INTRODUÇÃO: a introdução de esquemas antirretrovirais altamente potentes, no tratamento da Aids pode estar associada ao aparecimento de alterações metabólicas em pacientes com HIV/Aids. Além da terapia antirretroviral, outros fatores, como a dieta podem contribuir para o aparecimento dessas alterações em adolescentes com HIV/Aids. Assim, faz-se necessária a avaliação da qualidade da dieta de indivíduos dessa população. OBJETIVO: analisar a qualidade da dieta de adolescentes com HIV/Aids. MÉTODOS: Trata-se de um estudo transversal aninhado a uma coorte de pacientes com HIV/Aids atendidos pela Unidade de Infectologia do Instituto da Criança (ICr-São Paulo). Foram avaliados 88 adolescentes (10 a 19 anos). Informações sobre o histórico da doença e uso de medicamentos foram obtidas a partir de prontuários médicos. Os adolescentes responderam a dois recordatórios de 24 horas e um questionário sobre atividade física habitual. Peso, altura e circunferência da cintura foram medidos em duplicata. A qualidade da dieta foi avaliada por meio do Índice de Qualidade da Dieta (IQD-R). O IQD-R é composto de 12 itens e a pontuação final varia de 0 a 100 pontos. Foram calculados os coeficientes de correlação de Pearson entre o IQD-R e as variáveis independentes. Também foram feitas as comparações das médias do IQD-R segundo as variáveis independentes pelo teste t-Student ou Mann-Whitney. RESULTADOS: a média para o IQD-R foi 51,90 pontos (EP=0,90 pontos). Os componentes que apresentaram menores médias foram cereais integrais e sódio. Os componentes que tiveram maiores médias foram cereais totais e óleos. Adolescentes moradores de casas de apoio tiveram média maior para fruta total e menor para carnes e leguminosas, quando comparados aos adolescentes que moravam com a família. Meninas apresentaram média maior para leite e derivados e menor para calorias provenientes de gorduras sólidas, bebidas alcoólicas e açúcares adicionados quando comparadas com meninos. CONCLUSÃO: os adolescentes com HIV/Aids avaliados apresentaram padrão de consumo alimentar semelhante ao de adolescentes da população geral: alto consumo de açúcar, gordura saturada e sódio e consumo insuficiente de cereais integrais e frutas. Atenção especial deve ser dada à dieta de adolescentes com HIV/Aids, pois eles estão em maior risco de desenvolver doenças cardiovasculares ou outras doenças crônicas. / INTRODUCTION: the introduction of the highly active antiretroviral therapy in the treatment of AIDS might be associated with the emergence of metabolic disturbances in patients with HIV/AIDS. Apart from the antiretroviral therapy, other factors, such as diet may contribute to the emergence of these disturbances in adolescents with HIV/Aids. Therefore, it is necessary to evaluate diet quality of individuals from this population. OBJECTIVE: to assess diet quality among adolescents with HIV/AIDS. METHODS: in a cross-sectional study nested in a cohort of patients with HIV/AIDS treated at the Infectious Disease Unity of the Instituto da Criança (ICr-São Paulo) 88 adolescents (10 to 19 years old) were assessed. Information on disease history and use of medication were obtained from medical records. Adolescents responded to two 24-hour recalls and one questionnaire on habitual physical activity. Weight, height and waist circumference were measured twice. Diet quality was assessed by means of the Healthy Eating Index-2005 (HEI-2005). The HEI-2005 is composed of 12 items and the final score ranges from 0 to 100 points. Pearson´s correlation coefficients between the HEI-2005 and the independent variables were calculated. HEI-2005 means were also compared according to the independent variables by means of Student´s t-test or Mann-Whitney test. RESULTS: The mean for the HEI-2005 was 51.90 points (SE=0.90 points). The components with the lowest means were whole grains and sodium. The components with highest means were total grains and oils. Adolescents living in foster homes had higher mean for total fruit and lower mean for meats and beans when compared to adolescents living with their families. Girls had higher mean for milk and dairy products and lower for calories from solid fats, alcoholic beverages, and added sugars when compared to boys. CONCLUSION: Adolescents with HIV/Aids showed an eating pattern similar to the adolescents from the general population: high consumption of added sugar, saturated fat and sodium and inadequate ingestion of whole grains and fruits. Special attention should be paid to the diet of adolescents with HIV/AIDS, because they are at higher risk of developing cardiovascular and other chronic diseases.

abstract: Diet quality is closely intertwined with overall health status and deserves close examination. Healthcare providers are stretched thin in the current stressed system and would benefit from a validated tool for rapid assessment of diet quality. The Rapid Eating and Activity Assessment for Participants Short Version (REAP-S) represents one such option. The objective of the current study was to evaluate the effectiveness of the REAP-S and Healthy Eating Index 2010 (HEI-2010) for scoring the diet quality of omnivorous, vegetarian and vegan diets. Eighty-one healthy male and female subjects with an average age of 30.9 years completed the REAP-S as well as a 24-hour dietary recall. REAP-S and HEI-2010 scores were calculated for each subject and evaluated against each other using Spearman correlations and Chi Square. Further analysis was completed to compare diet quality scores of the HEI-2010 and REAP-S by tertiles to examine how closely these two tools score diet quality. The mean HEI-2010 score was 47.4/100 and the mean REAP-S score was 33.5/39. The correlation coefficient comparing the REAP-S to the HEI-2010 was 0.309 (p=0.005), and the REAP-S exhibited a precision of 44.4% to the HEI-2010 for diet quality. The REAP-S significantly correlated with the HEI-2010 for whole fruit (r=0.247, p=0.026), greens and beans (r=0.276, p=0.013), seafood proteins (r=0.298, p=0.007), and fatty acids (r=0.400, p<0.001). When evaluated by diet type, the REAP-S proved to have increased precision in plant-based diets, 50% for vegetarian and 52% for vegan, over omnivorous diets (32%). The REAP-S is a desirable tool to rapidly assess diet quality in the community setting as it is significantly correlated to the HEI-2010 and requires less time, labor and money to score and assess than the HEI-2010. More studies are needed to evaluate the precision and validity of REAP-S in a broader, more diverse population. / Dissertation/Thesis / Masters Thesis Nutrition 2015

INTRODUÇÃO: a introdução de esquemas antirretrovirais altamente potentes, no tratamento da Aids pode estar associada ao aparecimento de alterações metabólicas em pacientes com HIV/Aids. Além da terapia antirretroviral, outros fatores, como a dieta podem contribuir para o aparecimento dessas alterações em adolescentes com HIV/Aids. Assim, faz-se necessária a avaliação da qualidade da dieta de indivíduos dessa população. OBJETIVO: analisar a qualidade da dieta de adolescentes com HIV/Aids. MÉTODOS: Trata-se de um estudo transversal aninhado a uma coorte de pacientes com HIV/Aids atendidos pela Unidade de Infectologia do Instituto da Criança (ICr-São Paulo). Foram avaliados 88 adolescentes (10 a 19 anos). Informações sobre o histórico da doença e uso de medicamentos foram obtidas a partir de prontuários médicos. Os adolescentes responderam a dois recordatórios de 24 horas e um questionário sobre atividade física habitual. Peso, altura e circunferência da cintura foram medidos em duplicata. A qualidade da dieta foi avaliada por meio do Índice de Qualidade da Dieta (IQD-R). O IQD-R é composto de 12 itens e a pontuação final varia de 0 a 100 pontos. Foram calculados os coeficientes de correlação de Pearson entre o IQD-R e as variáveis independentes. Também foram feitas as comparações das médias do IQD-R segundo as variáveis independentes pelo teste t-Student ou Mann-Whitney. RESULTADOS: a média para o IQD-R foi 51,90 pontos (EP=0,90 pontos). Os componentes que apresentaram menores médias foram cereais integrais e sódio. Os componentes que tiveram maiores médias foram cereais totais e óleos. Adolescentes moradores de casas de apoio tiveram média maior para fruta total e menor para carnes e leguminosas, quando comparados aos adolescentes que moravam com a família. Meninas apresentaram média maior para leite e derivados e menor para calorias provenientes de gorduras sólidas, bebidas alcoólicas e açúcares adicionados quando comparadas com meninos. CONCLUSÃO: os adolescentes com HIV/Aids avaliados apresentaram padrão de consumo alimentar semelhante ao de adolescentes da população geral: alto consumo de açúcar, gordura saturada e sódio e consumo insuficiente de cereais integrais e frutas. Atenção especial deve ser dada à dieta de adolescentes com HIV/Aids, pois eles estão em maior risco de desenvolver doenças cardiovasculares ou outras doenças crônicas. / INTRODUCTION: the introduction of the highly active antiretroviral therapy in the treatment of AIDS might be associated with the emergence of metabolic disturbances in patients with HIV/AIDS. Apart from the antiretroviral therapy, other factors, such as diet may contribute to the emergence of these disturbances in adolescents with HIV/Aids. Therefore, it is necessary to evaluate diet quality of individuals from this population. OBJECTIVE: to assess diet quality among adolescents with HIV/AIDS. METHODS: in a cross-sectional study nested in a cohort of patients with HIV/AIDS treated at the Infectious Disease Unity of the Instituto da Criança (ICr-São Paulo) 88 adolescents (10 to 19 years old) were assessed. Information on disease history and use of medication were obtained from medical records. Adolescents responded to two 24-hour recalls and one questionnaire on habitual physical activity. Weight, height and waist circumference were measured twice. Diet quality was assessed by means of the Healthy Eating Index-2005 (HEI-2005). The HEI-2005 is composed of 12 items and the final score ranges from 0 to 100 points. Pearson´s correlation coefficients between the HEI-2005 and the independent variables were calculated. HEI-2005 means were also compared according to the independent variables by means of Student´s t-test or Mann-Whitney test. RESULTS: The mean for the HEI-2005 was 51.90 points (SE=0.90 points). The components with the lowest means were whole grains and sodium. The components with highest means were total grains and oils. Adolescents living in foster homes had higher mean for total fruit and lower mean for meats and beans when compared to adolescents living with their families. Girls had higher mean for milk and dairy products and lower for calories from solid fats, alcoholic beverages, and added sugars when compared to boys. CONCLUSION: Adolescents with HIV/Aids showed an eating pattern similar to the adolescents from the general population: high consumption of added sugar, saturated fat and sodium and inadequate ingestion of whole grains and fruits. Special attention should be paid to the diet of adolescents with HIV/AIDS, because they are at higher risk of developing cardiovascular and other chronic diseases.

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A healthy diet is related to a low risk of chronic diseases. A large body of research is devoted to improving social welfare by promoting healthy eating. This dissertation addresses the relation of food and health by analyzing the money and time inputs in food, the food poverty measurement, and a corresponding health outcome. The second chapter extends the current food poverty measure in headcount and proposes a set of Foster, Greer, and Thorbecke (FGT) indices, which is commonly used in development literature, in food poverty to allow for a more comprehensive understanding in food poverty evaluation. The counter-factual analysis on removing the American Recovery and Reinvestment Act (ARRA) component from the food expenditure shows that the original metrics underestimate the reduction to food expenditure poverty associated with ARRA, whereas the FGT indices indicate a slightly larger impact of ARRA in alleviating food poverty. The third chapter uses the same FGT indices in food poverty measurement but focuses on the sensitivity of these measurements to a different spatial and temporary food price. We use linear regression to estimate the local level of food poverty thresholds. The results show the spatial and temporal-specific thresholds are higher than the national threshold. The West region shows the most severe poverty situation, indicating the importance of considering spatial and temporal variations in measuring food expenditure poverty. The decompositions of food expenditures show that both the Supplemental Nutrition Assistance Program (SNAP) benefits and money spent on protein play an essential role in reducing food expenditure poverty. The fourth chapter combines the two datasets used in the previous two chapters to investigate the connection between the resources (money and time) devoted to food and a corresponding health outcome (Healthy Eating Index, HEI). Two-Sample-2-Stage-Least-Square (TS2SLS) model is used to account for the two different datasets in predicting the time spent on food-related activities. After obtaining the time input, a Three-Stage-Least-Square (3SLS) model shows the time input improves the HEI for Non-SNAP households, who are more constrained by time. The decomposition of the impact of education on the HEI shows the indirect impact account for 22% of the total impact. This analysis breaks down the impact of the characteristics on HEI through different channels, thus offers more comprehensive policy recommendations. / Doctor of Philosophy / A healthy diet is related to a low risk of chronic diseases. A large body of research is devoted to improving social welfare by promoting healthy eating. This dissertation is a series of studies on food and health regarding the money and time input on food, the food poverty measurement, and the corresponding health outcome. The second chapter extends the current food poverty measure in headcount and proposes a set of distributional metrics: depth and severity, which measures how far away households are away from the targeted threshold and how severe the food poverty is respectively. These distributional metrics allow for a more comprehensive understanding of food poverty evaluation. We also analyzed the change of the metrics when removing part of the food expenditure funding source. The analysis shows the original metrics tend to underestimate the reduction to food expenditure poverty and indicates a slightly larger impact of removed funding source in alleviating food poverty. The third chapter uses the same distributional food poverty metrics, but focuses on the sensitivity of these measurements to different spatial and temporal food prices. We use linear regression in estimating the local food poverty thresholds. The results show the spatial and temporal-specific thresholds are higher than the national threshold. The West region shows the most severe poverty situation, indicating the importance of considering spatial and temporal variations in measuring food expenditure poverty. The forth chapter combines the two datasets used in the previous two chapters to investigate the connection between the resources (money and time) spent on food and a corresponding health outcome. A special econometrics model is used to predict the time spent on food-related activities with two datasets. After obtaining the time input, a system of equations model shows the time input improves the healthy eating for households who are more constrained by time. The decomposition of the impact of education on healthy eating shows the indirect impact account for 22% of the total impact. This analysis breaks down the impact of the characteristics on HEI through different channels, thus offers more comprehensive policy recommendations.

Master of Science / Department of Food, Nutrition, Dietetics and Health / Sara K. Rosenkranz / Evidence from physical activity interventions suggests that women, in particular, may overcompensate for exercise energy expenditure by increasing caloric intake. Sedentary behavior and poor diet quality are independent risk factors for many major chronic diseases including cardiovascular disease (CVD). It is unknown whether insufficiently active women alter dietary quality or caloric intake when participating in an intervention to reduce sedentary behavior. Insufficiently active women (n=49) working full-time sedentary jobs were randomized into one of two 8-week sedentary interventions occurring during the work week [short breaks (SB) (1-2 min every half hour, n=24) or long breaks (LB) (15 min twice daily, n=25)]. Dietary information was collected through 3-day food records at baseline, week 4 and week 8. Dietary quality was assessed using the Alternative Healthy Eating Index 2010 (AHEI-2010). CVD risk factors (systolic and diastolic blood pressure (BP), fasting cholesterol, triglycerides, and blood glucose, and body mass index) were assessed at baseline and week 8. For all participants there were no changes in AHEI-2010 scores over time (baseline: M=53.4, 95% CI [49.2, 57.6], week 4: M=50.3, 95% CI [45.9, 54.7], week 8: M=48.4, 95% CI [44.1, 52.7], p>0.05). Average caloric intake in the SB group (baseline: M=1943.8 kcals/day, 95% CI [1716.2, 2171.5], week 4: M=1728.8 kcals/day, 95% CI [1462.4, 1995.2], week 8: M=1616.8 kcals/day, 95% CI [1450.2, 1783.4]) decreased significantly from baseline to week 4 (p=0.015) and baseline to week 8 (p=0.002). There were no significant changes in caloric intake in the LB group (p>0.05) at either time point. In all participants, absolute changes in LDL were positively correlated with absolute changes in caloric intake (r=0.473, p=0.005). There were no other significant associations between changes in dietary quality or caloric intake with changes in any other CVD risk factor (p>0.05). Following an 8-week sedentary intervention in the workplace, insufficiently active women did not alter their dietary quality, but decreased caloric intake. Future research should explore sedentary interventions compared to physical activity interventions in women as a means to create negative energy balance, as sedentary breaks throughout the day may be effective for improving health outcomes.

Using focus group methodology, this research identifies the behavioural, normative and control beliefs associated with consuming a local diet. Using these findings as a platform, a questionnaire was developed to quantify attitudes, subjective norms, and perceived behavioural control, the theoretical constructs of the Theory of Planned Behaviour (TPB). In addition, moral obligations were measured for the first time in relation to local food consumption in an extended TPB model. The sample consisted of 114 individuals consuming various levels of local food in the Austin, TX area. Results indicate that perceived behavioural control and moral obligations had both a direct effect on intention to consume local food, as well as an indirect effect on intention, which is mediated via current behaviour. Dietary analysis was conducted using an online dietary assessment tool, the National Cancer Institute's Automated Self-Administered 24-hr recall. Between one and four recalls were collected from participants and a mean Healthy Eating Index (HEI) score was applied. Findings suggest that while controlling for age, sex, income and education, as the amount of local food in the diet increases, the total HEI score and the Dark Green and Orange Vegetables and Legumes (DOLs) component score also increases. In addition, the Saturated Fat component score increases, indicating lower intakes of saturated fat are associated with higher local food intake. This suggests that saturated fat in the diet is being displaced by local vegetable intake, particularly DOLs.

OBJECTIVES: This dissertation was divided into two studies. The aim of the first study was to investigate whether there is an association between diet quality of preschool children and their caregivers. The aim of the second study was to examine the relationship of children diet quality and dental caries risk. METHODS: The study utilized a longitudinal population-based data of a representative sample of low-income African American families in Detroit, Michigan. Analyses were limited to 522 children aged 3-5 years old and their primary caregivers. For caregivers, dietary histories were obtained at wave I using the Block 98.2 food frequency questionnaire. For children, dietary histories were obtained at wave I and wave II using the Block Kids Food Questionnaire. Healthy Eating Index-2005 was used to evaluate overall diet quality. Dental caries in primary teeth were measured by the ICDAS criteria. The mean number of decayed surfaces (noncavitated and cavitated), missing, and filled surfaces for each child was estimated. Statistical analyses were conducted using SAS 9.4 and STATA 14 to account for the complex sampling design. RESULTS: The first study found that the mean total HEI-2005 scores were 57.47 for caregivers at wave I, 56.04 for children at wave I, and 57.39 for children at wave II indicating that the diet quality of this population needs improvement. Significant, positive relationship was found between caregivers-child overall diet quality at wave I (β=0.35; p <0.0001) and wave II (β=0.31; p <0.0001). The second study found that children who had high diet quality or improved their diet quality throughout the study period had significantly lower dental caries incidence compared to those with low diet quality scores (IRR = 0.59 and 0.55, respectively) (CI = 0.36-0.96 and 0.35-0.86 , respectively). CONCLUSION: Our findings suggest that caregiver’s and children’s diet quality are associated. Therefore, caregiver’s diet quality should be considered in efforts to improve diets of their children. Additionally, preschooler children in our study with improved diet quality showed lower caries incidence. These results suggest that strategies and intervention to prevent dental caries among children should focus on improving overall diet quality. / 2018-09-28T00:00:00Z

abstract: ABSTRACT This study evaluated the LoseIt Smart Phone app by Fit Now Inc. for nutritional quality among users during an 8 week behavioral modification weight loss protocol. All participants owned smart phones and were cluster randomized to either a control group using paper and pencil record keeping, a memo group using a memo function on their smart phones, or the LoseIt app group which was composed of the participants who owned iPhones. Thirty one participants completed the study protocol: 10 participants from the LoseIt app group, 10 participants from the memo group, and 11 participants from the paper and pencil group. Food records were analyzed using Food Processor by ESHA and the nutritional quality was scored using the Healthy Eating Index - 2005 (HEI-2005). Scores were compared using One-Way ANOVA with no significant changes in any category across all groups. Non-parametric statistics were then used to determine changes between combined memo and paper and pencil groups and the LoseIt app group as the memo and paper and pencil group received live counseling at biweekly intervals and the LoseIt group did not. No significant difference was found in HEI scores across all categories, however a trend was noted for total HEI score with higher scores among the memo and paper and pencil group participants p=0.091. Conclusion, no significant difference was detected between users of the smart phone app LoseIt and memo and paper and pencil groups. More research is needed to determine the impact of in-person counseling versus user feedback provided with the LoseIt smart phone app. / Dissertation/Thesis / M.S. Nutrition 2011