Metabolic syndrome in elderly from tertiary health care in Porto Alegre, Rio Grande do Sul, Brazil: association with the Healthy Eating Index

Vera Elizabeth Closs, Ana Maria Pandolfo Feoli, Carla Helena Augustin Schwanke

Abstract


Aims: To evaluate the association of metabolic syndrome with the Healthy Eating Index in elderly patients treated in a tertiary care facility affiliated with the Brazilian public health system.

Methods: A cross-sectional study was performed at the geriatric outpatient clinic of Sao Lucas Hospital of the Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil, between November 2009 and November 2010. All elderly patients treated during this period were invited to participate in the study. Those with cognitive decline, severe psychiatric disorders, severe mobility restriction, or severe hearing impairment that could compromise nutritional assessment were excluded. The diagnosis of metabolic syndrome was established according to the revised "Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults", and the dietary pattern was evaluated using the Healthy Eating Index adapted to the Brazilian population.

Results: The sample included 186 elderly patients, mostly women (81.7%). The frequency of metabolic syndrome was 58.6%. No difference was found between the Healthy Eating Index scores of elderly individuals with and without metabolic syndrome. The diet had to be adjusted in most of the patients. Elderly patients with metabolic syndrome presented lower scores only for the intake of legumes and vegetables (p=0.026). In the total sample, the score for cereals, breads, tubers, and roots was directly associated with central obesity (p=0.005); the score for legumes and vegetables was inversely associated with triglycerides (p=0.002) and directly with high-density lipoprotein cholesterol (HDL-c) (p=0.004); the score for fruits was directly associated with central obesity (p=0.048), blood glucose (p=0.024), and triglycerides (p=0.001), and inversely associated with HDL-c (p=0.015); the score for pulses was associated with blood glucose (p=0.019); total fat was indirectly associated with central obesity (p=0.004) and blood glucose (p=0.041); and dietary variety was inversely associated with blood glucose (p=0.005) and diastolic blood pressure (p=0.031).

Conclusions: The diet of this sample of elderly from tertiary health care needed some adjustment. No association was observed between the total score of the Healthy Eating Index and metabolic syndrome. However, among 10 components of the index, six were associated with some diagnostic criteria of metabolic syndrome. Thus, it is important that nutritional adequacy be met at all levels of health care, since nutrition is an important factor in the modulation of metabolic syndrome and its components.

Keywords


metabolic syndrome X; healthy eating index; nutrition assessment; food consumption; aged.

References


World Healt Organization. World Report on Ageing and Health. Geneva: WHO; 2014.

Ervatti LR, Borges GM, Jardim APO. Mudança Demográfica no Brasil no início do século XXI. Subsídios para as projeções da população. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2015.

Ministério da Saúde (BR). Caderno de atenção básica 19 - Envelhecimento e saúde da pessoa idosa. Brasília (DF): Ministério da Saúde; 2009.

Veras R. Envelhecimento populacional contemporâneo: demandas, desafios e inovações. Rev Saude Publica. 2009;43(3):548-54. http://dx.doi.org/10.1590/S0034-89102009000300020

American Heart Association. The Third Report of the National Cholesterol Education Program (NCEP). Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. (Adult Treatment Panel III) final report. Circulation. 2002;106:3143-421.

Curtis LH, Hammill BG, Bethel MA, Anstrom KJ, Gottdiener JS, Schulman KA. Costs of the metabolic syndrome in elderly individuals: findings from the Cardiovascular Health Study. Diabetes Care. 2007 Oct;30(10):2553-8. http://dx.doi.org/10.2337/dc07-0460

Saad MAN, Cardoso GP, Martins WA, Velarde LGC, Cruz Filho RA. Prevalence of metabolic syndrome in elderly and agreement among four diagnostic criteria. Arq Bras Cardiol. 2014;102(3)263-9. http://dx.doi.org/10.5935/abc.20140013

Gottlieb MGV, Da Cruz IBM, Bodanese LC. Origem da síndrome metabólica: aspectos genético-evolutivos e nutricionais. Sci Med. 2008;18(1):31-8.

World Health Organization. Reducing risks, Promoting Healthy Life. World Health Report. Genebra: WHO; 2002.

Sociedade Brasileira de Cardiologia. I Diretriz brasileira de diagnóstico e tratamento da síndrome metabólica. Arq Bras Cardiol. 2005;84(1):1-28.

Steemburgo T, Dall'Alba V, Gross JL, Azevedo MJ. Fatores dietéticos e síndrome metabólica. Arq Bras Endocr Metab. 2007;51(9):1425-33. http://dx.doi.org/10.1590/S0004-27302007000900004

Fisberg RM, Slater B, Barros RR, Lima FD, Cesar CLG, Carandina L, Barros MBA, Goldbaum M. Índice de Qualidade da Dieta: avaliação da adaptação e aplicabilidade. Rev Nutr. 2004;17(3):301-8. http://dx.doi.org/10.1590/S1415-52732004000300003

Kennedy ET, Ohls J, Carlson S, Fleming K. The Healthy Eating Index. J Am Diet Assoc. 1995;95(10):1103-8. http://dx.doi.org/10.1016/S0002-8223(95)00300-2

Basiotis PP, Carlson A, Gerrior SA, Juan WY, Lino M. The healthy eating index: 1999-2000. Washington DC: Center for Nutrition Policy and Promotion, U.S. Department of Agriculture; 2002.

Silva KF, Prata A, Cunha DF. Frequency of metabolic syndrome and the food intake patterns in adults living in a rural area of Brazil. Rev Soc Bras Med Trop. 2011;44(4):425-9. http://dx.doi.org/10.1590/S0037-86822011000400005

Moreira PRS, Rocha NP, Milagres LC, JNovaes JF. Análise crítica da qualidade da dieta da população brasileira segundo o Índice de Alimentação Saudável: uma revisão sitemática. Cien Saude Colet. 2015;20(12):3907-23. http://dx.doi.org/10.1590/1413-812320152012.18352015

Closs VE, Feoli AMP, Gomes I, Schwanke CHA. Healthy eating index of eldely: description and association with energy, macronutrients and micronutrients intake. Arch Latinoam Nutr. 2014;64(1):34-41.

Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC, Spertus JA, Costa F. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112(17):2735-52. http://dx.doi.org/10.1161/CIRCULATIONAHA.105.169404

Coelho MASC, Amorim RB. Avaliação nutricional em geriatria. In: Duarte ACG. Avaliação nutricional: aspectos clínicos e laboratoriais. São Paulo: Atheneu; 2007. p. 155-76.

Sociedade Brasileira de Cardiologia. IV Diretriz brasileira sobre dislipidemias e prevenção de aterosclerose. Arq Bras Cardiol. 2007;88(1):2-19.

Imhof BV, Campos C, Polanczyk CA. Hipertensão essencial. In: Xavier RM, Albuquerque GC, Barros E. Laboratório na prática clínica: consulta rápida. Porto Alegre: Artmed; 2005. p. 155-7.

Gibson RS. Principles of nutritional assessment. Oxford: Oxford University Press; 2005.

Reinstein CSB. DietWin Software de avaliação nutricional. Porto. Alegre: Brubins; 2008.

Tabela Brasileira de Composição de Alimentos. 2ª ed. Campinas: NEPA-UNICAMP; 2006.

Fisberg RM, Morimoto JM, Slater B, Barros MB, Carandina L, Goldbaum M, Latorre MRDO, César CLG. Dietary quality and associated factors among adults living in the state of Sao Paulo, Brazil. J Am Diet Assoc. 2006;106(12):2067-72. http://dx.doi.org/10.1016/j.jada.2006.09.010

Philippi ST, Latterza AR, Cruz ATR, Ribeiro LC. Pirâmide alimentar adaptada: guia para escolha dos alimentos. Rev Nutr. 1999;12:65-80. http://dx.doi.org/10.1590/S1415-52731999000100006

U.S. Department of Health and Human Services and U.S. Department of Agriculture.Dietary Guidelines for americans. Washington, DC: Government Printing Office; 2010.

Bowman SA, Lino M, Gerrior SA, Basiotis PP. The Healthy Eating Index: 1994-96. Washington, DC: U.S. Department of Agriculture, Center of Nutrition Policy ansd Promotion; 1998.

NHANES. Anthropometry procedures manual [Internet]. Center of Disease Control; 2007 [cited 2015 Mar 29]. Available from: http://www.cdc.gov/nchs/data/nhanes/nhanes_07_08/manual_an.pdf

Garrow JS, Webster J. Quetelet's index (W/H2) as a measure of fatness. Int J Obes. 1985;9(2):147-53.

Lipschitz DA. Screening for nutritional status in the elderly. Primary care. 1994;21(1):55-67.

Instituto Brasileiro de Geografia e Estatística. Censos demográficos. Estatística. Rio de Janeiro: IBGE; 2013.

Bandeira L, Melo HP, Pinheiro LS. Mulheres em dados: o que informa a PNAD/IBGE. Brasília-DF: Observatório Brasil da Igualdade de Gênero; 2010.

Gomes R, Nascimento EF, Araújo FC. Por que os homens buscam menos os serviços de saúde do que as mulheres As explicações de homens com baixa escolaridade e homens com ensino superior. Cad Saude Pública. 2007;23(3):565-74. http://dx.doi.org/10.1590/S0102-311X2007000300015

Gottlieb MGV, Schwanke CHA, Gomes I, Cruz IBM. Envelhecimento e longevidade no Rio Grande do Sul: um perfil histórico, étnico e de morbi-mortalidade dos idosos. Rev Bras Geriatr Gerontol. 2011;14(2):365-80. http://dx.doi.org/10.1590/S1809-98232011000200016

Silva ZP, Ribeiro MCSA, Barata RB, Almeida MF. Perfil sociodemográfico e padrão de utilização dos serviços de saúde do Sistema Único de Saúde (SUS), 2003-2008. Cien Saude Colet. 2011;16(9):3807-16. http://dx.doi.org/10.1590/S1413-81232011001000016

Paskulin LMG, Vianna LAC. Perfil sociodemográfico e condições de saúde auto-referidas de idosos de Porto Alegre. Rev Saude Publica. 2007;41(5):757-68. http://dx.doi.org/10.1590/S0034-89102007000500010

Moimaz SAS, Marques J.A.M, Saliba O, Garbin CAS, Zina LG, Saliba NA. Satisfação e percepção do usuário do SUS sobre o serviço público de saúde. Physis. 2010;20(4):1419-40. http://dx.doi.org/10.1590/S0103-73312010000400019

Louvison MCP, Lebrão ML, Duarte YAO, Santos JLF, Malik AM, Almeida ES. Desigualdades no uso e acesso aos serviços de saúde entre idosos do município de São Paulo. Rev Saude Publica. 2008;42(4):733-40. http://dx.doi.org/10.1590/S0034-89102008000400021

Senger AEV, Ely LS, Gandolfi T, Schneider RH, Gomes I, De Carli GA. Alcoolismo e tabagismo em idosos: relação com ingestão alimentar e aspectos socioeconômicos. Rev Bras Geriatr Gerontol. 2011;14(4):713-9. http://dx.doi.org/10.1590/S1809-98232011000400010

Caputo F, Vignoli T, Leggio L, Addolorato G, Zoli G, Bernardi M. Alcohol use disorders in the elderly: a brief overview from epidemiology to treatment options. Exp Gerontol. 2012;47(6):411-6. http://dx.doi.org/10.1016/j.exger.2012.03.019

Gadenz SD, Benvegnú LA. Hábitos alimentares na prevenção de doenças cardiovasculares e fatores associados em idosos hipertensos. Cien Saude Colet. 2013;18(12):3523-33. http://dx.doi.org/10.1590/S1413-81232013001200009

Girotto E, Andrade SM, Cabrera MA. Prevalência de obesidade abdominal em hipertensos cadastrados em uma Unidade de Saúde da Família. Arq Bras Cardiol. 2010;94(6):754-62. http://dx.doi.org/10.1590/S0066-782X2010005000049

Geib LTC. Determinantes sociais da saúde do idoso. Cien Saude Colet 2012. 17(1):123-33. http://dx.doi.org/10.1590/S1413-81232012000100015

Organização Pan-Americana da Saúde. Saúde nas Américas. Washington DC: OPAS; 2007. Publicação Científica e Técnica No 622.

Galassi A, Reynolds K, He J. Metabolic syndrome and sisk of cardiovascular disease: a meta-analysis. Am J Med. 2006;119(10):812-9. http://dx.doi.org/10.1016/j.amjmed.2006.02.031

Marquez-Sandoval F, Macedo-Ojeda G, Viramontes-Horner D, Fernandez Ballart JD, Salas Salvado J, Vizmanos B. The prevalence of metabolic syndrome in Latin America: a systematic review. Public Health Nutr. 2011;14(10):1702-13. http://dx.doi.org/10.1017/S1368980010003320

Ford EE, Giles WH, Mokdad AH. Increasing prevalence of the metabolic syndrome among U.S. adults. Diabetes care. 2004;27:2444-9. http://dx.doi.org/10.2337/diacare.27.10.2444

McNeill AM, Katz R, Girman CJ, Rosamond WD, Wagenknecht LE, Barzilay JI, Tracy RP, Savage PJ, Jackson SA. Metabolic syndrome and cardiovascular disease in older people: The cardiovascular health study. J Am Geriatr Soc. 2006;54(9):1317-24. http://dx.doi.org/10.1111/j.1532-5415.2006.00862.x

Hildrum B, Mykletun A, Hole T, Midthjell K, Dahl AA. Age-specific prevalence of the metabolic syndrome defined by the International Diabetes Federation and the National Cholesterol Education Program: the Norwegian HUNT 2 study. BMC Public Health. 2007;7:220. http://dx.doi.org/10.1186/1471-2458-7-220

Panagiotakos DB, Pitsavos C, Skoumas Y, Stefanadis C. The association between food patterns and the metabolic syndrome using principal components analysis: The ATTICA Study. J Am Diet Assoc. 2007;107(6):979-87. http://dx.doi.org/10.1016/j.jada.2007.03.006

Medina-Lezama J, Zea-Diaz H, Morey-Vargas OL, Bolanos-Salazar JF, Munoz-Atahualpa E, Postigo-MacDowall M, Corrales-Medina F, Valdivia-Ascu-a Z, Cuba-Bustinza C, Paredes-Diaz S, Villalobos-Tapia P, Chirinos-Pacheco J, Goldberg R.B, Chirinos J.A. Prevalence of the metabolic syndrome in Peruvian Andean hispanics: the PREVENCION study. Diabetes Res Clin Pract. 2007;78(2):270-81. http://dx.doi.org/10.1016/j.diabres.2007.04.004

Gao X, Nelson ME, Tucker KL. Television viewing is associated with prevalence of metabolic syndrome in Hispanic elders. Diabetes care. 2007;30(3):694-700. http://dx.doi.org/10.2337/dc06-1835

Simons LA, Simons J, Friedlander Y, McCallum J. Does a diagnosis of the metabolic syndrome provide additional prediction of cardiovascular desease and total mortality in the elderly? The Dubbo Study. Med J Aust. 2007;186(8):400-3.

Cabré J-J, Martín F, Costa B, Pi-ol JL, Llor JL, Ortega Y, Basora J, Baldrich M, Solà R, Daniel J, Hernández JM, Saumell J, Bladé J, Sagarra R, Basora T, Monta-és D, Frigola JL, Donado-Mazarrón A, García-Vidal MT, Sánchez-Oro I, Magri-a JM, Urbaneja A, Barrio F, Vizcaíno J, Sabaté JM, Pascual I, Revuelta V. Metabolic syndrome as a cardiovascular disease risk factor: patients evaluated in Primary Care. BMC Public Health. 2008;8(1):251. http://dx.doi.org/10.1186/1471-2458-8-251

Pérez CM, Guzmán M, Ortiz AP, Estrella M, Valle Y, Pérez N, Haddock L, Suárez E. Prevalence of the metabolic syndrome in San Juan, Puerto Rico. Ethn Dis. 2008;18(4):434-41.

Wen CJ, Lee YS, Lin WY, Huang HL, Yao CA, Sung PK, Huang KC. The metabolic syndrome increases cardiovascular mortality in Taiwanese elderly. Eur J Clin Invest. 2008;38(7):469-75. http://dx.doi.org/10.1111/j.1365-2362.2008.01965.x

Rigo JC, Vieira ACF, Dalacorte RD, Reichert CL. Prevalência de síndrome metabólica em idosos de uma comunidade: comparação entre três métodos diagnósticos. Arq Bras Cardiol. 2009;93(2):85-91. http://dx.doi.org/10.1590/S0066-782X2009000800004

Ervin RB. Prevalence of metabolic syndrome among adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index: United States, 2003-2006. Division of Health and Nutriition Examination Surveys. Natl Health Stat Report. 2009 May 5;(13):1-7.

De Luis DA, Lopez Mongil R, Gonzalez Sagrado M, Lopez Trigo JA, Mora PF, Castrodeza Sanz J; Group Novomet. Prevalence of metabolic syndrome with International Diabetes Federation criteria and ATP III program in patients 65 years of age or older. J Nutr Health Aging. 2010 May;14(5):400-4. http://dx.doi.org/10.1007/s12603-010-0087-9

Gronner MF, Bosi PL, Carvalho AM, Casale G, Contrera D, Pereira MA, Diogo TM, Torquato MTCG, Souza GMD, Oishi J, Leal AMO. Prevalence of metabolic syndrome and its association with educational inequalities among Brazilian adults: a population-based study. Braz J Med Biol Res. 2011;4:713-9. http://dx.doi.org/10.1590/s0100-879x2011000700016

Saukkonen T, Jokelainen J, Timonen M, Cederberg H, Laakso M, Harkonen P, Keinänen-Kiukaanniemi S, Rajala U. Prevalence of metabolic syndrome components among the elderly using three different definitions: a cohort study in Finland. Scand J Prim Health Care. 2012;30(1):29-34. http://dx.doi.org/10.3109/02813432.2012.654192

Heiss G, Snyder M, Teng Y, Schneiderman N, Llabre MM, Cowie C, Carnethon M, Kaplan R, Giachello A, Gallo L, Loehr L, Avilés-Santa L. Prevalence of Metabolic Syndrome among Hispanics/Latinos of diverse background: the Hispanic Community Health Study/Study of Latinos. Diabetes care. 2014;37:2391-9. http://dx.doi.org/10.2337/dc13-2505

Botoseneanu A, Ambrosius WT, Beavers DP, Rekeneire N, Anton S, Church T, Folta SC, Goodpaster BH, King AC, Nicklas BJ, Spring B, Wang X, Gil TM. Prevalence of metabolic syndrome and its association with physical capacity, disability, and self-rated health in Lifestyle Interventions and Independence for Elders Study participants. J Am Geriatr Soc. 2015;63(2):222-32. http://dx.doi.org/10.1111/jgs.13205

Mancia G, Bombelli M, Corrao G, Facchetti R, Madotto F, Giannattasio C, Trevano FQ, Grassi G, Zanchetti A, Sega R. Metabolic syndrome in the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study: daily life blood pressure, cardiac damage, and prognosis. Hypertension. 2007;49(1):40-7. http://dx.doi.org/10.1161/01.HYP.0000251933.22091.24

Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults. JAMA. 2002;287(3):356. http://dx.doi.org/10.1001/jama.287.3.356

Oliveira EP, Souza MLA, Lima MDA. Prevalência de síndrome metabólica em uma área rural do semi-árido baiano. Arq Bras Endocrinol Metab. 2006;50(3):456-65. http://dx.doi.org/10.1590/S0004-27302006000300008

Ravaglia G, Forti P, Maioli F, Bastagli L, Chiappelli M, Montesi F, Bolondi L, Patterson C. Metabolic syndrome: prevalence and prediction of mortality in elderly individuals. Diabetes care. 2006;29(11):2471-6. http://dx.doi.org/10.2337/dc06-0282

Marquezine GF, Oliveira CM, Pereira AC, Krieger JE, Mill JG. Metabolic syndrome determinants in an urban population from Brazil: social class and gender-specific interaction. Int J Cardiol. 2008;129(2):259-65. http://dx.doi.org/10.1016/j.ijcard.2007.07.097

Mozaffarian D, Kaminemi A, Primeas RJ, Siscovick DS. Metabolic syndrome and mortality in older adults. Arch Intern Med. 2008;168(9):969-78. http://dx.doi.org/10.1001/archinte.168.9.969

Mendizabal Y, Llorens S, Nava E. Hypertension in metabolic syndrome: vascular pathophysiology. Int J Hypertens. 2013;2013:230868. http://dx.doi.org/10.1155/2013/230868

Salaroli LB, Barbosa GC, Mil JG, Molina MCB. Prevalência de síndrome metabólica em estudo de base populacional, Vitoria, ES - Brasil. Arq Bras Endocrinol Metab. 2007;51(7):1143-52. http://dx.doi.org/10.1590/S0004-27302007000700018

Duvnjak L, Tomislav B, Metelko Z. Hypertension and the metabolic syndrome. Diabetol Croat. 2008;37(4):83-9.

Wachholz PA, Masuda PY. Caracterização e prevalência de síndrome metabólica em idosos segundo dois critérios diagnósticos diferentes. Estud Interdiscipl Envelhec. 2009;14(1):95-106.

Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Vigitel Brasil 2013 [Internet]. Vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília - DF: Secretaria de Vigilância em Saúde; 2013 [cited 2016 Jan 06]. Available from: http://portalsaude.saude.gov.br.

Sachs A, Oliveira PA, Magnoni D. Riscos Nutrinionais na terceira idade. In: Magnoni D. Cukier C, Oliveira PA. Nutrição na terceira idade. São Paulo: Sarvier.; 2005. p. 43-52.

Santos CRB, Portella ES, Avila SS, Soares EA, Lanzillotti HS. Índice de Alimentação Saudável: avaliação do consumo alimentar de diabéticos tipo 2. Nutrire Rev Soc Bras Aliment Nutr. 2009;34(1):115-29.

Sarno F, Claro RM, Levy RB, Bandoni DH, Monteiro CA. Estimativa de consumo de sódio pela populacao brasileira, 2008-2009. Rev Saude Publica. 2013;47(3):571-8. http://dx.doi.org/10.1590/S0034-8910.2013047004418

Jovanovic GK, Zezelj SP, Malatestinic D, Sutic IM, Stefanac VN, Dorcic F. Diet quality of middle age and older women from Primorsko-Goranska County evaluated by healthy eating index and association with body mass index. Coll Antropol. 2010;34(2):155-60.

World Health Organization. Global status report on noncommunicable deseases. Geneva: WHO; 20

Almeida Ventura D, Fonseca VM, Ramos EG, Miarinheiro LPF, Souza RAG, Chaves CR, Peixoto MV. Association between quality of the diet and cardiometabolic risk factors in postmenopausal women. Nutr J. 2014;13:121-31. http://dx.doi.org/10.1186/1475-2891-13-121

Carter P, Gray LJ, Troughton J, Khunti K, Davies MJ. Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis. BMJ. 2010;341:c4229. http://dx.doi.org/10.1136/bmj.c4229

Li M, Fan Y, Zhang X, Hou W, Tang Z. Fruit and vegetable intake and risk of type 2 diabetes mellitus: meta-analysis of prospective cohort studies. BMJ open. 2014;4(11):e005497. http://dx.doi.org/10.1136/bmjopen-2014-005497

Cooper AJ, Sharp SJ, Lentjes MA, Luben RN, Khaw KT, Wareham NJ, Forouhi NG. A prospective study of the association between quantity and variety of fruit and vegetable intake and incident type 2 diabetes. Diabetes care 2012;35(6):1293-300. http://dx.doi.org/10.2337/dc11-2388

Cooper AJ, Forouhi NG, Ye Z, Buijsse B, Arriola L, Balkau B, Barricarte A, Beulens JW, Boeing H, Büchner FL, Dahm CC, Lauzon-Guillain B, Fagherazzi G, Franks, PW, Gonzales, C, Grioni S, Kaaks R, Key TJ, Massala G, Navarro C, Nilsson P, Overvad K, Panico S, Ramón Quirós J, Rolandsson O, Roswall N, Sacerdote C, Sánchez MJ, Simani N, Sluijs I, Spikermann AM, Teucher B, Tjonneland A, Tumino R, Sharp SJ, Langenberg C, Feskens EJ, Riboli E, Wareham NJ. Fruit and vegetable intake and type 2 diabetes: EPIC-InterAct prospective study and meta-analysis. Eur J Clin Nutr. 2012;66(10):1082-92. http://dx.doi.org/10.1038/ejcn.2012.85

Dahl WJ, Stewart ML. Position of the Academy of Nutrition and Dietetics: health implications of dietary fiber. J Acad Nutr Diet. 2015;115(11):1861-70. http://dx.doi.org/10.1016/j.jand.2015.09.003

Appel LJ, Brands MW, Daniels SR, Karanja N, Elmer PJ, Sacks FM. Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. Hypertension. 2006;47(2):296-308. http://dx.doi.org/10.1161/01.HYP.0000202568.01167.B6

Willett WC, Sacks FM, Trichopoulos A, Drescer G, Ferro-Luzzi A, Helsing E, Trichopoulus D. Mediterranean diet pyramid: a cultural a cultural model for healthy eating. Am J Clin Nutr. 1995;61(Suppl):1402S-6S.

Hamer M, Chida Y. Intake of fruit, vegetables, and antioxidants and risk of type 2 diabetes systematic review and meta-analysis. J Hipertens. 2007;25(12):2361-9. http://dx.doi.org/10.1097/HJH.0b013e3282efc214

Wang L, Manson JE, Gaziano JM, Buring JE, Sesso HD. Fruit and vegetable intake and the risk of hypertension in middle-aged and older women. Am J Hypertens. 2012;25(2):180-9. http://dx.doi.org/10.1038/ajh.2011.186

Oude Griep LM, Verschuren WM, Kromhout D, Ocke MC, Geleijnse JM. Variety in fruit and vegetable consumption and 10-year incidence of CHD and stroke. Public Health Nutr. 2012;15(12):2280-6. http://dx.doi.org/10.1017/S1368980012000912

Vioque J, Weinbrenner T, Castello A, Asensio L, Garcia de la Hera M. Intake of fruits and vegetables in relation to 10-year weight gain among Spanish adults. Obesity. 2008;16(3):664-70. http://dx.doi.org/10.1038/oby.2007.121

Oude Griep LM, Verschuren WM, Kromhout D, Ocke MC, Geleijnse JM. Raw and processed fruit and vegetable consumption and 10-year stroke incidence in a population-based cohort study in the Netherlands. Eur J Clin Nutr. 2011;65(7):791-9. http://dx.doi.org/10.1038/ejcn.2011.36

Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in Diet and Lifestyle and Long-Term Weight Gain in Women and Men. N Engl J med. 2011;364:2392-404. http://dx.doi.org/10.1056/NEJMoa1014296

Liese AD, Roach AK, Sparks KC, Marquart L, D'Agostino RB, Mayer-Davis J. Whole-grain intake and insulin sensitivity: the Insulin Resistance Atherosclerosis Study. Am J Clin Nutr. 2003;78:965-71.

McKeown NM, Meigs JB, Liu S, Saltzman E, Wilson PWF, Jacques PF. Carbohidrate Nutrition, Insulin Resistance, and the Prevalence of the Metabolic Syndrome in the Framingham Offspring cohort. Diabetes care. 2004;27:538-46. http://dx.doi.org/10.2337/diacare.27.2.538

Liu RH. Health benefits of fruit and vegetables are from additive and synergistic combinations of phytochemicals. Am J Clin Nutr. 2003;78(suppl):517S-20S.

Buijsse B, Feskens EJ, Schulze MB, Forouhi NG, Wareham NJ, Sharp S, Palli D, Toqnon G, Halkjaer J, Tjonneland A, Jakobsen MU, Overvad K, van der A DL, Du H, Sorensen TI, Boeing H. Fruit and vegetable intakes and subsequent changes in body weight in European populations: results from the project on Diet, Obesity, and Genes (DiOGenes). Am J Clin Nutr. 2009;90(1):202-9. http://dx.doi.org/10.3945/ajcn.2008.27394

Mello VD, Laaksonen DE. Fibras na dieta: tendências atuais e benefícios à saúde na síndrome metabólica e no diabetes melito tipo 2. Arq Bras Endocr Metab. 2009;53(5):509-18. http://dx.doi.org/10.1590/S0004-27302009000500004

Sartorelli DS. Índice glicêmico e carga glicêmica na síndrome metabólica. In: Giacaglia LR, Silva MER, Santos RFS. Tratado de síndrome metabólica. São Paulo: Roca; 2010. p. 834.

Oliveira EP, Camargo KF, Castanho GKF, Nicola M, Portero-McLellan KC, Burini RC. A Variedade da dieta é fator protetor para a pressão arterial sistólica elevada. Arq Bras Cardiol. 2012;98(4):338-43. http://dx.doi.org/10.1590/S0066-782X2012005000024

Rezende EM, Sampaio IBM, Ishitani. Mortalidade de idosos com desnutrição em Belo Horizonte, Minas Gerais, Brasil uma análise multidimensional sob o enfoque de causas múltiplas de morte. Cad Saude Publica. 2010;26(6):1109-21. http://dx.doi.org/10.1590/S0102-311X2010000600005

Santos RD, Gagliardi ACM, Xavier HT, Magnoni CD, Cassani, R., Lottenberg AM, Sociedade Brasileira de Cardiologia. I Diretriz sobre o Consumo de Gorduras e Saúde Cardiovascular. Arq Bras Cardiol. 2013;100:1-40. http://dx.doi.org/10.5935/abc.2013s003




DOI: http://dx.doi.org/10.15448/1980-6108.2016.3.23422

This journal is a member of COPE (Committee on Publication Ethics) and follow the principles recommended by this international reference organization on integrity and ethics in scientific publication.

Licença Creative Commons
Except where otherwise noted, the material published in this journal is licensed under a Creative Commons Attribution 4.0 International licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original publication is properly cited.
Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.

 
 Member of OASPA

Copyright: © 2006-2019 EDIPUCRS