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- Eating Attitudes of Patients with Celiac Disease in Brazil: A Nationwide Assessment with the EAT-26 InstrumentPublication . Franco, Luiza; Yoshio Nakano, Eduardo; Raposo, Antonio; Alturki, Hmidan; Alarifi, Sehad; Chaves, Claudia; Teixeira-Lemos, Edite; Romão, BernardoCeliac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of gluten in genetically predisposed individuals. In this sense, a gluten-free diet is the only safe treatment available. Due to the restrictions resulting from this eating pattern, this treatment may impair the relationship of the people with CD with food, increasing the risk of a disordered eating attitude, which is associated with eating disorders. The EAT-26 is a validated instrument already applied worldwide in different populations, and higher scores are suggestive of eating attitudes prone to evolve into eating disorders. Studies carried out in other countries have already shown that people with CD are prone to developing eating disorders; however, no study has been carried out with this theme in the population with CD in Brazil. We carried out a nationwide cross-sectional study in three steps: (i) study design and instrument; (ii) recruitment of participants and ethics; (iii) statistical analysis. A total of 385 participants were included in our sample, 96.36% of them being women. The internal consistency of the applied self-administered Brazilian version of the EAT-26 online questionnaire presented a satisfactory Cronbach’s alpha of 0.812, and in total, 36.1% of the respondents were classified with a disordered eating attitude. No differences were found among the scores of participants when divided by categories regarding gender, average monthly income, age, and educational level. However, scores classified as a disordered eating attitude were found in respondents with a body mass index classified as overweight and obese. Our study highlights that disordered eating attitudes are present in overweight and obese women with celiac disease; thus, public health politics are needed to prevent and treat these attitudes.
- Assessing Serra da Estrela PDO cheeses’ origin-production date using fatty acids profilesPublication . Lima, M. J. Reis; Bahri, Hamdi; Morais, Jorge Sá; Veloso, Ana CA; Fontes, Luísa; Lemos, Edite Teixeira de; Peres, AntónioSerra da Estrela is a Portuguese traditional cheese produced with raw ewe’s milk from “Churra Mondegueira” and “Bordaleira” autochthonous breeds and the wild thistle flower (Cynara cardunculus L.), which benefits from the status of Protected Designation of Origin. Cheese chemical composition, namely the fatty acids profile, depends on milk composition and on manufacturing practices. Thus, the identification of possible chemical biomarkers capable of classifying Serra da Estrela cheeses according to the dairy manufacturing plant, geographical origin or production date would be of utmost relevance for producers and consumers. A typical fatty acids profile, including 23 saturated and unsaturated fatty acids, was identified for the studied cheeses, being butyric, caproic, caprilic, capric, lauric, miristic, palmitic, stearic, oleic, linoleic and its trans-isomer and α-linolenic acids the most abundant ones (relative mean abundances ranging from 1.4% ± 0.5% to 23.9% ± 1.9%). Linear discriminant models were established based on the most discriminative fatty acids (namely, caproic, caprilic, undecanoic, lauric, pentadecanoic, palmitic, palmitoleic, heptadecanoic, oleic, linoleic trans-isomer, heneicosanoic and arachidonic acids) that included less abundant fatty acids, which were selected using the simulated annealing algorithm. The established models enabled assessing cheeses’ origin (models based on 10–12 fatty acids) and/or production date (model based on 20 fatty acids) with predictive sensitivities of 71–88%. Therefore, fatty acids profiles coupled with chemometric techniques, could be foreseen as a fingerprint of cheese’s genuineness, enhancing the consumers’ confidence when purchasing this high-value cheese.
- Psychometric Evaluation of the Food Life Questionnaire—Short Form among Brazilian Adult WomenPublication . de Sousa, Edilene Márcia; Resende, Thainá Richelli Oliveira; Alvarenga, Marle dos Santos; Raposo, António; Teixeira-Lemos, Edite; Guiné, Raquel; Alturki, Hmidan A.; de Carvalho, Pedro Henrique BerbertMeasures of beliefs and attitudes toward food have generally been limited to the measurement of more pathological eating attitudes (e.g., disordered eating). The Food Life Questionnaire (FLQ) and its short form (FLQ-SF) were developed to examine attitudes toward a broader range of foods; however, the factor structure of the FLQ-SF was not confirmed in any study with young women. In the present study, we performed a psychometric evaluation of the Brazilian Portuguese translation of the FLQ-SF in a sample of 604 women. We evaluated the factor structure using a two-step, split-sample exploratory and confirmatory factor analytic approach. Results supported a four-factor structure (i.e., weight concern, diet–health orientation, belief in a diet–health linkage, and food and pleasure) with 18 items (χ2/df = 2.09; CFI = 0.95; TLI = 0.94; RMSEA = 0.05 (90% CI = 0.04; 0.06; p > 0.05); and SRMR = 0.08). Additionally, we found good internal consistency for all FLQ-SF subscales (McDonald’s ω = 0.79–0.89) and convergent validity with measures of feelings, beliefs, and behaviors involved in food attitudes. Collectively, these results support the use of the FLQ-SF in Brazilian women and provide a foundation to expand the literature on beliefs and attitudes toward food in this population.
- The Role of Social Media Advertisement and Physical Activity on Eating Behaviors among the General Population in Saudi ArabiaPublication . Alshahrani, Najim Z.; Branca Carvalho, Ana; J. Reis Lima, M.; Teixeira-Lemos, Edite; Raposo, AntónioAbstract: Over the past few decades, people in Saudi Arabia have become less inclined to adopt active lifestyles and healthy eating habits due to the increasing use of digital technologies such as social media. The objective of this online-based cross-sectional study was to assess the role of social media food advertisements and physical activity on eating behaviors among the general population in Saudi Arabia (n = 471). Data were collected through a structured questionnaire, which consisted of four parts: (i) sociodemographic information, (ii) attitude towards social media, (iii) eating behaviorsrelated information, and (iv) exposure to and engagement with social media advertisements. The study’s outcome variable, eating behaviors (healthy vs. unhealthy), was assessed using the following question: “Are you on a healthy diet (such as a balanced diet, keto, or low carb)?” A multiple binary logistic regression analysis was performed to investigate the factors that influence unhealthy eating behaviors. Approximately 79.6% of the participants had unhealthy eating behaviors. Participants who were not involved in daily physical activity were more likely to have unhealthy eating behaviors compared to their counterparts (adjusted odds ratio, AOR = 4.86). Participants who watched food ads on social media channels 1–3 times a week (AOR = 2.58) or daily (AOR = 3.49) were more likely to have unhealthy eating behaviors than their counterparts. Participants whose appetite to try foods increases always (AOR = 1.42) or usually (AOR = 2.88) after viewing ads on social media were more likely to have unhealthy eating behaviors. These findings suggest that policymakers should take immediate action to regulate food advertising policy to promote a healthy food environment across the country. Saudis should be encouraged to engage in more physical activity, which could support the maintenance of healthy eating patterns and lifestyles.
- Pharmaceuticals in the Environment: Focus on Drinking-WaterPublication . Teixeira-Lemos, Edite; Teixeira De Lemos, Luís Pedro; Oliveira, Jorge; Pais do Amaral, JoséAbstract The presence of pharmacological compounds in drinking water has been a cause for concern in recent years and are believed to have serious impacts on human and environmental health. Current research has shown that they can pose an ecotoxicological risk due to their potential long-term negative effects on living organisms, even though they exist in relatively low concentrations in drinking water (ng L− 1). This article is a review of the most important available literature on pharmaceutical residues in water cycle, focusing mostly on drinking water. The authors start by approaching the occurrence and fate of pharmacological compounds in drinking waters, with a particular emphasis on the pharmacological classes which are more frequently detected. Then, existing processes to remove these xenobiotics from drinking waters and analytical detection methods are also explored, followed by an analysis of the ecotoxicity and potential risks for human health of exposure to trace amounts of pharmaceuticals in drinking water. Finally, after examining existing legislation regarding pharmaceuticals in drinking water, namely the European Union regulatory frameworks, the authors discuss future perspectives in research, social, and legislative measures on this matter are discussed in light of the currently identified gaps in both scientific knowledge and legislation.
- Fruit and vegetable consumption: Study involving Portuguese and French consumersPublication . LE TURC, Nolwenn; Silva, Ana Isabel; Florença, Sofia De Guiné E; C. Goncalves, J.; Lemos, Edite Teixeira de; Lima, M. J. Reis; Guiné, RaquelThe regular consumption of vegetables and fruits has been indicated as part of a healthy diet. They are considered healthy foods because they are sources of vitamins, minerals, and fibre. Adequate intake of these foods can reduce the risk of certain chronic diseases, like cardiovascular disease, diabetes, obesity, and various types of cancer. The objective of the present study was to determine the consumption habits of vegetables and fruits in two different countries, Portugal and France. For this descriptive study, it was used a questionnaire survey, applied to individuals over 18 years old and carried out through the internet, being disseminated on social networks and by email. The sample was constituted by 640 participants (257 from Portugal and 383 from France). Statistical tools were used for the treatment of data, like the T-Test and chi-square test utilised to compare the results between Portuguese and French consumers. The results showed that the Portuguese eat out more often than the French. Portuguese and French like vegetables equally but the French eat more vegetables and fruit per week on average than the Portuguese. The French like soup as much as the Portuguese but the Portuguese eat soup more regularly than the French and prefer soup with cut pieces, unlike the French which prefer soup with grounded vegetables. The global consumption of vegetables and fruits is low in both countries and should be increased, most especially in Portugal, where the consumption is lower. In conclusion, despite some differences found across consumers according to country, the consumption of these foods is still below the recommendations of the World Health Organisation, and therefore, some more actions are necessary to incentivise a higher consumption of fruits and vegetables as part of a healthy lifestyle.
- Dietary Patterns among Smokers and Non-Smokers: Findings from the National Health and Nutritional Examination Survey (NHANES) 2017–2018Publication . Lin, Wenxue; Alfheeaid, Hani A.; Alasqah, Ibrahim; Alqarawi, Nada; Alotaibi, Saad Abdullah; Alribdi, Fatmah Fahad; Almutairi, Sulaiman; Lima, M. J. Reis; Teixeira-Lemos, Edite; Raposo, AntónioDiet behavior and nutrition are critical for maintaining health and improving quality of life. Cigarette smoking remains the leading cause of preventable death in the United States. Poor dietary choices, such as excessively frequenting restaurants, consuming ready-to-eat foods from grocery stores, and ingesting ultra-processed foods (like frozen meals and pizzas), can adversely impact health. Despite this, research comparing dietary behaviors between smokers and non-smokers is limited. Using data from the National Health and Nutritional Examination Survey 2017–2018, we analyzed diet behavior based on smoking status. Our findings reveal that smokers had a significant increase (90%) in the frequency of consuming frozen meals/pizzas in the past 30 days compared to non-smokers (coefficient: 1.9; 95% CI: 1.4, 2.6; p-value < 0.001). Additionally, over 70% of participants, regardless of their smoking status, were unaware of MyPlate, a nutritional guide created by the United States Department of Agriculture (USDA) to encourage Americans to make healthier food choices. There is an urgent need to increase public awareness of MyPlate and promote a better understanding of healthy dietary behaviors.
- Brazilian Front-of-Package Labeling: A Product Compliance Analysis 12 Months after Implementation of RegulationsPublication . Senda, Marcos Vinícius Garcia; Raposo, António; Teixeira-Lemos, Edite; Margarida Correia Balula Chaves, Cláudia; Alturki, Hmidan A.; Alsharari, Zayed D.; Romão, BernardoThis study investigated the presence of front-of-package labeling on food products in major retailers in Brazil after its implementation in 2022. Carried out from May to October 2023, we analyzed 2145 products of brands present in five Brazilian states. A total of 541 products presented front-of-package warnings. The categories varied in their adherence to front-of-package labeling, highlighting a prevalence of combined warnings, such as high in added sugar and high in saturated fat on sweet biscuits and chocolates. Sausages showed a high prevalence of high in sodium and high in saturated fat warnings. Beverages stood out as high in added sugar, while fats, dairy products, frozen preparations, seasonings, and sauces presented diversity in the warnings. Other products, such as panettone, showed a high presence of alerts. The study demonstrated the widespread presence of front-of-package labeling on ultra-processed products highly consumed by the Brazilian population. Considering the alarming presence of these foods in the Brazilian diet, it is concluded that front-of-package nutrition labeling is crucial to inform and raise awareness among consumers, allowing healthier choices and potentially contributing to a reduction in chronic diseases and the costs associated with treatment in the health system.
- Exercise training decreases proinflammatory profile in Zucker diabetic (type 2) fatty ratsPublication . Teixeira-Lemos, Edite; Reis, F.; Baptista, S.; Pinto, R.; Sepodes, B.; Vala, Helena; Rocha-Pereira, P.; et al.Objective In the present study we evaluated the effect of exercise on the plasma levels of proinflammatory cytokines, interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), and the anti-inflammatory molecule uric acid in the Zucker diabetic fatty (ZDF) rats that are more prone to develop type 2 diabetes mellitus. Methods Sixteen obese ZDF (Gmi fa/fa) rats (8 wk old, 228.40 ± 4.05 g) were randomly assigned to one of two groups (n = 8 each): an exercise-trained group and a sedentary one. In addition, 16 lean ZDF (Gmi +/+) rats (8 wk old, 199.00 ± 3.50 g) were subjected to identical sedentary and exercise conditioning (n = 8 each). Initially, rats swam 15 min/d (5 d/wk) in a 36°C bath. The exercise protocol was gradually increased by 15 min/d until a swimming period of 1 h/d (1 wk) was attained. Thereafter, rats swam 1 h/d, 3 d/wk, for an additional period of 11 wk. Rats were sacrificed 48 h after the last training period and the blood and pancreas were collected. Circulating levels of glucose, glycosylated hemoglobin, total cholesterol, triglycerides, insulin, uric acid, IL-6, and TNF-α were assessed. The concentrations of proinflammatory cytokines in the pancreas were also evaluated. Results In the diabetic ZDF (fa/fa) rats, exercise decreased hyperuricemia (−37.3%) and IL-6 and TNF-α levels (−16.9% and −12.7% respectively) and maintained the weight of the pancreas at near normal. Immunohistochemistry revealed a marked decrease in the expression of TNF-α and IL-6 in the pancreatic islet cells of ZDF (fa/fa) rats. Conclusion These results indicate that aerobic exercise is anti-inflammatory in nature.
- The Prevalence of Polypharmacy and Potentially Inappropriate Medications and Its Relationship with Cognitive Status in Portuguese Institutionalized Older Adults: A Cross-Sectional StudyPublication . Caçador, Catarina; Teixeira-Lemos, Edite; Oliveira, Jorge; Pinheiro, João; Teixeira-Lemos, Luís; Ramos, FernandoThe aim of this study was to evaluate the prevalence of polypharmacy and potentially inappropriate medications (PIMs) in a population of older adults living in nursing homes. Furthermore, we also intended to assess the possible association between polypharmacy, potentially inappropriate medications and cognitive impairment in institutionalized older adults. A cross-sectional study analyzed data from 193 nursing home residents in the district of Viseu, Portugal, between September 2018 and June 2019, with a mean age of 82.4 ± 6.2 years (ranging from 65 to 95 years old); 72.5% (n = 140) were female participants. Major polypharmacy was presented in 80.8% of the study population, who took 7.6 ± 3.3 drugs per day. Using the Beers Criteria, we found that 79.3% took PIMs. There was a positive association between polypharmacy and PIM (p < 0.001), showing that higher medicines intake increased the number of PIMs. Polypharmacy was not associated with the functionality of the older adults to perform activities of daily living, but was associated with cognitive impairment. The older adults with lower scores on the Mini Mental State Examination (MMSE) took more drugs (p = 0.039) and used more PIM (p < 0.001). Moreover, patients taking five or more prescription drugs per day (major polypharmacy) consuming any psychiatric, gastrointestinal or oral antidiabetic agents (regardless of whether they were considered potentially inappropriate or not) had higher odds of displaying cognitive impairment than those who did not (p < 0.05). Older adult residents of the studied nursing homes were potentially affected by polypharmacy and inappropriate polypharmacy. This observation reveals the need to adopt and implement strategies that make drug therapy more adequate and safer for older adults.
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