Purpose: Snacking is an important component of dietary intake yet remains understudied, particularly among adolescents who consume 25% of their daily calories from snacks. Previous research provides evidence that adolescents with overweight (OW) and obesity (OB) consume larger and more frequent snacks than adolescents with normal weight (NW). The objective of this study was to compare the food group composition of snacks by weight status as well as to identify snacking patterns and predictors among adolescents in the United States (US). Methods: Anthropometric, dietary, and demographic data from adolescents, 12-19 years old, in the 2005-2016 National Health and Nutrition Examination Survey were analyzed. The mean of the two days of dietary recall was used to measure dietary intake, which serves as a proxy for usual intake. Mean equivalents of the 37 food components present in individual snack foods reported by each adolescent across two days of intake were estimated using the Food Patterns Equivalents Database. Latent Class Analysis (LCA) was used to study the effect of mutually exclusive food component consumption groups. Multivariate logistic regression models were used to analyze membership in relation to dietary quality (Healthy Eating Index 2015 [HEI-2015] scores), weight status (BMI & BMI Z-score), selected snacking parameters (e.g., mean snack calories), and socio-demographic (e.g., race, gender) covariates. Results: Adolescents with two days of reliable dietary recall data and complete anthropometrics were included in the descriptive analysis (n = 6423). Adolescents with NW consumed greater energy, vegetable, whole grains, refined grains, dairy, and solid fat from snacks than adolescents with OW and OB (p < 0.05). LCA identified two main snacking patterns. The “Heavy Snackers” pattern was associated with higher consumption of each food component, total energy and snacking energy while the “Light Snackers” pattern was associated with lower consumption each food component, total energy and snacking energy. After adjustment for energy misreporting, OW or OB classification did not significantly increase the odds of being in either class while being classified with NW decreased the odds of being in the “Heavy Snacker” class. In addition, increasing BMI z-score and HEI-2015 total score increased and decreased the odds of being in the “Heavy Snackers” class respectively. The strongest predictors of a “Heavy Snacker” pattern were male gender, non-Hispanic white race, lower dietary quality, and increased snacking parameters, while female gender, all races except non-Hispanic white, better dietary quality, and decreased snacking parameters were strong predictors of a “Light Snacker” pattern. Conclusion: We can conclude that consuming less foods as snacks contributed positively to weight status and overall diet quality among US adolescents. Findings from this cross-sectional study remain consistent with snacking, diet quality, and weight status associations, but add to existing knowledge with the identification of snack consumption patterns. The dietary patterns derived may provide a useful basis for dietary interventions targeted at snacking among adolescents by recommending light snacking and low consumption of energy dense snack foods. Additional studies are needed to further understand what the main food pattern components are across gender and racial backgrounds and to confirm whether associations between snacking and weight status are due to food quality, quantity, or both. / Epidemiology

Background: Childhood, adolescent, and adult obesity is a major health and economic concern affecting the United States and various countries across the globe. Obese children and adolescents are at a potential risk for developing certain chronic diseases as they transition into adulthood. There are community-based cooking intervention programs designed to increase children and adolescents' intake of fruits, vegetables, and whole grains, whether these programs improve self-efficacy and perceptions related to food and eating behaviors is not currently known. Objective: The aim of the study was to evaluate the effectiveness of Teen Cuisine, an Extension-based cooking program on self-efficacy with cooking and perceptions of their eating behaviors in a diverse group of adolescents across the Commonwealth of Virginia. Subjects: Students involved in the 4-H Teen Cuisine Program during the 2013-2015 academic years. Cooking Program: Teen Cuisine is a six-week 90-minute extension-based cooking program created by the Virginia Family Nutrition Program targeting adolescents and teens throughout the Commonwealth of Virginia. The program focused on kitchen safety and sanitation, knife skills, food preparation, and nutrition education. Measures: A survey was used to assess n=531 student's self-efficacy for general nutrition knowledge, food choices, and cooking skills as a result of the 4-H Teen Cuisine Program during the academic year of fall 2013 to spring 2015. Methods: Surveys were administered upon completion of the Teen Cuisine program to assess students' self-efficacy and perceived gains in kitchen skills, dietary patterns and preferences, and nutrition knowledge. Results: Teens that self-reported living in rural areas throughout the Commonwealth of Virginia perceived gains (p < 0.05) in an increased consumption of fruits and vegetables. Teens also indicated an increased frequency in cooking and a decrease in their consumption of soda/soft drinks. Conclusion: Overall Teen Cuisine was found to be effective in improving perceptions of curriculum specific health behaviors, cooking skills, food safety and sanitation, and perceived gains in self-efficacy in the kitchen. / Master of Science / Over the past 10 years, 4-H has delivered numerous childhood obesity prevention programs across the state of Virginia. 4-H Extension Agents expressed a need and for a curriculum targeting tweens and teens. Based on a national search, no programs existed. As a result, the Virginia Family Nutrition Program developed Teen Cuisine, a skilled and cooking based curriculum that focuses on nutrition education, food preparation and safety. In 2011, the Teen Cuisine program was targeted for low-income youth. The aim of this study was to create a culinary and nutrition education foundation to aid in the prevention of chronic diseases. Once students completed the six 90 minute lesson program, a posttest was distributed to students throughout the state of Virginia who participated in Teen Cuisine. Results were evaluated using the 4-H Common Measures Evaluation Instruments. Based on evidence from Teen Cuisine 72.1% of students agreed they consume more fruits and vegetables. While 73.0% agreed they drink fewer soft drinks. Students who successfully completed Teen Cuisine significantly improved their knowledge in nutrition education, physical activity, food safety and sanitation, acquired knife skills, and are now more conscious of their eating behaviors. Reinforcing the Dietary Guidelines and MyPlate, teens now have a road map to how their plate should look, and how to maintain a healthy weight.

Observer les modèles alimentaires et les modes de consommation permet d’apercevoir une série de phénomènes tels que les changements sociaux apportés par le dynamisme économique à l’échelle du Brésil. Les recherches menées dans la réserve de Ciriaco visent à établir un profil alimentaire pour comprendre le poids des choix effectués par les habitants et leur origine. Etablir un profil global permet également de mesurer l’impact des choix alimentaires sur la vie quotidienne et de s’emparer du phénomène de transition alimentaire. La monétarisation de l’alimentation, l’éducation carencée ainsi que les changements de saisonnalité sont à l’origine de transformations majeures du modèle, par l’accès aux aliments nouveaux, transformés et sans valeur identitaire, responsables des conséquences sur la santé et d’une forme d’insécurité alimentaire, entrainant également des bouleversements sociaux, économiques, politiques, épidémiologiques et environnementaux. / Observing dietary role model and the ways of consumption allow to glimpse a succession of phenomenons such as social changes brought by the economic dynamism at the scale of the Brazil. Researches led in the Ciriaco reserve aim to establish a dietary profile in order to understand the weight of the choices made by its inhabitants , and the origins of such choices. The point of creating a global profil is also to measure the impact of their dietary choices on their daily lives, and to take possession of the phenomenon called dietary transition. The dietary monetization, the lack of education so much as the changes of seasons are considered the origins of the transformation of the role model and thus by the access on new food, changed and without any identity value ; responsible for the consequences on the health and also responsible of some kind of dietary insecurity which also bring social, economic, political, epidemiological and environmental disruptions.

Submitted by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2018-09-14T12:44:39Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese versão Final Agosto 2018 13.08.2018.pdf: 7627228 bytes, checksum: 9282ace9672356acc87c12bcd465402e (MD5) / Approved for entry into archive by Márcia Silva (marcialbuquerq@yahoo.com.br) on 2018-09-14T12:45:18Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese versão Final Agosto 2018 13.08.2018.pdf: 7627228 bytes, checksum: 9282ace9672356acc87c12bcd465402e (MD5) / Approved for entry into archive by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2018-09-14T12:45:36Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese versão Final Agosto 2018 13.08.2018.pdf: 7627228 bytes, checksum: 9282ace9672356acc87c12bcd465402e (MD5) / Made available in DSpace on 2018-09-14T12:45:36Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese versão Final Agosto 2018 13.08.2018.pdf: 7627228 bytes, checksum: 9282ace9672356acc87c12bcd465402e (MD5) Previous issue date: 2018-06-22 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The dissertation presents approaches on the changes concerning food patterns found in the daily life of lowland and dry land dwellers living in the rural settlements in Amazonas. This analysis points out the actions of the national public policies related to food security, agrarian reform and Bolsa Família, the income generation program, in two settlements of the Instituto Nacional de Colonização e Reforma INCRA. The first settlement is located in the floodplain area, in Manacapuru, and it is called Costa do Caldeirão, SDP (Sustainable Development Project) and the second area is located in Nova Olinda do Norte, in Paquequer settlement, FSP (Federal Settlement Project). The studies carried out in these areas have allowed collecting geographic information, environmental, socioeconomic and cultural conditions, and especially, recognition of the way these public policies influence the increase family income, market relations, family farming activities and consumption of processed foods by the settlers and their relationship with the market. The research was carried out in two moments; in the flood and river ebb periods, and involved seventh families benefited from Bolsa Família Program in each of the settlements, providing an A Sample of two hundred and eighty participants. In order to identify changes in the dietary pattern of the interviewees, three methodological approaches were carried out, such as: collecting information with R24h application forms (24-hour Reminder Method), filling in the FFQ (Food Frequency Questionnaire) and analyzing isotopic proportions of Carbon (δ13C) and Nitrogen (δ15N) identified in the keratin of participants' nails. The results of the isotopic analyzes vary according to the greater or lesser consumption in natura, processed or ultraprocessed foods found in the participants' diets. The research allowed to evaluate the relationship between life in the city and life in the countryside in the periods of flood and ebb of the rivers, associating these moments with the process of transition of food patterns experienced in the daily life of the settled population, pointing as a result, the existence of changes found in the dietary patterns of the participants with the progressive abandonment of the local menu and the adoption of an urban diet based on the consumption of processed and ultraprocessed food. / A tese apresenta abordagens sobre as mudanças nos padrões alimentares encontradas no cotidiano de moradores de várzea e de terra firme residentes em áreas de assentamentos rurais do Amazonas. A análise é focada nas ações das políticas públicas nacionais direcionadas para segurança alimentar, reforma agrária e o programa de geração de renda conhecido como Bolsa Família, em dois assentamentos do INCRA. O primeiro localizado na área de várzea, no município de Manacapuru, Assentamento Costa do Caldeirão, modalidade PDS (Projeto de Desenvolvimento Sustentável) e o segundo na área de terra firme, localizado no município de Nova Olinda do Norte, no Assentamento Paquequer, modalidade PA (Projeto de Assentamento Federal). Os estudos realizados nestas áreas permitiram levantar informações geográficas, das condições ambientais, socioeconômicas, culturais e, principalmente o reconhecimento de que forma as políticas públicas analisadas influenciam na concentração do aumento de renda familiar, nas relações de mercado, nas atividades da agricultura familiar e no consumo de alimentos industrializados por parte dos assentados e na relação dos mesmos com o mercado. A pesquisa foi realizada em dois momentos: nos períodos da enchente e da vazante dos rios e envolveu 70 famílias beneficiárias do Programa Bolsa Família em cada um dos assentamentos, proporcionando um N Amostral de 280 participantes. Para identificar as mudanças no padrão alimentar dos entrevistados, foram realizadas três abordagens metodológicas, que consistiram na coleta de informações com a aplicação de formulários do R24h (Método Recordatório de 24 horas); no preenchimento do QFA (Questionário de Frequência Alimentar); e nas análises das proporções isotópicas de Carbono (δ13C) e de Nitrogênio (δ15N) identificadas na queratina das unhas dos entrevistados. Os resultados das análises isotópicas variam de acordo com o maior ou menor consumo de alimentos in natura, processados ou ultraprocessados encontrados nas dietas dos participantes. A pesquisa permitiu avaliar as relações entre o rural e o urbano nos períodos de enchente e vazante dos rios, associando esses momentos ao processo de transição dos padrões alimentares vivenciados no cotidiano da população assentada, apontando como resultado, a existência de mudanças encontradas nos padrões alimentares dos participantes com o abandono progressivo do cardápio local e a adoção de dieta urbana baseada no consumo de comida processada e ultraprocessada

Introdução: A produção de alimentos é o setor que exerce maior Pegada Hídrica (PH), definida como o volume de água doce usado durante a produção e o consumo de bens e serviços. Os padrões alimentares contemporâneos vêm sofrendo mudanças em função das transições demográfica, epidemiológica e nutricional. Além disso, a primeira década do século XXI no Brasil foi marcada por políticas de proteção social que culminaram em redução da pobreza e da desigualdade. É necessário compreender como essas transformações repercutiram na demanda de água necessária para sustentar os novos padrões alimentares da população brasileira. Objetivo: Analisar a evolução da associação entre os padrões alimentares (PA) brasileiros e a PH associada à produção dos alimentos adquiridos nos domicílios brasileiros entre os anos 2003 e 2009. Métodos: Estudo transversal com dados de aquisição domiciliar de alimentos, disponibilizados pela Pesquisa de Orçamentos Familiares nos anos de 2002-2003 e 2008-2009. Os alimentos adquiridos foram compatibilizados com dados de PH de produtos. A PH média per capita foi descrita segundo grupos de alimentos, macrorregião, área e quintos de renda per capita. Os PA foram estimados para os setores censitários por análise de componentes principais. As variações observadas entre os dois anos do inquérito foram testadas com o teste t de Student para médias independentes, com nível de significância de 5 por cento . Os efeitos dos padrões alimentares sobre a PH e seus componentes foram estimados por regressão linear multivariada. Resultados: A PH média associada à produção dos alimentos adquiridos nos domicílios brasileiros foi de 2.650 m³ por ano per capita (EP ± 37,3 m³ por ano per capita), em 2003 e 2.446 m³ por ano per capita (EP ± 37,3 m³ por ano per capita) em 2009. Cerca de 91,4 por cento desses valores corresponderam ao componente verde, 4,7 por cento ao azul e 3,9 por cento ao cinza. Todas as regiões apresentaram redução da PH per capita em 2009, mas revelaram-se significativas apenas nas regiões NE e SE. Observou-se tendência linear de aumento da PH conforme incremento da renda. Foram identificados 6 PA, diferenciados quanto ao tipo de fonte proteica, sendo o PA1 predominante em carnes vermelhas e processadas, o PA2 em leite e ovos, o PA3 em peixes e oleaginosas, o PA4 em cereais e leguminosas, o PA5 em peixes e produtos processados, e o PA6 em peixes, análogos proteicos à base de soja e outras fontes vegetais de proteínas. Os padrões PA1 e PA6 apresentaram tendência de aumento em 2009, mas o PA1 apresentou impacto três vezes superior à PH que o PA6. O PA6 foi apontado como um padrão mais sustentável, em consonância com as recomendações da literatura e dos guias alimentares contemporâneos. Conclusões: As transformações socioeconômicas na primeira década do século XXI refletiram em mudanças nos padrões alimentares da população, que impactaram a PH. Sugere-se a necessidade de intervenções que considerem tanto as variantes socioeconômicas, como o consumo alimentar adequado, saudável e sustentável. / Introduction: Food production is the sector that exerts the major Water Footprint (WF), defined as the volume of freshwater resources used for production and consumption of goods and services. Contemporary eating patterns have changed in face of demographic, epidemiological, and nutritional transitions. In addition, in Brazil, the first decade of XXI century was marked by social protection policies that culminated in poverty reduction and inequality attenuation. It is necessary to understand how these changes may have affected the water demand required to sustain the new dietary patterns of the population. Aim: To examine the association between Brazilian dietary patterns (DP) and the WF associated to the production of the food products purchased in Brazilian households between 2003 and 2009. Methods: Cross-sectional study with household food purchase data provided by the Household Budget Surveys for the years 2002-2003 and 2008-2009. The purchased foods were matched with WF data. The average per capita WF was described into food groups, macro-region, area and level of income. The DP were estimated for the censitary sectors by principal component analysis. The differences observed between the two surveys were tested with the t Student test for independent means, with a significance level of 0.05. The effects of dietary patterns on WF and components were estimated by multivariate linear regression. Results: The average water footprint, associated with the production of foods purchased in Brazilian households, was 2,650 m³ per year per capita (EP ± 37.3 m³ per year per capita) in 2003 and 2,446 m³ per year per capita (EP ± 37.3 m³ per year per capita) in 2009. Approximately 91.4 per cent of these values corresponded to the green component, 4.7 per cent to the blue component and 3.9 per cent to the gray component. All regions showed a reduction in WF in 2009, but this was significant only in the Northeast and Southeast regions. It was observed a positive linear trend between WF and income. Six DP were identified and characterized by the type of protein source: DP1 by red and processed meat, DP2 by milk and eggs, DP3 by fish and oilseeds, DP4 by cereals and legumes, DP5 by fish and processed foods and DP6 by fish, soy-based meat analogues and other vegetable sources of protein. The DP1 and DP6 patterns showed an upward trend in 2009, but the impact of PA1 on WF was three times higher than of PA6. The PA6 was suggested as a more sustainable pattern, in agreement with the literature and with the contemporary food guides recommendations. Conclusions: Socioeconomic changes in the first decade of this century reflected in modifications concerning the dietary patterns of the population, which affected the WF. Interventions that consider both the socioeconomic variants and healthy and sustainable food consumption are necessary.

Introdução: A produção de alimentos é o setor que exerce maior Pegada Hídrica (PH), definida como o volume de água doce usado durante a produção e o consumo de bens e serviços. Os padrões alimentares contemporâneos vêm sofrendo mudanças em função das transições demográfica, epidemiológica e nutricional. Além disso, a primeira década do século XXI no Brasil foi marcada por políticas de proteção social que culminaram em redução da pobreza e da desigualdade. É necessário compreender como essas transformações repercutiram na demanda de água necessária para sustentar os novos padrões alimentares da população brasileira. Objetivo: Analisar a evolução da associação entre os padrões alimentares (PA) brasileiros e a PH associada à produção dos alimentos adquiridos nos domicílios brasileiros entre os anos 2003 e 2009. Métodos: Estudo transversal com dados de aquisição domiciliar de alimentos, disponibilizados pela Pesquisa de Orçamentos Familiares nos anos de 2002-2003 e 2008-2009. Os alimentos adquiridos foram compatibilizados com dados de PH de produtos. A PH média per capita foi descrita segundo grupos de alimentos, macrorregião, área e quintos de renda per capita. Os PA foram estimados para os setores censitários por análise de componentes principais. As variações observadas entre os dois anos do inquérito foram testadas com o teste t de Student para médias independentes, com nível de significância de 5 por cento . Os efeitos dos padrões alimentares sobre a PH e seus componentes foram estimados por regressão linear multivariada. Resultados: A PH média associada à produção dos alimentos adquiridos nos domicílios brasileiros foi de 2.650 m³ por ano per capita (EP ± 37,3 m³ por ano per capita), em 2003 e 2.446 m³ por ano per capita (EP ± 37,3 m³ por ano per capita) em 2009. Cerca de 91,4 por cento desses valores corresponderam ao componente verde, 4,7 por cento ao azul e 3,9 por cento ao cinza. Todas as regiões apresentaram redução da PH per capita em 2009, mas revelaram-se significativas apenas nas regiões NE e SE. Observou-se tendência linear de aumento da PH conforme incremento da renda. Foram identificados 6 PA, diferenciados quanto ao tipo de fonte proteica, sendo o PA1 predominante em carnes vermelhas e processadas, o PA2 em leite e ovos, o PA3 em peixes e oleaginosas, o PA4 em cereais e leguminosas, o PA5 em peixes e produtos processados, e o PA6 em peixes, análogos proteicos à base de soja e outras fontes vegetais de proteínas. Os padrões PA1 e PA6 apresentaram tendência de aumento em 2009, mas o PA1 apresentou impacto três vezes superior à PH que o PA6. O PA6 foi apontado como um padrão mais sustentável, em consonância com as recomendações da literatura e dos guias alimentares contemporâneos. Conclusões: As transformações socioeconômicas na primeira década do século XXI refletiram em mudanças nos padrões alimentares da população, que impactaram a PH. Sugere-se a necessidade de intervenções que considerem tanto as variantes socioeconômicas, como o consumo alimentar adequado, saudável e sustentável. / Introduction: Food production is the sector that exerts the major Water Footprint (WF), defined as the volume of freshwater resources used for production and consumption of goods and services. Contemporary eating patterns have changed in face of demographic, epidemiological, and nutritional transitions. In addition, in Brazil, the first decade of XXI century was marked by social protection policies that culminated in poverty reduction and inequality attenuation. It is necessary to understand how these changes may have affected the water demand required to sustain the new dietary patterns of the population. Aim: To examine the association between Brazilian dietary patterns (DP) and the WF associated to the production of the food products purchased in Brazilian households between 2003 and 2009. Methods: Cross-sectional study with household food purchase data provided by the Household Budget Surveys for the years 2002-2003 and 2008-2009. The purchased foods were matched with WF data. The average per capita WF was described into food groups, macro-region, area and level of income. The DP were estimated for the censitary sectors by principal component analysis. The differences observed between the two surveys were tested with the t Student test for independent means, with a significance level of 0.05. The effects of dietary patterns on WF and components were estimated by multivariate linear regression. Results: The average water footprint, associated with the production of foods purchased in Brazilian households, was 2,650 m³ per year per capita (EP ± 37.3 m³ per year per capita) in 2003 and 2,446 m³ per year per capita (EP ± 37.3 m³ per year per capita) in 2009. Approximately 91.4 per cent of these values corresponded to the green component, 4.7 per cent to the blue component and 3.9 per cent to the gray component. All regions showed a reduction in WF in 2009, but this was significant only in the Northeast and Southeast regions. It was observed a positive linear trend between WF and income. Six DP were identified and characterized by the type of protein source: DP1 by red and processed meat, DP2 by milk and eggs, DP3 by fish and oilseeds, DP4 by cereals and legumes, DP5 by fish and processed foods and DP6 by fish, soy-based meat analogues and other vegetable sources of protein. The DP1 and DP6 patterns showed an upward trend in 2009, but the impact of PA1 on WF was three times higher than of PA6. The PA6 was suggested as a more sustainable pattern, in agreement with the literature and with the contemporary food guides recommendations. Conclusions: Socioeconomic changes in the first decade of this century reflected in modifications concerning the dietary patterns of the population, which affected the WF. Interventions that consider both the socioeconomic variants and healthy and sustainable food consumption are necessary.

Submitted by Daiane Roncato Cardozo null (daianecardozo@msn.com) on 2016-07-11T19:25:00Z No. of bitstreams: 1 TESE DOUTORADO - DAIANE CARDOZO.pdf: 2143468 bytes, checksum: 45c7e7d903320501d823759b16356747 (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-07-12T18:32:03Z (GMT) No. of bitstreams: 1 cardozo_dr_dr_arafcf.pdf: 2143468 bytes, checksum: 45c7e7d903320501d823759b16356747 (MD5) / Made available in DSpace on 2016-07-12T18:32:03Z (GMT). No. of bitstreams: 1 cardozo_dr_dr_arafcf.pdf: 2143468 bytes, checksum: 45c7e7d903320501d823759b16356747 (MD5) Previous issue date: 2016-05-13 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Objetivo: identificar potenciais indicadores complementares à percepção da insegurança alimentar e nutricional para o monitoramento de programas sociais de transferência de renda, tomando como referência o Programa Bolsa Família (PBF) em Araraquara/SP. Métodos: Foi realizado um estudo transversal incluindo 100 famílias beneficiárias e 50 não beneficiárias do PBF. Com um formulário semiestruturado foram obtidas informações sócio-demográficas e socioeconômicas, de percepção da insegurança alimentar e nutricional (Escala Brasileira de Medida de Insegurança Alimentar – EBIA), o estado nutricional (peso e altura para o Índice de Massa Corporal – IMC) e o padrão de consumo e hábitos alimentares. Associações entre exposições e desfecho foram testadas usando testes Qui-quadrado para variáveis categóricas e ANOVA para variáveis contínuas. A razão de prevalência (r) e intervalos de confiança de 95% (IC) foram avaliados utilizando modelo de Regressão de Poisson. A identificação de padrões alimentares foi realizada usando análise de Cluster e o estudo do poder preditivo de potenciais indicadores à percepção da insegurança alimentar foi avaliada utilizando a Curva ROC (Receiver Operating Characteristic). Foram considerados significativos valores p iguais ou menores do que 0,05. Resultados: Foram identificados três padrões alimentares: restrito, saudável e tradicional. O padrão restrito foi associado a um menor grau de escolaridade, relatos de anemia pregressa, percepção da insegurança alimentar e com maior idade media dos moradores do domicilio. Na análise não ajustada e ajustada para a idade média dos moradores da família encontrou-se maior prevalência de famílias com insegurança alimentar moderada ou grave no padrão restrito (1,55; IC95% 1,00 – 2,42 e 1,57 IC95% 099 – 2,49, respectivamente). No estudo dos potenciais indicadores de insegurança alimentar, componentes da renda cobriram mais de 70% da área sobre a curva ROC entre beneficiários do PBF, destacando-se os gastos com alimentação e com gás de cozinha. Conclusão: O padrão alimentar restrito relacionou-se com a proporção de insegurança alimentar moderada e grave da população estudada, enquanto a escolha do padrão alimentar saudável ou tradicional esteve associada à origem das famílias. Entre os potenciais indicadores estudados, a renda mostrou melhor desempenho na predição de insegurança alimentar e nutricional entre beneficiários de programas de transferência de renda, principalmente em relação à proporção da renda gasta com despesas básicas da família, como o aluguel e gás de cozinha. / Objective: This study aimed to identify potential complementary indicators of food and nutrition security for monitoring social program of income transfers, using as a reference the allowance family program (AFP) in Araraquara, SP. Methods: In a cross sectional study design, 100 beneficiary and 50 nonbeneficiary families of the AFP. Social demographic, economic, nutrition status, food consumption, and of food and nutrition security perception (EBIA) was collected using a pre-tested form. The association between exposure and outcome variables was tested using the chi-square test for categorical variables, and the ANOVA for numerical variables. The prevalence ratio (r) and confidence interval of 95% (CI95%) were assessed using the poisson regression model. Food patterns were identified using the cluster analysis and the predictive value of potential indicators of food and nutrition insecurity was tested using the ROC (Receiver Operating Characteristic) curve methodology. P-values below 0.05 were considered significant. Results: Three food patterns were identified: Restrictive, Healthy, and Traditional. The restrictive food pattern was related to a lower education level, reports of prior anemia, food and nutrition insecurity, and higher family age average. In the non-adjusted and in the analysis adjusted for the family average age, families with moderate or severe food and nutrition insecurity were more likely to adhere to a restrictive food pattern (1.55; CI95% 1,00 – 2,42 e 1.57 CI95% 099 – 2,49, respectively). In the study of the potential indicators of food and nutrition insecurity, the income components covered more than 70% of the ROC curve among the AFP beneficiaries, which can be considered as a acceptable predictive value. The proportion of the income spent on elementary facilities, such as domestic gas cooking and the rent, had the major predictive values. Conclusion: The restrictive food pattern was related to higher proportion of the population in moderate and severe food and nutrition insecurity; whereas the healthy or the traditional food pattern was more likely to be followed by families in security or minor food and nutrition insecurity. Among the potential indicators, the income has shown the best performance in predicting the food and nutrition insecurity for AFP beneficiary families, mainly for the proportion of the income spent with the elementary household expenses, such as the rent and domestic gas cooking.

Introdução: Comer fora de casa tem sido relacionado com o aumento no consumo de alimentos caracterizados pelo alto grau de processamento, tal como refrigerantes, doces e fast food. Embora indiquem uma associação entre alimentação fora do domicilio e o consumo de alimentos ultraprocessados, estudos realizados até o momento não consideraram o grau e extensão de processamento industrial dos alimentos na avaliação da dieta fora de casa. Objetivo: Avaliar o consumo de alimentos fora de casa e verificar sua associação com características socioeconômicas e indicadores nutricionais. Métodos: Trata-se de um estudo transversal utilizando o Módulo de Consumo Pessoal da Pesquisa de Orçamentos Familiares realizada pelo Instituto Brasileiro de Geografia e Estatística entre maio de 2008 e maio de 2009. Os alimentos foram agrupados de acordo com a extensão e propósito do processamento industrial. O hábito de comer fora de casa foi avaliado por meio de dois indicadores: o percentual de calorias consumidas fora e a frequência de dias em que cada indivíduo relatou realizar refeições fora de domicílio, ambos descritos segundo características sociodemográficas. Foi estimado o percentual de participação dos grupos e subgrupos alimentares no total de calorias e segundo local de consumo. Adicionalmente, o percentual de participação de alimentos ultraprocessados dentro e fora de casa foi descrito segundo características sociodemográficas. Modelo multinível foi aplicado para avaliar a associação entre comer fora de casa e a participação de alimentos ultraprocessados na dieta. Análise fatorial foi conduzida para identificar padrões de alimentação fora de casa e modelos de regressão linear foram utilizados para explorar associação entre os padrões encontrados e indicadores nutricionais. Resultados: Observa-se uma maior contribuição de alimentos ultraprocessados fora de casa, destacando a participação de itens alimentares como refrigerantes e refeições prontas. Quando comparado com o consumo exclusivamente dentro do domicílio, realizar refeições fora de casa aumenta em 51% o consumo de alimentos ultraprocessados. A análise de componentes principais, no entanto, monstra que existem padrões de alimentação fora de casa que podem ter ou não um impacto negativo na dieta. Foram encontrados três padrões de alimentação na população que explicam conjuntamente 13,6% da variância. O primeiro padrão, denominado refeição tradicional, inclui em sua composição arroz, feijão, legumes e verduras, raízes e tubérculos, macarrão e outras massas, carne bovina, aves e ovos. O segundo padrão, nomeado lanche, é composto por manteiga, leite, café e chás, pão francês, queijos processados e margarina. O terceiro padrão, denominado alimentos de conveniência por ser composto exclusivamente por alimentos ultraprocessados, inclui doces, refeições prontas (tais como fast food, salgados, pizza, entre outras) e refrigerantes. De maneira geral, observou-se uma associação direta entre o padrão de refeições tradicionais e nutrientes saudáveis na dieta, enquanto o padrão lanches e alimentos de conveniência foram associados diretamente com nutrientes não saudáveis. Conclusão: Os resultados apresentados indicam que no Brasil, comer fora de casa está associado ao aumento na participação de alimentos ultraprocessados na dieta. Existem, porém, padrões de alimentação fora de casa. Quando baseada em lanches e alimentos de conveniência, comer fora de casa acarreta em um impacto negativo na dieta. É, no entanto, possível manter uma alimentação saudável fora de casa quando se adere a padrões tradicionais da culinária brasileira / Introduction: Eating out has been related to the increase on the consumption of food characterized by high degree of processing, such as soft drinks, sweets and fast food. Although they indicate an association between eating out and ultra-processed food consumption, studies do not consider the extent and purpose of food processing to evaluate eating out diet. Objective: Evaluate eating out food and verify its association with socioeconomic characteristics and nutritional indicators. Method: Cross-sectional study using the Individual Food Intake Survey, carried out with 34,003 individuals aged 10 or more, between May 2008 and May 2009. All food items were classified according to the extent and purpose of food processing. The habit of eating out was evaluated through two indicators: the percentage of calories eating out and the frequency of days in which each individual reported eating out, both indicators are described according to the sociodemographic characteristics. The percentage of food calories per group and subgroups was estimated according to the place of consumption. In addition, the ultra-processed food percentage eaten at home and out was described according to sociodemographic characteristics. Multilevel model was applied to evaluate an association between eating out and the participation of ultra-processed food on diet. Factor analysis was used to identify the eaten out food consumption patterns and linear regression models were used to explore the association between patterns and the nutrient content of the diet. Results: It is possible to observe a higher contribution of ultra-processed food out home, emphasizing the participation of food items such as soft drinks and ready-to-eat meals. When compared to consumption exclusively at home, eating meals out increases the consumption of ultra-processed foods by 51%. Principal component analysis, however, demonstrates that there are eating out patterns, whether or not may have a negative impact on the diet. We identified three food patterns. The first pattern, called traditional meal, was positive for rice, beans, vegetables and greens, roots and tubers, pasta, beef, poultry and eggs. The second pattern, called snack, was positive for butter, milk, coffee and tea, processed bread, processed cheese and margarine. The third pattern, called convenience food because it consists exclusively of ultra-processed food, was positive for sweet, ready to eat meals and soft drinks. In general, there was a positive association between traditional meal pattern and healthy dietary markers, while snacks and the convenience pattern were positively associated to unhealthy dietary markers. Conclusion: In Brazil, eating out is directly associated to ultra-processed food consumption. There is, however, eating out patterns. When based on snacks and convenience food, eating out has a negative impact in diet. It is, however, possible to maintain a healthy diet out when adhering to traditional Brazilian patterns

Introdução: Comer fora de casa tem sido relacionado com o aumento no consumo de alimentos caracterizados pelo alto grau de processamento, tal como refrigerantes, doces e fast food. Embora indiquem uma associação entre alimentação fora do domicilio e o consumo de alimentos ultraprocessados, estudos realizados até o momento não consideraram o grau e extensão de processamento industrial dos alimentos na avaliação da dieta fora de casa. Objetivo: Avaliar o consumo de alimentos fora de casa e verificar sua associação com características socioeconômicas e indicadores nutricionais. Métodos: Trata-se de um estudo transversal utilizando o Módulo de Consumo Pessoal da Pesquisa de Orçamentos Familiares realizada pelo Instituto Brasileiro de Geografia e Estatística entre maio de 2008 e maio de 2009. Os alimentos foram agrupados de acordo com a extensão e propósito do processamento industrial. O hábito de comer fora de casa foi avaliado por meio de dois indicadores: o percentual de calorias consumidas fora e a frequência de dias em que cada indivíduo relatou realizar refeições fora de domicílio, ambos descritos segundo características sociodemográficas. Foi estimado o percentual de participação dos grupos e subgrupos alimentares no total de calorias e segundo local de consumo. Adicionalmente, o percentual de participação de alimentos ultraprocessados dentro e fora de casa foi descrito segundo características sociodemográficas. Modelo multinível foi aplicado para avaliar a associação entre comer fora de casa e a participação de alimentos ultraprocessados na dieta. Análise fatorial foi conduzida para identificar padrões de alimentação fora de casa e modelos de regressão linear foram utilizados para explorar associação entre os padrões encontrados e indicadores nutricionais. Resultados: Observa-se uma maior contribuição de alimentos ultraprocessados fora de casa, destacando a participação de itens alimentares como refrigerantes e refeições prontas. Quando comparado com o consumo exclusivamente dentro do domicílio, realizar refeições fora de casa aumenta em 51% o consumo de alimentos ultraprocessados. A análise de componentes principais, no entanto, monstra que existem padrões de alimentação fora de casa que podem ter ou não um impacto negativo na dieta. Foram encontrados três padrões de alimentação na população que explicam conjuntamente 13,6% da variância. O primeiro padrão, denominado refeição tradicional, inclui em sua composição arroz, feijão, legumes e verduras, raízes e tubérculos, macarrão e outras massas, carne bovina, aves e ovos. O segundo padrão, nomeado lanche, é composto por manteiga, leite, café e chás, pão francês, queijos processados e margarina. O terceiro padrão, denominado alimentos de conveniência por ser composto exclusivamente por alimentos ultraprocessados, inclui doces, refeições prontas (tais como fast food, salgados, pizza, entre outras) e refrigerantes. De maneira geral, observou-se uma associação direta entre o padrão de refeições tradicionais e nutrientes saudáveis na dieta, enquanto o padrão lanches e alimentos de conveniência foram associados diretamente com nutrientes não saudáveis. Conclusão: Os resultados apresentados indicam que no Brasil, comer fora de casa está associado ao aumento na participação de alimentos ultraprocessados na dieta. Existem, porém, padrões de alimentação fora de casa. Quando baseada em lanches e alimentos de conveniência, comer fora de casa acarreta em um impacto negativo na dieta. É, no entanto, possível manter uma alimentação saudável fora de casa quando se adere a padrões tradicionais da culinária brasileira / Introduction: Eating out has been related to the increase on the consumption of food characterized by high degree of processing, such as soft drinks, sweets and fast food. Although they indicate an association between eating out and ultra-processed food consumption, studies do not consider the extent and purpose of food processing to evaluate eating out diet. Objective: Evaluate eating out food and verify its association with socioeconomic characteristics and nutritional indicators. Method: Cross-sectional study using the Individual Food Intake Survey, carried out with 34,003 individuals aged 10 or more, between May 2008 and May 2009. All food items were classified according to the extent and purpose of food processing. The habit of eating out was evaluated through two indicators: the percentage of calories eating out and the frequency of days in which each individual reported eating out, both indicators are described according to the sociodemographic characteristics. The percentage of food calories per group and subgroups was estimated according to the place of consumption. In addition, the ultra-processed food percentage eaten at home and out was described according to sociodemographic characteristics. Multilevel model was applied to evaluate an association between eating out and the participation of ultra-processed food on diet. Factor analysis was used to identify the eaten out food consumption patterns and linear regression models were used to explore the association between patterns and the nutrient content of the diet. Results: It is possible to observe a higher contribution of ultra-processed food out home, emphasizing the participation of food items such as soft drinks and ready-to-eat meals. When compared to consumption exclusively at home, eating meals out increases the consumption of ultra-processed foods by 51%. Principal component analysis, however, demonstrates that there are eating out patterns, whether or not may have a negative impact on the diet. We identified three food patterns. The first pattern, called traditional meal, was positive for rice, beans, vegetables and greens, roots and tubers, pasta, beef, poultry and eggs. The second pattern, called snack, was positive for butter, milk, coffee and tea, processed bread, processed cheese and margarine. The third pattern, called convenience food because it consists exclusively of ultra-processed food, was positive for sweet, ready to eat meals and soft drinks. In general, there was a positive association between traditional meal pattern and healthy dietary markers, while snacks and the convenience pattern were positively associated to unhealthy dietary markers. Conclusion: In Brazil, eating out is directly associated to ultra-processed food consumption. There is, however, eating out patterns. When based on snacks and convenience food, eating out has a negative impact in diet. It is, however, possible to maintain a healthy diet out when adhering to traditional Brazilian patterns

Contexte : La prévalence de l'asthme et des allergies a augmenté au cours de ces dernières décennies,en particulier chez les enfants et dans le monde occidental. Cette augmentation de la prévalence estdevenue un problème très grave de santé publique et pourrait être liée à une combinaison deprédisposition génétique, de facteurs environnementaux et des changements dans le mode de vie, ycompris les habitudes alimentaires. Cependant, les études épidémiologiques concernant les maladiesallergiques chez l’enfant en relation avec l'alimentation sont rares.Objectifs : Ce travail analyse la littérature récente traitant l'alimentation, les habitudes alimentaires et lanutrition en relation avec les maladies allergiques chez les enfants en tenant compte de la méthodologieutilisée pour évaluer les habitudes alimentaires. En outre, il évalue en premier lieu l'association entre leshabitudes alimentaires et l'asthme et les maladies allergiques et en deuxième lieu la relation entrel'asthme et le surpoids/l’obésité dans l’étude des six villes françaises.Méthodes : MEDLINE/PubMed et Cochrane Database of Systematic Reviews ont été utilisés pour larevue de la littérature concernant l'alimentation et les maladies allergiques. Des études transversales ontété menées à Bordeaux, Clermont-Ferrand, Créteil, Marseille, Reims, Strasbourg sur 7 432 enfantsscolaires, choisis au hasard et âgés de 9-11 ans. Des questionnaires adressés aux parents, basés surl'Enquête internationale sur l'asthme et les allergies dans l'enfance (ISAAC), ont été utilisés pourrecueillir des informations sur les maladies allergiques et les facteurs de risque potentiels, y compris unquestionnaire de fréquence alimentaire pour évaluer les habitudes alimentaires des enfants. Des testscutanés aux allergènes communs ont été effectués afin d'identifier l'existence d'une hypersensibilitéallergique et des tests d’effort ont été effectués pour évaluer l'asthme à l’effort.Résultats : Les apports moyens de 12 principaux produits alimentaires consommés par les élèves ontété calculées et trois profils alimentaires ont été extraits par analyse en composantes principales:l’alimentation proche du régime méditerranéen, l’alimentation à base d’oméga-3 et de poissons gras etl’alimentation non équilibrée. Les risques relatifs des maladies allergiques ont été estimés par des odds7ratios (OR) et le contrôle des facteurs de confusion a été réalisé par des régressions logistiques. Lessifflements, l’asthme et la rhinite sont plus fréquents chez les garçons que chez les filles. En analysemultivariée, l’alimentation à base d’oméga-3 avait un effet protecteur contre l'asthme vie et l’asthmesévère chez les enfants (OR ajusté: 0,77 ; IC 95%: [0,62 -0,96] et OR ajusté: 0,55 ; IC 95%: [0,32 -0,94]respectivement). L’adhérence à une alimentation proche du régime méditerranéen et riche enantioxydants semble avoir un effet protecteur contre les maladies allergiques. Le surpoids et l’obésitéont été positivement associés avec l’asthme vie chez les enfants ne présentant pas de sifflements (ORajusté: 1,98 ; IC 95%: [1,06 -3,70]) et ont été de même associé positivement avec la rhinite vie et larhinite 12 mois chez les enfants présentant des sifflements (OR ajusté: 1,63 ; IC 95%: [1,09 -2,45] etOR ajusté: 2,20 ; IC 95%: [1,13 -4,27] respectivement), mais pas avec l’asthme à l’effort.Conclusion: Dans l'ensemble, l'adhésion à un régime alimentaire sain, y compris les antioxydants et lesoméga-3 semble avoir un effet protecteur sur l'asthme et les allergies chez les enfants. Le surpoids etl’obésité a été associé significativement avec l’asthme chez les enfants non atopiques et la rhiniteallergique chez les enfants atopiques. Des études prospectives longitudinales sont donc nécessaires pourpouvoir évaluer les relations de causalité. / Background: The prevalence of asthma and allergy has risen in recent decades, especially amongchildren and in the Western world. This increase in prevalence has become a serious public healthproblem and might be related to a combination of genetic predisposition, environmental factors, andlifestyle changes, including dietary habits. However, epidemiological studies concerning childhood dietrelatedallergic diseases are scarce.Objectives: This work reviews published literature dealing with diet, dietary patterns and nutrition inrelation with allergic diseases among children taking into account the methodology used to evaluatedietary patterns. Moreover, it assesses primary the association between food patterns and asthma andallergic diseases and secondary the relation between asthma and overweight/obesity in the French SixCities Study.Methods: MEDLINE/PubMed and Cochrane Database of Systematic Reviews were used for theliterature review concerning diet and allergic diseases. Cross-sectional studies were conducted inBordeaux, Clermont-Ferrand, Créteil, Marseille, Reims, and Strasbourg among 7432 randomly selectedschoolchildren aged 9-11 years. Parental questionnaires, based on the International Study on Asthmaand Allergies in Childhood (ISAAC), were used to collect information on allergic diseases and potentialrisk factors including a food frequency questionnaire to evaluate dietary habits. Skin prick testing tocommon allergens was performed to identify the existence of an allergic hypersensitivity and exercisetest was performed to assess Exercise-Induced Asthma (EIA).Results: The mean intakes of 12 main food items were calculated and three food patterns wereextracted by principal component analysis labeled: the Mediterranean-like diet, the diet rich in omega-3fatty acids and the unhealthy diet. Relative risks of allergic diseases were estimated as odds ratios (OR)and confounders control was performed with multiple logistic regressions. Wheezing, asthma andrhinitis were more prevalent in boys than in girls. In the multivariate analysis, diet rich in omega-3 wasprotective for lifetime and severe asthma in children (adjusted OR: 0.77; 95% CI: [0.62 -0.96] and9adjusted OR: 0.55; 95% CI: [0.32 -0.94] respectively). Adherence to the Mediterranean-like diet rich inantioxidants tended to be protective against allergic diseases. Overweight and obesity were positivelyassociated with lifetime asthma in non-wheezing children (adjusted OR: 1,98 ; 95% CI: [1,06 -3,70])and were also positively associated with lifetime and past year allergic rhinitis in wheezing children(adjusted OR: 1.63; 95% CI: [1.09 -2.45] and adjusted OR: 2.20; 95% CI: [1.13 -4.27] respectively), butwere not associated with EIA.Conclusion: Overall, adherence to a healthy diet including antioxidants and omega-3 fatty acids seemsto have a protective effect on asthma and allergy in childhood. Overweight and obesity weresignificantly associated with asthma in non-atopic children and with allergic rhinitis in atopic children.Prospective longitudinal studies should be necessary for evaluation of causal relations.