The objective of this study was to identify clustering patterns of four energy balance-related behaviors (EBRB): television (TV) watching, moderate and vigorous physical activity (MVPA), consumption of fruits and vegetables (F&V), and consumption of sugar-sweetened beverages (SSB), among European and Brazilian adolescents. EBRB associations with different body fat composition indicators were then evaluated. Participants included adolescents from eight European countries in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescents) study (n = 2,057, 53.8% female; age: 12.5-17.5 years) and from the metropolitan region of Rio de Janeiro/Brazil in the ELANA study (the Adolescent Nutritional Assessment Longitudinal Study) (n = 968, 53.2% female; age: 13.5-19 years). EBRB data allowed for sex- and study-specific clusters. Associations were estimated by ANOVA and odds ratios. Five clustering patterns were identified. Four similar clusters were identified for each sex and study. Among boys, different cluster identified was characterized by high F&V consumption in the HELENA study and high TV watching and high MVPA time in the ELANA study. Among girls, the different clusters identified was characterized by high F&V consumption in both studies and, additionally, high SSB consumption in the ELANA study. Regression analysis showed that clusters characterized by high SSB consumption in European boys; high TV watching, and high TV watching plus high MVPA in Brazilian boys; and high MVPA, and high SSB and F&V consumption in Brazilian girls, were positively associated with different body fat composition indicators. Common clusters were observed in adolescents from Europe and Brazil, however, no cluster was identified as being completely healthy or unhealthy. Each cluster seems to impact on body composition indicators, depending on the group. Public health actions should aim to promote adequate practices of EBRB.

Objective To examine the prevalence of the behavioral risk factors – both isolated and clustered – for chronic diseases, among adolescents. Additionally, its association with various social and demographic variables was estimated. Methods This was a cross-sectional study conducted on 1,039 high school students, from public and private schools, elected for convenience, in Rio de Janeiro, Brazil. A Chi-square test, Mann-Whitney U test, as well as crude and adjusted ordinal logistic regression were used to assess the association between the variables. Results The most frequently observed risk factors were sedentary behavior (68.8%), alcohol consumption (36.8%), and overweight (26.8%). The clustering of risk factors was observed in 67.5% of the students. Being a girl (OR=1.28; 95%CI=1.01–1.63), Caucasian (OR=1.35; 95%CI=1.06–1.72) or private school student (OR=1.46; 95%CI=1.12–1.88) increased the chance of the clustering of risk factors. The co-occurrence of risk factors was predominantly observed in the case of smoking (OR=4.94; 95%CI=1.46–16.75), alcohol consumption (OR=1.43; 95%CI=1.09–1.88), high consumption of ultra-processed foods (OR=1.57; 95%CI=1.19–2.07), and sedentary behavior (OR=1.40; 95%CI=1.07–1.82). Conclusion The co-occurrence of behavioral risk factors was observed to be higher among girls, Caucasian adolescents, and private school students, as well as, among smokers, alcohol users and adolescents with sedentary habits and a high consumption of ultra-processed foods.

Epidemiological studies have supported the hypothesis that dietary calcium intake is protective for adiposity. This study aimed to estimate the association of dietary calcium with adiposity indicators during adolescence. This is a cohort study with high school adolescents (n = 962) from selected schools of the Metropolitan Region of Rio de Janeiro, Brazil, which were followed from 2010 to 2012. Calcium intake was assessed by a validated self-reported food frequency questionnaire. Cross-sectional and longitudinal analyses of dietary calcium intake were performed regarding body mass index (BMI), waist circumference (WC), body fat percentage (%BF), fat mass (FM), fat-free mass (FFM), fat mass index (FMI), and fat-free mass index (FFMI). The analysis of variance was used for cross-sectional analysis with baseline data and linear mixed models applied to assess changes across the follow-up. At baseline, BMI, %BF, fat mass, and FMI (p for trend < 0.05) had lower means at the highest quintile of calcium intake whereas FFM and FFMI had higher means (p for trend < 0.05), especially for boys. During follow-up, boys had decreased FMI at the 4th and 5th quintiles of calcium intake (p < 0.05); among girls, only WC was significantly lower at the 4th quintile than in the 1st. These results support the hypothesis that low calcium intake increases adiposity among adolescents.

destacam a importância de identificar os efeitos deletérios da ingestão insuficiente de cálcio sobre a saúde dos adolescentes, os quais podem ser percebidos ainda na adolescência e que, frequentemente, persistem ao longo da vida adulta. Entre as repercussões desfavoráveis da insuficiência de cálcio, são citados a fragilidade óssea, o excesso de peso e os distúrbios metabólicos. Os autores apontam também os fatores que se associam a essa deficiência, como os hábitos irregulares de realização de refeições, o consumo elevado de preparações ricas em açúcares e gorduras, como os fast foods, e produtos ultraprocessados, e o consumo frequente de bebidas carbonatadas ricas em açúcares e cafeína.Del Ciampo & Del Ciampo 2 também assinalam a necessidade de ações de educação alimentar e nutricional, especialmente no ambiente escolar, para promover a alimentação saudável e apontam que os profissionais de saúde também devem estar conscientizados da necessidade de atuar no sentido de minimizar o problema da ingestão inadequada de cálcio. Nesse sentido, consideramos importante pontuar que, na promoção da alimentação saudável, os profissionais de saúde devem ter em conta as recomendações do Guia Alimentar para a População Brasileira 3 , o qual preconiza que a alimentação saudável deve se basear substancialmente em alimentos frescos e minimamente processados, evitando ao máximo a inclusão de produtos ultraprocessados. Os princípios da Dieta de Saúde Planetária 4 também constituem outro paradigma a ser levado em consideração na formulação de ações de promoção da saúde, que incorpora a noção de que a nossa alimentação deve favorecer a saúde humana e a sustentabilidade ambiental. Essa proposta defende que a dieta saudável deve consistir em uma grande diversidade de alimentos de origem vegetal, quantidades pequenas de alimentos de origem animal e proporções limitadas de produtos com adição de açúcar, à base de cereais refinados e com elevado grau de processamento. Entretanto, o custo é um fator limitante para a proposição de dietas com conteúdo adequado de cálcio, particularmente no momento em que o país passa por uma crise política e econômica profunda que levou ao incremento da insegurança alimentar 5 , assim é necessário que o custo da alimentação seja outro parâmetro a ser considerado nas ações de promoção da alimentação saudável, como evidenciado em análise de Verly Junior et al. 6 .Por fim, assinalamos que o uso de suplementos só deve ser recomendado em circunstâncias muito específicas 7 . A suplementação com cálcio deve ser cuidadosamente tratada, visto que a ingestão CARTA LETTER Dieta saudável e ingestão adequada de cálcioHealthy diet and adequate calcium intake Dieta saludable y consumo adecuado de calcio