Objective: To evaluate red and processed meat intake, and the impact meat consumption has on diet quality and the environment. Design: A large cross-sectional health survey performed in São Paulo, Brazil. Setting: Diet was assessed by two 24 h dietary recalls. Usual intakes were calculated using the Multiple Source Method. The World Cancer Research Fund recommendation of an average of 71?4 g/d was used as the cut-off point to estimate excessive red and processed meat consumption. To investigate the relationship between meat consumption and diet quality we used the Brazilian Healthy Eating Index Revised. The environmental impact was analysed according to estimates of CO 2 equivalent emissions from meat consumption. Subjects: Brazilians (n 1677) aged 19 years and older were studied. Results: The mean red and processed meat intake was 138 g/d for men and 81 g/d for women. About 81 % of men and 58 % of women consumed more meat than recommended. Diet quality was inversely associated with excessive meat intake in men. In Brazil alone, greenhouse gas emissions from meat consumption, in 2003, were estimated at approximately 18 071 988 tonnes of CO 2 equivalents, representing about 4 % of the total CO 2 emitted by agriculture. Conclusions: The excessive meat intake, associated with poorer diet quality observed, support initiatives and policies advising to reduce red and processed meat intake to within the recommended amounts, as part of a healthy and environmentally sustainable diet.

The EAT-Lancet Commission has proposed a planetary health diet. We propose the development of the Planetary Health Diet Index (PHDI) based on this proposed reference diet. We used baseline dietary data obtained through a 114-item FFQ from 14,779 participants of the Longitudinal Study on Adult Health, a multicenter cohort study conducted in Brazil. The PHDI has 16 components and a score from 0 to 150 points. Validation and reliability analyses were performed, including principal component analyses, association with selected nutrients, differences in means between groups (for example, smokers vs. non-smokers), correlations between components and total energy intake, Cronbach’s alpha, item-item correlations, and linear regression analysis between PHDI with carbon footprint and overall dietary quality. The mean PHDI was 60.4 (95% CI 60.2:60.5). The PHDI had six dimensions, was associated in an expected direction with the selected nutrients and was significantly (p < 0.001) lower in smokers (59.0) than in non-smokers (60.6). Cronbach’s alpha value was 0.51. All correlations between components were low, as well as between components and PHDI with total energy intake. After adjustment for age and sex, the PHDI score remained associated (p < 0.001) with a higher overall dietary quality and lower carbon footprint. Thus, we confirmed the PHDI validity and reliability.

Self-reported weight measurements can substitute measured parameters in this population, in both genders and in the age groups studied. Self-reported height measurements should be used with caution. Calibration coefficients can be used to adjust self-reported measurements.

ObjectiveTo characterize trends in meat consumption, and verify the percentage of excessive red and processed meat consumption in the last decade in São Paulo, Brazil.DesignCross-sectional weighted data from the Health Survey for São Paulo, conducted in São Paulo, Brazil among people aged 12 years and older.SettingDiet was assessed by two 24-hour recalls in each survey. Usual meat consumption was estimated by Multiple Source Method. Wald tests were used to compare means across survey years. Data were collected from adolescents, adults, and elderly using a representative, complex, multistage probability-based survey in 2003 and in 2008 in São Paulo, southeast of Brazil.Subjects2631 Brazilians were studied in 2003 and 1662 in 2008.ResultsDaily mean of red and processed meat consumption was 100 g/day in 2003, and 113 g/day in 2008. Excessive red and processed meat consumption was observed in almost 75% of the subjects, especially among adolescents in both surveys. Beef represented the largest proportion of meat consumed, followed by poultry, pork and fish in both surveys.ConclusionsDaily red and processed meat consumption was higher in 2008 than in 2003, and almost the entire population consumed more than what is recommended by World Cancer Research Fund. Public health strategies are needed, in order to reduce red and processed meat consumption to the recommended amounts, for a healthy diet.

Limb‐girdle muscular dystrophies (LGMD) are a group of genetically heterogeneous disorders characterized by predominantly proximal muscle weakness. We aimed to characterize epidemiological, clinical and molecular data of patients with autosomal recessive LGMD2/LGMD‐R in Brazil. A multicenter historical cohort study was performed at 13 centers, in which index cases and their affected relatives' data from consecutive families with genetic or pathological diagnosis of LGMD2/LGMD‐R were reviewed from July 2017 to August 2018. Survival curves to major handicap for LGMD2A/LGMD‐R1‐calpain3‐related, LGMD2B/LGMD‐R2‐dysferlin‐related and sarcoglycanopathies were built and progressions according to sex and genotype were estimated. In 370 patients (305 families) with LGMD2/LGMD‐R, most frequent subtypes were LGMD2A/LGMD‐R1‐calpain3‐related and LGMD2B/LGMD‐R2‐dysferlin‐related, each representing around 30% of families. Sarcoglycanopathies were the most frequent childhood‐onset subtype, representing 21% of families. Five percent of families had LGMD2G/LGMD‐R7‐telethonin‐related, an ultra‐rare subtype worldwide. Females with LGMD2B/LGMD‐R2‐dysferlin‐related had less severe progression to handicap than males and LGMD2A/LGMD‐R1‐calpain3‐related patients with truncating variants had earlier disease onset and more severe progression to handicap than patients without truncating variants. We have provided paramount epidemiological data of LGMD2/LGMD‐R in Brazil that might help on differential diagnosis, better patient care and guiding future collaborative clinical trials and natural history studies in the field.

The aims of the present study were to verify the proportion of population that consumed more red and processed meat than the World Cancer Research Fund (WCRF) dietary recommendation, to estimate the environmental impact of beef intake and the possible reduction of greenhouse gas emissions if the dietary recommendation was followed. We used the largest, cross-sectional, population-based survey entitled the National Dietary Survey (34 003 participants aged 10-104 years). The usual meat intake was obtained by two food records completed on 2 non-consecutive days. The usual intake was estimated by the multiple source method. The environmental impact was analysed according to estimates of CO2 equivalent emissions from beef intake as a proxy for beef production in Brazil. The red and processed meat intake mean was 88 g/d. More than 80 % of the population consumed more red and processed meat than the WCRF recommendation. Beef was the type of meat most consumed, accounting to almost 50 %. Each person contributed 1005 kg of CO2 equivalents from beef intake in 2008, the same quantity of CO2 produced if a car travelled a distance between the extreme north and south of Brazil (5370 km). The entire Brazilian population contributed more than 191 million tons of CO2 equivalents, which could have been reduced to more than 131 million tons if the dietary recommendation was followed. The present study shows that the magnitude of the excessive red and processed meat intake in Brazil can impact on health and the environment, pointing to the urgency of promoting a sustainable diet.

The food frequency questionnaire analyzed has good validity and reproducibility for estimating the food consumption of adults in São Paulo compared to the reference method, so it is an appropriate instrument to be used in epidemiological studies on similar populations. Estimates of polyunsaturated fat and folate should be interpreted with caution.

High meat intake has been related to chronic diseases such as cancer and CVD. One hypothesis is that heterocyclic amines (HCA), which are formed during the cooking process of meat, can generate reactive species. These compounds can cause oxidation of lipids, proteins and DNA, resulting in oxidative stress, cell damage and loss of biological function. This association has been seen in vitro; however, it remains unclear in vivo. The aim of the present study was to investigate the association between oxidative stress and HCA intake, and oxidative stress and meat intake. Data were from the Health Survey for Sao Paulo -ISA-Capital (561 adult and elderly). Food intake was estimated by one 24-h dietary recall (24HR) complemented by a detailed FFQ with preferences of cooking methods and level of doneness for meat. HCA intake was estimated linking the meat from the 24HR to a database of HCA. Oxidative stress was estimated by malondialdehyde (MDA) concentration in the plasma, after derivatisation with thiobarbituric acid and quantification by HPLC/diode array. Analyses were performed using multivariate logistic regressions adjusted for smoking, sex, age, BMI, skin colour, energy intake, fruit and vegetable intake, and physical activity. A positive association between HCA intake and MDA concentration (OR 1·17; 95 % CI 1·01, 1·38) was observed, showing that HCA from meat may contribute to increase oxidative stress, and may consequently increase the risk of chronic diseases. Key words: Meat: Heterocyclic amines: Oxidative stressMeat is an important food item for human nutrition(1) ;however, excessive meat intake, especially red and processed meat, has been linked to chronic diseases (2) such as CVD (3) and cancer (4) . According to a recent systematic review and a meta-analysis, involving more than one million people, the intake of 50 g/d of processed meat increases the risk of CVD by 42 %, and of diabetes by 19 % (3) . Another meta-analysis (5) has reported that the intake of 110 g/d of red meat is associated with a 27 % increased risk of colorectal cancer, and the intake of 50 g/d of processed meat is associated with a 29 % increased risk of colorectal cancer. Other studies have reported an association between red and processed meat intake and risk of cancer of the stomach (6) , oesophagus (7,8) , lungs (9 ) and other organs.There are some reasons for meat to be linked to the risk of chronic diseases, such as heterocyclic amines (HCA) that are potentially carcinogenic substances, formed during the cooking process of meat (baking, frying and barbequing) (3,10) , besides high saturated fat content, high cholesterol content, Na and nitrites that are added to processed meat. During HCA metabolism, reactive species are formed, especially by cytochrome P450, which can cause oxidation of lipids, proteins and nucleic acids, resulting in oxidative stress, cell damage and loss of biological function, thus increasing the risk of CVD and cancer (4,11 -13) . The levels of HCA formed are highly dependent on the type of meat coo...