Nutritional quality of breakfast in the São Paulo population and its association with cardiometabolic risk factors

Author(s)

Paula Victória Félix dos Santos

• Document type: Master's Dissertation
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Saúde Pública (FSP/CIR)
• Defense date: 2019-12-09

Examining board members

Regina Mara Fisberg; Marilisa Berti de Azevedo Barros; Ágatha Nogueira Previdelli; Flávia Mori Sarti

• Advisor: Regina Mara Fisberg

Abstract

Introduction: Breakfast consumption is known to provide health benefits, contributing to a healthy diet, and assisting in controlling risk factors for non-communicable diseases. Its structure can acquire various compositions, with different foods, and consequently, different nutritional qualities. In this context, breakfast quality indexes come as quantitative tools to evaluate nutritional quality of breakfast. However, few studies have been conducted to evaluate their associations with health outcomes. Objective: To evaluate the nutritional quality of breakfast using the Brazilian Breakfast Quality Index (BQI) and its association with cardiometabolic risk factors in residents of São Paulo city, Brazil. Methods: Data were drawn from the 2015 São Paulo Health Survey (ISA-Capital 2015), a cross-sectional population-based study, with probabilistic sample of individuals living in permanent homes located in the urban area of São Paulo, Brazil. 606 adults and 537 older adults of both sexes were included. Socioeconomic, lifestyle and diet information was collected in personal and phone interviews. Blood sample, blood pressure and anthropometric measurements were collected at home by a nurse assistant. The breakfast quality was evaluated considering 24-h recalls and classified in scores ranging from 0 to 10 according to BQI. To verify associated factors, individuals were stratified according to their category of breakfast quality into: Low (0 - 3 scores), Medium (4 - 6 scores) or High quality (7 - 10 scores). The cardiometabolic risk factors evaluated were: overweight, metabolic syndrome, increased waist circumference, high blood pressure, high fasting glucose, insulin resistance, and dyslipidemia. BQI associations with cardiometabolic risk, demographic, socioeconomic and lifestyle variables were determined using multiple logistic regression models adjusted for the complex sampling design. Results: Individuals in higher categories of household income, educational level, age, with racial self-identification as white or yellow, who never smoke, and meet the recommendation of leisure-time physical activity had higher breakfast quality. The majority of the population had a medium breakfast quality (67%), and the mean BQI score was 4.9. Older adults had the highest mean BQI score (5.4), and smokers the lowest mean score (4.4). For individuals in the high breakfast quality (16%) there was an increase in the breakfast intake of total energy, total grams of foods and beverages, protein, total saturated fatty acids, total fiber and calcium, and a decrease in added sugar, carbohydrate and sodium. At total dietary intake there was an increase of total saturated fatty acids, total fiber, and calcium, BHEI-R, and a decrease in added sugar, carbohydrate and sodium. Higher scores of BQI was negatively associated with 7 of the 10 cardiometabolic risks factors investigated: elevated blood pressure (OR: 0.81; IC95%: 0.70, 0.94), fasting glucose (OR: 0.85; IC95%: 0.73, 0.98), HOMA-IR (OR: 0.86; IC95%: 0.74, 0.98), total cholesterol (OR: 0.86; IC95%: 0.76, 0.99), LDL (OR: 0.85; IC95%: 0.74, 0.97), excess body weight (OR: 87; IC95%:0.76, 0.99), and metabolic syndrome (OR: 0.82, IC95%: 0.72, 0.93). Conclusion: The Brazilian Breakfast Quality Index was associated with lower odds of cardiometabolic risk factors, suggesting a beneficial effect in this population and emphasizing the role of breakfast in reducing risk of cardiovascular disease. (AU)

• FAPESP's process: 17/17348-0 - Breakfast quality in São Paulo population: Brazilian index validity and associated factors
• Grantee: Paula Victória Félix dos Santos
• Support Opportunities: Scholarships in Brazil - Master