCH, néfaste dans la MC. L'exposition solaire, la vitamine D, l'alimentation, les agents infectieux et les médicaments ont été associés aux MICI mais leur effet est moins bien démontré. Cette thèse d'épidémiologie est consacrée aux MICI; plus précisément, à l'étude de leurs facteurs d'environnement, et au risque de cancer associé aux médicaments des MICI. Elle est fondée sur l'étude de bases de données françaises et européennes. Un premier travail a exploré l'association entre l'exposition à l'isotrétinoïne (médicament prescrit pour traiter l'acné) et la survenue de RCH, rapportée par une étude américaine. Cette étude cas témoin a été menée à l'échelle de la France entière à partir des données du système national d'information inter-régimes de l'assurance maladie (SNIIRAM). Dans ce travail très peu de patients atteints de MICI ont reçu de l'isotrétinoïne durant l'année précédant le diagnostic de la maladie. La prise d'isotrétinoïne n'est pas associée au risque de RCH mais inversement associée au risque de MC.Dans un deuxième travail, nous avons étudié l'impact gobal de l'alimentation en modélisant les profils alimentaires associés à la survenue de RCH et de MC dans la cohorte prospective européenne EPIC (European Prospective Investigation Into Cancer). Un profil alimentaire riche “en produits sucrés et sodas” est associé à l'incidence de RCH dans le sous-groupe diagnostiqué au delà de 2 ans. Aucun profil alimentaire n'est associé au risque de MC. Le régime méditerranéen n'est ni associé à la RCH ni à la MCDans un troisième travail, nous nous sommes intéressés aux risques de cancer associés à l'exposition aux médicaments des MICI : immunosuppresseurs et anti-TNF. Leur prescription a beaucoup augmenté ces dernières années. Cependant ils ont été associés à un risque de lymphome, de cancer de la peau non mélanocytaire et de mélanome pour les thiopurines et les anti-TNF, respectivement. Nous avons évalué prospectivement le risque de cancer associé à ces médicaments, à l'échelle de la France entière dans des conditions de prescription courante, grâce aux données du SNIIRAM. Les résultats sont en en cours d'analyse.Notre thèse montre que l'étude des bases de données peut apporter une réponse à une question importante en pratique clinique , portant sur le lien entre isotrétinoïne et MICI. Notre travail a également permis de générer des hypothèses sur le lien entre les profils alimentaires et la survenue de MICI. Les limites de l'exercice (détaillées dans le manuscrit) ne doivent pas être sous estimées. Nos résultats suscitent des questions et appellent d'autres travaux, menés à une échelle encore plus vaste et avec d'autres méthodes statistiques. / Inflammatory bowel diseases refer to two conditions: Crohn's disease and ulcerative colitis. These diseases display an important geographic heterogeneity worldwide and an increase in incidence during the last fifty years. Their physiopathology is complex, involving anormal composition of gut microbiota (dysbiosis), dysfonction of epithelial barrier and dysregulation of innate and adaptative immune response. More than 163 predisposing genes have been identified, but most of them carry modest association with IBD (Odds ratios varrying from 1.02 to 1.3) (1–3). Environmental factors seem to play an important role in IBD onset. Smoking has a positive effect on UC and harmfull effect on CD. Sun exposure, vitamin D, diet, infections have been inconsistently associated with IBD. This epidemiology thesis is devoted to IBD and specifically, to environemental risk factors, and also to the risk of cancer associated to IBD drugs. It is based on French and European databases. Our first work, explored the association between isotretinoin and UC reported in a US study. Our study was performed in a case-control study in the whole French territory thanks to a medico-administrative database (SNIIRAM). In this work, only a few patients with IBD were exposed to isotetinoin in the year before disease onset. Exposure to isotretinoin was not associated with UC but negatively associated with CD.In a second study, we explored the global impact of diet on UC and CD in a European prospective study (European Prospective Investigation Into Cancer (EPIC)). A dietary pattern with “high sugars and soft drinks” was associated with UC risk when restricted to cases diagnosed at least two years after dietary assessment. No dietary pattern was associated with CD. Mediterranean diet had no effect on UC nor CD risks.In the third part of this work, we investigated the risk of cancer associated with IBD drugs: immunosuppresive agents and anti-TNF. These medications are more and more prescribed nowadays. Howevere, they are associated with an increased risk of cancer in observationnal studies: lymphoma and non melanoma skin cancer with thiopurines and anti-TNF agents respectively. Therefore, we aimed to investigate the cancer risks associated with thiopurine and/or anti-TNF exposure in the whole French territory in the real life , using a medico-adminstrative database (SNIRAM). Currently, we are still analyzing the results.Our work shows that studying large databases can answer an important issue in clinical practice related to a potential link between isotretinoin and IBD. Also, it has generated hypotheses about the link between dietary pattern and IBD. Limitations of our work (detailed in the manuscript) should be considered.. Otr studies using larger databases and other statistical methods should address these limitations.

<p>Food insecurity, or limited access to enough foods for an active, healthy life, characterizes the situation of 65% of US food pantry clients. Food insecurity is associated with poor dietary intake of key food groups and nutrients, diet-related chronic disease, poor physical and mental health, and reduced quality of life. Although food pantry clients are prevalently food insecure, there is a sizeable proportion of clients who are classified as food secure (FS), or report having adequate access to healthy foods. Previous studies suggest that food secure pantry clients may use pantry resources differently, and have diets that differ in quality and intake, compared to food insecure clients (including low food secure [LFS] and very low food secure [VLFS] clients). </p><p>Food pantries may be an important venue for interventions to improve food security and dietary outcomes. Since dietary intake and use of food pantries may differ by food security status, the efficacy of such interventions may also differ by food security status. A social ecological modeled (SEM), community-based intervention in the food pantry setting is promising in sustaining local change efforts and may facilitate long-term implementation of strategies to improve diet-related outcomes among food pantry clients. Therefore, the aims of this dissertation were to 1) characterize differences in diet quality and intake between FS, LFS and VLFS pantry clients; 2) explore associations between the nutritional quality of the pantry food environment (foods in stock and foods distributed to clients) and client diet quality by food security status; and 3) evaluate the intermediate effects of a SEM, community-based intervention to improve diet-related outcomes among pantry clients with comparison by food security status.</p><p>Aim 1 was addressed by examining associations between food security and both diet quality and usual intake (in separate mixed multiple linear regression models) in a cross-sectional analysis of adult food pantry clients at baseline. FS status was associated with a higher Healthy Eating Index-2010 (HEI-2010) whole grains score, as well as a higher mean usual intakes of whole grains and iron, compared to LFS status. FS status was also associated with higher mean usual intakes of dark green vegetables and total dairy compared to LFS and VLFS status.</p><p>Aim 2 was addressed by evaluating the relationship between the quality of the mix of foods in stock (pantry inventories) and distributed (client food bags) at food pantries with client diet quality, and investigating how these relationships varied by food security status, in a cross-sectional analysis of adult food pantry clients at baseline. Client food bag HEI-2010 scores were positively associated with client diet scores for the total vegetables, total fruit, total protein foods, and sodium components, while pantry inventory HEI-2010 scores were negatively associated with client diet scores for the total score and for the total fruit and fatty acids components. VLFS clients consumed more whole grains from client food bags compared to FS clients, and consumed more greens and beans from pantry inventories compared to LFS clients.</p><p>Aim 3 was addressed by evaluating longitudinal changes in adult food security, diet quality and usual intake over the first two years (baseline to midpoint) of a three-year SEM, community-based food pantry intervention‒ Voices for Food (Clinical Trial Registry: NCT0356609). Adult food security score improved in the intervention group, while HEI-2010 total score and several component scores improved in the comparison group. When comparing the change in main outcomes over time between the intervention and comparison groups, no favorable differences were observed at this intermediate time point.</p><p> </p><p>Food pantries do not comprise a homogeneous population of clients. Pantry clients have different quality diets and rely on pantries to acquire different types of foods depending on their food security status. Food pantries may be an important venue to target interventions that improve diet-related outcomes, with consideration for the complex interplay between food security status, the pantry food environment and availability of resources to prepare healthy foods. Evaluation of the final study time point, as well as further investigation of the dose-dependent effect of each intervention component and other individual community characteristics, may elucidate the relationship between the intervention and client outcomes.</p><p></p>