Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro / Nas últimas décadas, tem sido observado o aumento da oferta de bebidas com elevado conteúdo calórico e com grandes quantidades de açúcar de rápida absorção. Essas bebidas adoçadas, cujo consumo tem aumentado no Brasil assim como em outras partes do mundo, são consideradas fatores de risco para obesidade e diabetes. O consumo de bebidas adoçadas pode levar ao balanço energético positivo e consequentemente ao ganho de peso. Essa associação pode ser explicada pelo mecanismo regulatório de compensação de calorias líquidas. Compensação calórica ocorre quando há redução no consumo de calorias provenientes de alimentos sólidos para compensar as calorias líquidas adicionadas à refeição ou dieta. No entanto, não há consenso em relação a evidências da compensação calórica, dificultando a elaboração de recomendações sobre essas bebidas em saúde pública. Razões para a falta de consenso incluem a diversidade de desenhos de estudos, experimentos realizados em ambientes controlados e não reais em relação ao consumo de alimentos e bebidas, e estudos com amostras pequenas ou de conveniência. Esta dissertação estudou a associação entre bebidas adoçadas e consumo calórico, verificando se calorias de bebidas adoçadas são compensadas em refeições realizadas em um ambiente pragmático. Os dados de consumo calórico de 34.003 indivíduos, com idade igual ou superior a dez anos, foram obtidos pelo Inquérito Nacional de Alimentação 2008-2009, em todo território nacional. Os participantes completaram dois registros alimentares, em dias não consecutivos da mesma semana. Foram selecionadas as refeições dos períodos café da manhã, almoço e jantar de cada indivíduo em cada um dos dias. Para cada refeição, foi calculado o valor calórico de alimentos e de bebidas adoçadas consumidos. Para testar a compensação calórica, um modelo de regressão linear multinível com efeitos mistos foi ajustado para analisar cada período. A variável reposta utilizada foi consumo calórico proveniente de alimentos e a variável explicativa foi consumo calórico de bebida adoçada na refeição. Os efeitos intra-indivíduo da bebida adoçada no consumo calórico foram estimados e interpretados. Esses efeitos são considerados não-enviesados pois são controlados pelas características constantes dos indivíduos, tendo assim o indivíduo atuando como seu próprio controle na análise. Covariadas incluídas no modelo foram variáveis da refeição: local, dia da semana, horário, consumo calórico na refeição anterior e intervalo de tempo desde a última refeição; e do indivíduo: sexo, faixa etária, categoria de Índice de Massa Corpórea e quartos de renda per capita. Efeitos aleatórios dos indivíduos e dos domicílios foram incluídos no modelo para melhor estimar a estrutura de erros de dados correlacionados. A compensação calórica foi de 42% para o café da manhã, não houve compensação no almoço e para o jantar, compensação variou de 0 a 22%, tendo interação com quartos de renda per capita. A conclusão desta dissertação é que as bebidas adoçadas não são completamente compensadas em refeições realizadas em ambiente pragmático. Assim, a redução do consumo de bebidas adoçadas em refeições pode ajudar a diminuir o consumo calórico excessivo e levar a um melhor controle do peso em indivíduos. / Over the past decades, an increase has been observed in the availability of beverages that are high in energy and rapidly absorbed sugar. These sugar-sweetened beverages, whose consumption has increased in Brazil as well as in other parts of the world, are considered risk factors for obesity and diabetes. The consumption of sugar-sweetened beverages can lead to positive energy balance and consequently to weight gain. This association can be explained by the compensatory regulation of liquid calories. Caloric compensation occurs when there is a reduction in the caloric consumption derived from solid food to compensate for the liquid calories added to the meal or diet. However, the evidence for a public health policy recommendation remains inconclusive. Among reasons for the lack of consensus are the diversity of study designs, experiments conducted in controlled environments that do not reflect the natural consumption of food and beverages, and the use of small or convenient samples. This dissertation studied the association between sugar-sweetened beverages and energy intake, analyzing if calories of sugar-sweetened beverages are compensated during meals in a pragmatic environment. The dietary data was obtained from the National Dietary Survey 2008-2009, which collected information on food consumption from 34,003 individuals, aged 10 years and older, from within the entire national territory. The participants completed two food records over non-consecutive days of the same week. The meals breakfast, lunch and dinner were identified for each individual on each of the days. For each meal, energy intake from food and sugar-sweetened beverages was measured. To test for caloric compensation, a multi-level mixed-effects linear regression model was adjusted for each meal type. The outcome variable was food energy intake and the explicative variable was energy from sugar-sweetened beverages during the meal. The intra-individual effects of the sugar-sweetened beverages on food energy intake were estimated and interpreted. These effects are considered unbiased because they are controlled by all stable characteristics of the subject, and thus the individual acts as his/her own control in the analysis. Covariates included in the model were the meal variables, such as location, day of the week, time of day, energy intake in the previous meal and time interval since the previous meal. And variables of the subject included sex, age group, BMI category and quartiles of per capita income. Random effects of subjects and of households were included in the model to better estimate the structure of errors within the correlated data. The caloric compensation was 42% for breakfast; there was no compensation for lunch; and for dinner, compensation ranged between 0 and 22%, with significant interaction with quartiles of per capita income. The conclusion of this dissertation is that sugar-sweetened beverages are not completely compensated in meals that take place in a pragmatic environment. Therefore, a reduction in the consumption of sugar-sweetened beverages in meals may help reduce excessive caloric consumption, leading to better weight control.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro / Nas últimas décadas, tem sido observado o aumento da oferta de bebidas com elevado conteúdo calórico e com grandes quantidades de açúcar de rápida absorção. Essas bebidas adoçadas, cujo consumo tem aumentado no Brasil assim como em outras partes do mundo, são consideradas fatores de risco para obesidade e diabetes. O consumo de bebidas adoçadas pode levar ao balanço energético positivo e consequentemente ao ganho de peso. Essa associação pode ser explicada pelo mecanismo regulatório de compensação de calorias líquidas. Compensação calórica ocorre quando há redução no consumo de calorias provenientes de alimentos sólidos para compensar as calorias líquidas adicionadas à refeição ou dieta. No entanto, não há consenso em relação a evidências da compensação calórica, dificultando a elaboração de recomendações sobre essas bebidas em saúde pública. Razões para a falta de consenso incluem a diversidade de desenhos de estudos, experimentos realizados em ambientes controlados e não reais em relação ao consumo de alimentos e bebidas, e estudos com amostras pequenas ou de conveniência. Esta dissertação estudou a associação entre bebidas adoçadas e consumo calórico, verificando se calorias de bebidas adoçadas são compensadas em refeições realizadas em um ambiente pragmático. Os dados de consumo calórico de 34.003 indivíduos, com idade igual ou superior a dez anos, foram obtidos pelo Inquérito Nacional de Alimentação 2008-2009, em todo território nacional. Os participantes completaram dois registros alimentares, em dias não consecutivos da mesma semana. Foram selecionadas as refeições dos períodos café da manhã, almoço e jantar de cada indivíduo em cada um dos dias. Para cada refeição, foi calculado o valor calórico de alimentos e de bebidas adoçadas consumidos. Para testar a compensação calórica, um modelo de regressão linear multinível com efeitos mistos foi ajustado para analisar cada período. A variável reposta utilizada foi consumo calórico proveniente de alimentos e a variável explicativa foi consumo calórico de bebida adoçada na refeição. Os efeitos intra-indivíduo da bebida adoçada no consumo calórico foram estimados e interpretados. Esses efeitos são considerados não-enviesados pois são controlados pelas características constantes dos indivíduos, tendo assim o indivíduo atuando como seu próprio controle na análise. Covariadas incluídas no modelo foram variáveis da refeição: local, dia da semana, horário, consumo calórico na refeição anterior e intervalo de tempo desde a última refeição; e do indivíduo: sexo, faixa etária, categoria de Índice de Massa Corpórea e quartos de renda per capita. Efeitos aleatórios dos indivíduos e dos domicílios foram incluídos no modelo para melhor estimar a estrutura de erros de dados correlacionados. A compensação calórica foi de 42% para o café da manhã, não houve compensação no almoço e para o jantar, compensação variou de 0 a 22%, tendo interação com quartos de renda per capita. A conclusão desta dissertação é que as bebidas adoçadas não são completamente compensadas em refeições realizadas em ambiente pragmático. Assim, a redução do consumo de bebidas adoçadas em refeições pode ajudar a diminuir o consumo calórico excessivo e levar a um melhor controle do peso em indivíduos. / Over the past decades, an increase has been observed in the availability of beverages that are high in energy and rapidly absorbed sugar. These sugar-sweetened beverages, whose consumption has increased in Brazil as well as in other parts of the world, are considered risk factors for obesity and diabetes. The consumption of sugar-sweetened beverages can lead to positive energy balance and consequently to weight gain. This association can be explained by the compensatory regulation of liquid calories. Caloric compensation occurs when there is a reduction in the caloric consumption derived from solid food to compensate for the liquid calories added to the meal or diet. However, the evidence for a public health policy recommendation remains inconclusive. Among reasons for the lack of consensus are the diversity of study designs, experiments conducted in controlled environments that do not reflect the natural consumption of food and beverages, and the use of small or convenient samples. This dissertation studied the association between sugar-sweetened beverages and energy intake, analyzing if calories of sugar-sweetened beverages are compensated during meals in a pragmatic environment. The dietary data was obtained from the National Dietary Survey 2008-2009, which collected information on food consumption from 34,003 individuals, aged 10 years and older, from within the entire national territory. The participants completed two food records over non-consecutive days of the same week. The meals breakfast, lunch and dinner were identified for each individual on each of the days. For each meal, energy intake from food and sugar-sweetened beverages was measured. To test for caloric compensation, a multi-level mixed-effects linear regression model was adjusted for each meal type. The outcome variable was food energy intake and the explicative variable was energy from sugar-sweetened beverages during the meal. The intra-individual effects of the sugar-sweetened beverages on food energy intake were estimated and interpreted. These effects are considered unbiased because they are controlled by all stable characteristics of the subject, and thus the individual acts as his/her own control in the analysis. Covariates included in the model were the meal variables, such as location, day of the week, time of day, energy intake in the previous meal and time interval since the previous meal. And variables of the subject included sex, age group, BMI category and quartiles of per capita income. Random effects of subjects and of households were included in the model to better estimate the structure of errors within the correlated data. The caloric compensation was 42% for breakfast; there was no compensation for lunch; and for dinner, compensation ranged between 0 and 22%, with significant interaction with quartiles of per capita income. The conclusion of this dissertation is that sugar-sweetened beverages are not completely compensated in meals that take place in a pragmatic environment. Therefore, a reduction in the consumption of sugar-sweetened beverages in meals may help reduce excessive caloric consumption, leading to better weight control.

Submitted by Aline Batista (alinehb.ufpel@gmail.com) on 2018-05-24T12:28:55Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Bruna_Ribas.pdf: 3067129 bytes, checksum: b1562f9e78dc58c29b7b6d01f7bd6e5c (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2018-05-24T13:55:48Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Bruna_Ribas.pdf: 3067129 bytes, checksum: b1562f9e78dc58c29b7b6d01f7bd6e5c (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2018-05-24T13:55:57Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Bruna_Ribas.pdf: 3067129 bytes, checksum: b1562f9e78dc58c29b7b6d01f7bd6e5c (MD5) / Made available in DSpace on 2018-05-24T13:55:58Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Bruna_Ribas.pdf: 3067129 bytes, checksum: b1562f9e78dc58c29b7b6d01f7bd6e5c (MD5) Previous issue date: 2017-07-31 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / As doenças cardiovasculares são a principal causa de morte no Brasil e no mundo. Uma vez já ocorrido o desfecho clínico cardiovascular, a prevenção secundária é fundamental. O objetivo deste trabalho foi avaliar a adequação do consumo alimentar de vitaminas e minerais antioxidantes, e associar o consumo de bebidas açucaradas à variáveis antropométricas e bioquímicas em pacientes com aterosclerose manifesta participantes do projeto Dieta Cardioprotetora Brasileira. Para isso, realizou-se um estudo transversal aninhado a um ensaio clínico randomizado, com a utilização de dados secundários referente à primeira consulta de todos os pacientes incluídos no projeto. Foram coletados dados clínicos, antropométricos, bioquímicos e alimentares. A análise estatística foi realizada no programa GraphPad® Prism 5. A amostra foi composta por 2172 pacientes com doença aterosclerótica manifesta, sendo a maioria do sexo masculino (58,5%), idosa (63,6%), de nível econômico C (57,3%), com escolaridade fundamental (45,8%), sedentários (65,8%), com excesso de peso (62,7%) e com doença arterial coronariana tratada (69,0%). O consumo alimentar de vitaminas e minerais antioxidantes foi inadequado, com exceção da vitamina C que foi adequada em homens e em mulheres e do zinco em mulheres. O consumo de bebidas açucaradas foi associado a maiores valores de índice de massa corporal (p= 0,029), circunferência da cintura (p= 0,004) e triglicerídeos (p= 0,023). Esses resultados reforçam a necessidade de intervenção nutricional, especialmente sobre o consumo desses nutrientes e do desaconselhamento em relação ao consumo de bebidas açucaradas, a fim contribuir na prevenção de um novo evento cardiovascular. / Cardiovascular diseases are the leading cause of death in Brazil and worldwide. Once cardiovascular clinical outcome hás occurred, secondary prevention is fundamental in these patients. The objective of this study was to compare dietary intake of antioxidant vitamins and minerals with proposed daily intake recommendations and also to analyze possible associations between consumption of sugar-sweetened beverages and anthropometric and biochemical variables in patients with established atherosclerosis in Brazilian Cardioprotective Nutritional Program (BALANCE Program). A cross-sectional study was carried out with secondary data of a randomized clinical Trial referring to the first visit of all patients included in project. Clinical, anthropometric, biochemical and dietary variables were collected. Statistical analysis was performed in GraphPad® Prism 5. The sample consisted of 2,172 patients, most of them male (58.5%), elderly (63.6%) from C economic level (57.3%), with elementary school (45.8%), sedentary (65.8%), overweight (62.7%) and treated coronary artery disease (69.0%). The dietary intake of antioxidant vitamins and minerals has been inadequate, with the exception of vitamin C that has been adequate in men and women and zinc in women. The consumption of sugar-sweetened beverages was associated with higher values of body mass index (p = 0.029), waist circumference (p = 0.004) and triglycerides (p = 0.023). These results emphasize the need for nutritional intervention, especially on consumption of these nutrients and the advice to avoid consumption of sugar-sweetened beverages, in order to prevent occurrence of new cardiovascular event.

In recent time, several reports have been published about a more and more unhealthy population world wide, with increasing Body Mass Index (BMI) in welfare countries, such as Sweden. Diseases, such as obesity and diabetes, which is strongly connected to a high BMI, have increased and together with them also the medical expenses for society/state. Several initiatives have been started, in different countries, to tackle these problems and some have introduced a “sugar tax” on unhealthy products, like candy and soda, which has become a well- debated subject also in Sweden today. In this MBA master thesis, a literature study has been conducted with the goal of evaluating if an excise tax should be introduced in an efficient way on unhealthy sugar-sweetened beverages in Sweden. This case study is built on secondary data where reports and official statistics, from governments and health authorities/organizations, have been studied both for Sweden as well as from other countries. There has been a particular focus on Sweden's neighbouring countries Denmark and Finland, who has both experiences in the implementation of a “sugar tax”. Our theory is that introducing an excise tax on sugar-sweetened beverages will reduce the demand and consumption of these products, which will reduce welfare disease such as obesity and diabetes and yield a tax income for the state. However it is important to have in mind that the reduced consumption also will result in less tax income from the no longer sold goods, fewer personnel employed in the producing industries etc. The results showed that the overall sugar consumption actually has decreased in Sweden, as well as the overall consumption of sugar-sweetened beverages. However during the same time period the average calorie consumption and BMI has continued to increase resulting in a more unhealthy population that results in increased medical expenses. In conclusion an excise tax on sugar-sweetened beverages will not solve the welfare disease problems but may positively influence health. However it comes with a price also for the state from both gains and loss in tax incomes and increased administrations costs for managing the new tax. Finally it should be noted that since sugar-sweetened beverages are unhealthy products, which do not contribute to any positive health effects, sugar taxation might still be considered.

M. Tech. (Department of Biotechnology, Faculty of Applied and Computer Sciences), Vaal University of Technology. / Obesity has steadily increased and represents a major public health problem worldwide, reducing quality of life and causing a range of health problems. Obesity has emerged as the fifth leading risk of global deaths. Annually, 2.8 million adults die as a result of being overweight or obese. The increase of obesity remains inexplicable in terms of genetic susceptibility to obesity. The genetic loci identified by genome-wide association studies (GWASs) explains about 2% of the heritability for obesity. Perhaps other factors such as epigenetics may be involved in the increase of obesity and may offer solutions for the management of obesity. Epigenetics is defined as a heritable change in gene expression without altering the genome sequences. It may help in providing a logical explanation between the genome and environment which shapes obesity risk and may help to explain the "missing heritability". Epigenetics may affect two mechanisms, namely: i) DNA methylation,and ii) histone modifications. DNA methylation might give scientists a link to the rise in obesity.The study aimed to investigate the effect of sugars used as sweeteners in sugar-sweetened beverages (SSB) on DNA methylation in a Caco-2 cell line in vitro. Four major objectives were pursued in the study which were to:(1) stimulate the Caco-2 cells with varying concentrations of sugar sweeteners and assess the morphological changes of the cells; (2) evaluate the cytotoxicity of different concentrations of the sugar sweetener on the Caco-2 cell line using the Alamar blue and LDH assay; (3) obtain genomic DNA from the treated Caco-2 cell line and perform bisulfite conversion and rest; and (4) amplify the WT1, MEG3, TNFRSF9, ATP10A, and CD44 obesity-associated genes and ascertain their degree of methylation. Caco-2 cells were stimulated with sugar sweeteners at varying concentrations (low, medium and high) for an incubation period of 62 days,and images of the cells were captured for morphological characterisation. The incubation condition entailed cells plated in a 12 or 96 well plate, incubated in a humidified 5% CO2 incubator at 37 °C and there is nutrient renewal every three days.Alamar blue, a cell proliferation colourimetric assay and lactate dehydrogenase assays (LDH), a homogenous membrane fluorimetric assay were used for the cytotoxicity studies. The results of the characterisation showed that different concentrations of sugar sweeteners affected the morphology of the cells as the incubation period progressed. The cytotoxicity results of both LDH and Alamar blue depicted low concentration of sweeteners that had low-to-moderate toxicity and the medium and high concentration of the sweeteners had a moderate to high toxicity on the Caco-2 cells. DNA from the Caco-2 cells was extracted. Techniques used to study DNA methylation such as bisulfite conversion, PCR amplification and restriction enzymes that have differential sensitivity to 5-methyl-cytosine were performed. The quality of DNA extracted was good. The bisulfite conversion was conducted andno amplification was observed, as a contingency plan Normal PCR was performed to amplify the CpG islands, and there was amplification. In conclusion, the study showed that a low concentration of a sugar sweetener (fructose: glucose) used in beverages had low toxicity to the Caco-2 cell line and prolonged exposure of the low concentration might have an adverse effect on the cells' morphology. At medium concentrations, the sugar sweetener used in beverages had medium toxicity to Caco-2 cells; prolonged exposure may lead to morphological changes. These findings indicated that control of dietary glucose intake is an important strategy in combating the development of obesity and type-2 diabetes. DNA methylation could not be established.

Thesis (M. A. (Physiology)) -- University of Limpopo, 2022 / Background: Metabolic syndrome (MetS) is amongst the underlying causes of mortality and morbidity globally. However, lifestyle habits such as frequent consumption of sugar-sweetened beverages (SSBs) contributes to its onset. The study was aimed at investigating the association between MetS and SSBs intake among Ellisras rural youth. Additionally, to find the best obesity indices to predict MetS. Methods: The current study included a total of 593 Ellisras rural youth, aged 22 to 30 years (289 males and 304 females). Anthropometric measurements, blood pressure (BP), and biochemical assessment were taken using standards procedures. A validated 24hrs recall questionnaire and food manuals were used to collect SSBs data. Binary logistic regression was applied to determine the association between SSBs intake and MetS components for the adjusted model. Confirmatory factor analysis was used to test the best single-factor models to predict MetS on commonly selected obesity indices. Results: The SSBs quartile 4 was associated with a high risk of high fasting blood glucose (FBG) for adjusted (OR=2.32; CI=1.15-4.70; p<0.05) and unadjusted (OR=2.34; CI=1.16-4.73; p<0.05) models were a significant linear trend (p for trend=0.049) in males was found. Low risk of reduced high density lipoprotein cholesterol (HDL-C) was associated with the second and fourth SSBs quartiles for unadjusted ((OR=0.40; CI=0.18-0.85; p<0.05; OR=0.37; CI=0.13-0.80; p<0.05) respectively and adjusted model (OR=0.40; CI=0.18-0.85; p<0.05; OR=0.37; CI=0.17-0.80; p<0.05) respectively in females. Moreover, the fourth SSBs quartile was likely to decrease the risk of high triglycerides (TG) for unadjusted (OR=0.12; CI=0.01-0.87; p<0.05) and adjusted (OR=0.10; CI=0.01-0.83; p<0.05) models were the significant linear trend (p= trend 0.006) was observed also in females. There was a significant linear trend association between SSBs quartiles consumption and high TG in males and high waist circumference (WC) in females, but logistic regression analysis didn’t depict any significant association (p>0.05). In males, single model fit built based on WC (comparative fit index (CFI)=1.00; turker lewis index (TLI)=1.05; RMSEA=0.00; akaike information criterion (AIC)=-2680) and waist to height ratio v (WHtR) (RMSEA=0.00, CFI=1.00; AIC=-2662, TLI=1.05;) suggested a better fit index as compared to body mass index (BMI) and neck circumference (NC). Among females, a single model fit built on NC obtained a better fit index (RMSEA=0.05, CFI=0.90, and AIC= -429.21, TLI=0.71). Conclusion: In this study, there was an association between SSBs consumption and some MetS components (high TG, reduced HDL-C, and high FBG). Obesity indices including WHtR, NC, and WC were the best predictors of MetS. Future studies are recommended to further investigate the association of the risk of MetS and the consumption SSBs and the best obesity indices to predict MetS to assist in efforts to help curb MetS and related risk factors in rural areas of South Africa.

Introduction: Little is known about dietary patterns among individuals with type 2 diabetes mellitus (T2DM) in Peru. This study aimed at determining whether there is association between glucosa metabolism disorder and consumption of fruits, vegetables and sweetened beverages. Material and Methods: Secondary analisis of a population-based cross-sectional study conducted in Tumbes, a región in northern Peru. The outcomes variable were consumption of fruits, vegetables and sweetened beverages, defined by self-report, whilst the exposure was glucose metabolism disorder status (euglicemic, with T2DM bit not aware of diagnosis, and with T2DM and aware of diagnosis), defined by the oral glucose tolerance test. To assess the associations of interest, Poisson regression models with robust variance were created, and prevalence ratios (PR) and 95% confidence intervals (95% CI) were reported. Results: A total of 1607 individuals, mean age 48.2 (SD:10.6); and 809 (50.3%) females, was enrolled. The prevalence of T2DM was 11.0% (95%CI: 9.5%-12.6%), and out of them, 105 (59.7%) had previous diagnosis. Only 213 (13.3%) reported consuming sweetened beverages > once/week, whilst 409 (25.5%) and 736 (45.8%) reported consuming vegetables and fruits, respectively. Those with previous T2DM diagnosis had lower probability of consuming sweetened beverages (sometimes vs. never: PR=0.57; 95%CI: 0.41-0.78, and >once/week vs. never PR=0.39; 95%CI: 0.18-0.85). Both the consumption of fruits and vegetables were similar among those with and without previous T2DM diagnosis. Conclusions: Compared to euglycemic subjects, individual with previous T2DM diagnosis had lower consumption of sweetened beverages, but such association was not present among those with T2DM but without previous diagnosis. Fruits and vegetables consumption were not different between the different glucose metabolism disorder categories. / Introducción: Poco se conoce sobre los patrones de dieta de individuos con diabetes mellitus tipo 2 (DM2) en Perú. El objetivo del presente estudio fue determinar si existe asociación entre la alteración del metabolismo de la glucosa y ciertos patrones de dieta (consumo de bebidas azucaradas, verduras y frutas). Materiales y métodos: Análisis secundario de un estudio poblacional de tipo transversal realizado en Tumbes, en el norte del Perú. Las variables resultado fueron consumo de bebidas azucaradas, consumo de verduras y consumo de frutas, definidas por autorreporte; mientras que la exposición fue la alteración del metabolismo de la glucosa (euglicémico, con DM2 pero sin diagnóstico previo, y con DM2 y diagnóstico previo), basado en la prueba de tolerancia oral a la glucosa. Para evaluar las asociaciones de interés se crearon modelos de regresión de Poisson con varianza robusta y se reportaron razones de prevalencia (RP) e intervalos de confianza al 95% (IC 95%) Resultados: Un total de 1607 individuos, media de edad de 48 , 2 (DE: 10,6), y 809 (50,3%) mujeres, fueron enrolados. La prevalencia de DM2 fue de 11,0% (IC95%: 9,5% -12,6%), y de ellos, 105 (59,7%) tuvieron diagnóstico previo. Solo 213 (13,3%) reportaron consumir bebidas azucaradas> 1 vez / semana, mientras que 409 (25,5%) y 736 (45,8%) reportaron consumir verduras y frutas en forma casi diaria, respectivamente. Aquellos con diagnóstico previo de DM2 tuvieron menor probabilidad de consumir bebidas azucaradas (algunas veces vs.Nunca: RP = 0,57; IC95: 0,41-0,78 y> 1 vez / semana vs.Nunca: RP = 0,39 ; IC95%: 0,18-0,85). Ni el consumo de frutas ni el de verduras fue mayor en aquellos con o sin diagnóstico previo de DM2. Conclusiones: Comparados con los euglicémicos, los individuos con diagnóstico previo de DM2 tuvieron un menor consumo de bebidas azucaradas, pero dicha asociación no estuvo presente en aquellos con DM2 sin diagnóstico previo. El consumo de frutas y verduras no fue diferente entre las categorías de alteración del metabolismo de la glucosa estudiadas. / Tesis

There are many different types of non-alcoholic beverages (NAB) available in the United States today compared to a decade ago. Additionally, the needs of beverage consumers have evolved over the years centering attention on functionality and health dimensions. These trends in volume of consumption are a testament to the growth in the NAB industry. Our study pertains to ten NAB categories. We developed and employed a unique cross-sectional and time-series data set based on Nielsen Homescan data associated with household purchases of NAB from 1998 through 2003. First, we considered demographic and economic profiling of the consumption of NAB in a two-stage model. Race, region, age and presence of children and gender of household head were the most important factors affecting the choice and level of consumption. Second, we used expectation-prediction success tables, calibration, resolution, the Brier score and the Yates partition of the Brier score to measure the accuracy of predictions generated from qualitative choice models used to model the purchase decision of NAB by U.S. households. The Yates partition of the Brier score outperformed all other measures. Third, we modeled demand interrelationships, dynamics and habits of NAB consumption estimating own-price, cross-price and expenditure elasticities. The Quadratic Almost Ideal Demand System, the synthetic Barten model and the State Adjustment Model were used. Soft drinks were substitutes and fruit juices were complements for most of non-alcoholic beverages. Investigation of a proposed tax on sugar-sweetened beverages revealed the importance of centering attention not only to direct effects but also to indirect effects of taxes on beverage consumption. Finally, we investigated factors affecting nutritional contributions derived from consumption of NAB. Also, we ascertained the impact of the USDA year 2000 Dietary Guidelines for Americans associated with the consumption of NAB. Significant factors affecting caloric and nutrient intake from NAB were price, employment status of household head, region, race, presence of children and the gender of household food manager. Furthermore, we found that USDA nutrition intervention program was successful in reducing caloric and caffeine intake from consumption of NAB. The away-from-home intake of beverages and potential impacts of NAB advertising are not captured in our work. In future work, we plan to address these limitations.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / O caju destaca-se dentre as espÃcies frutÃferas nativas do Nordeste, por possuir elevada potencialidade para o consumo in natura e processamento industrial. A polpa e o suco sÃo importantes componentes da dieta humana por serem considerados uma fonte natural de carboidratos, carotenoides, vitaminas e compostos fenÃlicos, substÃncias com alto potencial antioxidante, e tÃm despertado o interesse de diferentes grupos de pesquisa. Este trabalho teve como objetivo estudar a estabilidade da polpa de caju com conservantes, pasteurizada e concentrada congelada durante 12 meses de armazenamento, atravÃs de determinaÃÃes quÃmicas, fÃsico-quÃmicas e microbiolÃgicas e a elaboraÃÃo de nÃctar e suco tropical adoÃado, estudando a estabilidade sensorial dos mesmos durante 360 dias de armazenamento da polpa. As polpas nÃo apresentaram interaÃÃo significativa para pH, sÃlidos solÃveis, acidez titulÃvel e coordenada de cor a. O pH e os sÃlidos solÃveis variaram com o tempo mas mantiveram-se dentro dos padrÃes da legislaÃÃo. A acidez nÃo variou com o armazenamento. A coordenada de cor a* ajustaram ao modelo cÃbico. O Ãcido ascÃrbico variou de 190,65 a 308,45mg/100g na polpa com conservantes, 170,95 a 299,70 mg/100g na polpa pasteurizada e de 514,68 a 865,42mg/100g na polpa concentrada, valores estes bastante expressivos. Pigmentos escuros solÃveis, luminosidade, hue, croma, carotenoides, teor de polpa, aÃÃcares totais apresentaram interaÃÃo significativa e foram avaliados por regressÃo variando com o tempo de armazenamento, exceto a coordenada de cor b*. Os teores de aÃÃcares totais mantiveram-se em torno de 10,01 a 13,25% nas polpas com conservantes e pasteurizadas a 24 a 27% na polpa concentrada, sendo estes em sua maioria representados por aÃÃcares redutores. As anÃlises microbiolÃgicas confirmaram a eficÃcia das etapas de processamento, tratamento tÃrmico e concentraÃÃo na manutenÃÃo da qualidade microbiolÃgica, uma vez que nÃo foi observado crescimento de microrganismos durante o perÃodo de armazenamento. Os nÃctares e os sucos tropicais adoÃados de caju apresentam-se na faixa de aceitaÃÃo sensorial em todos os atributos avaliados. O congelamento das polpas de caju com conservantes, pasteurizada e concentrada à viÃvel uma vez que nÃo ocorrem perdas significativas na qualidade dos produtos. A polpa de caju concentrada apresentou as melhores notas nos atributos sensoriais avaliados. / The cashew (Anacardium occidentale, L.) has a great economic importance to the Northeast region, notably for the great acceptance by consumers, both for their sensory properties (color, aroma, flavor, texture) as for its nutritional and functional values. It stands out among the fruit species native to the Northeast because it has high potential for fresh consumption and industrial processing. The cashew and cashew apple juice are important components of the human diet because they are considered a natural source of carbohydrates, carotenoids, vitamins and phenolic compounds, substances with high antioxidant potential, and have attracted the interest of various research groups. This work aimed to study the stability of cashew apple pulp with preservatives, pasteurized and concentrated frozen storage for 12 months, through to chemical, physical-chemical and microbiological analysis. And production of cashew apple nectar and cashew apple sweetened tropical juice and sensorial stability during 360 days of storage of the pulp. The pulps showed no significant interaction for pH, soluble solids, acidity and color coordinated. The pH and soluble solids varied with time but remained within standards legislation. The acidity no change during the storage. The color coordinate set to the cubic model. The parameters vitamin C ranged from 190.65 to 308.45 in the pulp with preservatives, 170.95 to 299.70 in the pulp pasteurized and from 514.68 to 865.42 mg/100g in concentrated pulp, these values very expressive. Dark pigments soluble, brightness, hue*, chroma*, carotenoids, pulp content, total sugar showed significant interaction were assessed by regression with time varying storage except color coordinate b. The concentration of total sugars remained around 10.01 to 13.25% for pulps with preservatives and pasteurized,and to 24 to 27% in the concentrated pulp, which are mostly represented by sugars. The microbiological analyses confirmed the effectiveness of the processing, thermal treatment and concentration in the maintenance of the microbiological quality, once growth of microorganisms was not observed in the product during the storage period. The cashew apple nectars and juices sweetened have good acceptability in all sensory attributes. The frozen pulps cashew with preservatives, pasteurized and concentrated is viable since no significant losses occur in the quality of products.

Introducción: El consumo de bebidas azucaradas (SSB) se ha relacionado con un incremento en el Índice de Masa Corporal (IMC), lo cual sería especialmente preocupante en poblaciones con un potencial de exposición prolongada, tales como estudiantes. Objetivo: Evaluar la relación entre el consumo calórico proveniente de SSB medido mediante el cuestionario Bevq-15 e IMC en estudiantes de carreras de ciencias de la salud de una universidad peruana. Materiales y métodos: Estudio transversal analítico en base a la medición del consumo calórico de 15 bebidas mediante la administración del cuestionario BEVQ-15 y la toma de medidas antropométricas a universitarios durante 2018 - 2019. Se evaluó la asociación cruda y ajustada usando modelos de regresión lineal. Resultados: Se incluyó a 350 personas. La mediana fue de 21 años y el 58.29% fueron mujeres. La mediana del IMC fue de 24.00 (21.75 - 26.90). El consumo promedio de calorías provenientes de bebidas azucaradas fue de 25.35 kcal/día. Se asoció un IMC menor con el sexo femenino (p<0.001), la carrera de nutrición (p=0.002) y nunca haber consumido tabaco (p=0.027). Se asoció un IMC mayor a la dislipidemia (p=0.014) y a un mayor consumo de calorías diarias provenientes de SSB (p<0.001). En el análisis multivariado se encontró asociación significativa entre el consumo de calorías provenientes de SSB y el IMC, ajustado por edad, sexo y tabaquismo (coeficiente β: 0.68; IC95% 0.04-1.33; p=0.037). Conclusiones: Se encontró asociación entre el consumo de calorías derivadas de SSB y un mayor IMC. Se debe impulsar intervenciones destinadas a la disminución de su consumo en estudiantes. / Introduction: The consumption of sugar sweetened beverages (SSB) has been related to an increase in the Body Mass Index (BMI), which would be especially worrisome in populations with a prolonged exposure potential, such as students. Objective: To evaluate the relationship between the caloric intake from SSB measured by the Bevq-15 questionnaire and BMI in health sciences students at a Peruvian university. Materials and methods: Cross-sectional analytical study based on the measurement of the caloric consumption of 15 beverages based on the administration of the BEVQ-15 questionnaire and the measurement of college students’ anthropometric measurements during 2018-2019. The crude and adjusted association were evaluated using linear regression models. Results: We enrolled 350 participants. The median age was 21 years and 58.29% were women. The median BMI was 24.00 (21.75 - 26.90). The average consumption of calories from SSB was 25.35 kcal/day. A lower BMI was associated with the female sex (p <0.001), the nutrition career (p = 0.002) and never having used tobacco (p = 0.027). A higher BMI was associated with dyslipidemia (p = 0.014) and a greater consumption of daily calories from SSB (p <0.001). In the multivariate analysis, a significant association was found between the consumption of calories from SSB and BMI, adjusted for age, sex and smoking (β coefficient: 0.68, 95% CI 0.04-1.33, p = 0.037). Conclusions: An association was found between the consumption of calories derived from SSB and a higher BMI. Interventions aimed at reducing student consumption should be promoted. / Tesis