Análise exploratória dos padrões alimentares de pacientes com adenocarcinoma gástrico: um estudo de caso-controle na Região Brasil Central

SANTIAGO, Silvana Barbosa; SOUSA, Gabriela Rodrigues de; RAMOS, Amanda Ferreira Paes Landim; FERNANDES, Gisele Aparecida; CURADO, Maria Paula; BARBOSA, Mônica Santiago

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ORIGINAL ARTICLE • Arq. Gastroenterol. 60 (04) • Oct-Dec 2023 • https://doi.org/10.1590/S0004-2803.230402023-67 copiar

Análise exploratória dos padrões alimentares de pacientes com adenocarcinoma gástrico: um estudo de caso-controle na Região Brasil Central

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Contexto:

A dieta é um dos fatores de risco modificáveis mais importante para a incidência de câncer gástrico.

Objetivo:

Realizar uma análise exploratória sobre os padrões alimentares de indivíduos com adenocarcinoma gástrico (AdG) na região Brasil central.

Métodos:

Este é um estudo de caso-controle realizado no período de abril de 2019 a julho de 2022, em três centros de referência para o tratamento para câncer em Goiânia-GO. Os casos foram pacientes diagnosticados com AdG, o controle 1 pacientes dispépticos submetidos a endoscopia digestiva alta e o controle 2 pacientes sem queixas gástricas. Nos três grupos foram recrutados pacientes de 18 a 75 anos e de ambos os sexos. Para avaliar o consumo alimentar foi utilizado um Questionário de Frequência Alimentar validado para a população brasileira. Os padrões alimentares foram identificados por Análise Fatorial Exploratória (AFE), utilizando a análise de componentes principais como método de extração, seguida pela rotação Varimax.

Resultados:

Os valores de comunalidade na AFE para os alimentos/grupos alimentares consumidos pelos casos e controles ficaram acima de 0,30 para todas as variáveis. A variância explicada pelo modelo foi de 66,7%, para casos, 60,3% para o controle 1 e 59,7% para o controle 2. Foram identificados três padrões alimentares nos casos, controle 1 e controle 2 que explicaram 34,87%, 35,41% e 33,25% respectivamente da variância total. O primeiro padrão (“saudável”) foi caracterizado pelo consumo de vegetais, frutas, carne e queijos; o segundo (“não saudável”) por embutidos, pizzas, snacks, ketchup, bebidas doces e macarrão instantâneo e o terceiro (“prudente”) arroz, feijão, carnes e peixes fritos e massas.

Conclusão:

Esse estudo identificou três padrões alimentares entre os pacientes com AdG e os controles na região Brasil central. De acordo com os padrões identificados, será possível estabelecer uma relação entre a dieta e outras medidas epidemiológicas destinadas à prevenção do câncer gástrico.

Palavras-chave:
Neoplasias gástricas; comportamento alimentar; análise fatorial; estudos de caso e controle

Food groups	Description of food grouping (variables - g/day)
Tuber and Vegetables	Carrot, beet, tomato, onion, chayote, pumpkin, cucumber, zucchini and eggplant.
Fruits in general	Orange, pineapple, grape, red fruits, banana, apple, papaya, melon, mango, avocado, guava, persimmon, cupuaçu, bacuri, pupunha and soursop.
Coffee and tea	Coffee and tea
Sweets in general	Plain cake, stuffed cake, whipped cream, icing, biscuit with and without filling, cereal, chocolate, gelatin, ice cream, candy, and candies.
Vegetables and cruciferous	Kale, cauliflower, cabbage, and salad.
Dark green vegetables	Peppers, parsley, lettuce, spinach, watercress, caruru and green smell.
Meat and fish (fried and baked)	Pork, red meat, chicken, beef grilled, roasted chicken, fried chicken, giblets, barbecue, fried and roasted fish, shrimp and pirarucu.
Oil and butter	Mayonnaise, butter with or without salt, margarine with or without salt, light margarine, and butter with or without light salt.
Pizza, snacks (baked and fried), french fries, popcorn and snacks;	Pizza, snacks (baked and fried), french fries, popcorn, and snacks;
Ketchup, industrialized pepper sauce, ramen noodles and cream soup	Ketchup, industrialized pepper sauce, ramen noodles and cream soup
Sweet drinks	Soda, industrialized juice, and chocolate milk.
Beans and lentils	Beans and lentils
Pasta	Pasta (with and without meat) and lasagna.
Sausages in general	Sausage, bacon, dried meat, sausage, fried meat, feijoada, sausages, processed meat, canned meat, nuggets, and hot dogs.
Rice and brown rice	Rice and brown rice
French bread and whole meal bread	French bread and whole meal bread
Cheese	Cheese
Milk	Milk
Fried egg	Fried egg
Fruit smoothies, yogurt, natural fruit juices, Minas cheese, cupuaçu juice, bacuri juice, soursop juice and açaí	Fruit smoothies, yogurt, natural fruit juices, Minas cheese, cupuaçu juice, bacuri juice, soursop juice and açaí
Egg and potato (boiled)	Egg and potato (boiled)
Farofa, tapioca, oats and peanuts	Farofa, tapioca, oats and peanuts
Soup with vegetables and meat	Soup with vegetables and meat
Spices	Salt, vinaigrette, soy drink, mayonnaise, and soy sauce.
Pequi	Pequi

	Cases n=100	%	Endoscopic control n=158	%	Hospitalar Control n=137	%	P
Sex
Male	56	56.0	59	37.3	40	29.2	≤0.001^a
Female	44	44.0	99	62.7	97	70.8
Age
Age (min-max)	28-73		18-75		19-75		≤0.001^b
Mean age (years) ±SD	56±10.0		47.3±15.5		43.9±14.2
Age range
≤45	16	16.0	69	43.6	79	57.7	≤0.001^a
46-55	25	25.0	36	22.8	26	19
56-65	43	43.0	30	19	21	15.3
66-75	16	16.0	23	14.6	11	8
Level of education
Up to 5 years	23	23.0	24	15.2	7	5.1	≤0.001^a
6 years of high school	58	58.0	123	77.8	102	74.5
Higher education	19	19.0	11	7.0	28	20.4
Marital status
Married	73	73.0	84	53.2	82	59.8	0.006 ^a
Not married ^c	27	27.0	74	46.8	55	40.2
Ethnicity
Withe	33	33.0	37	23.4	49	35.8	0.015 ^a
Not white	67	67.0	121	76.6	88	64.2
BMI (kg/m²) ^d
Low weight (<18,5)	24	24.0	9	5,7	9	6.6	0.084 ^a
Eutrophic (18.5 a 24.9)	43	43.0	67	42.4	56	40.9
Overweight (25.0 a 29.9)	18	18.0	43	27.2	42	30.6
Obesity (30.0 a >60.0)	15	15.0	39	24.7	30	21.9
Tobacco consumption
Smoked regularly	50	50	59	37.3	44	32.1	0.018
Alcohol consumption
Consumed alcohol regularly	59	59	82	52	67	49	0.3

Food groups	Case n=100	Endoscopic control n=158	Hospitalar control n=137
Tuber and legum	91.56	77.75	96.35
Fruit	296.93	207.86	248.12
Coffee and tea	275.70	247.73	171.94
Sweets in general	119.73	104.08	58.82
Vegetables and crucifers	29.34	23.33	29.67
Dark green vegetables	35.14	33.97	36.37
Meat and fish (fried and baked)	148.54	142.18	120.68
Oil and butter	14.89	12.76	10.68
Pizza, French fries, Popcorn and snacks	60.63	64.61	40.78
Catchup, industrialized pepper sauce, noodles and cream soup	19.05	24.48	10.95
Sweet drinks	350.80	207.37	112.41
Beans and lentils	151.87	140.93	102.86
Pasta	58.53	67.35	50.55
Sausage	101.54	90.28	70.21
Rice and brown rice	260.19	237.71	177.31
French bread and whole grain bread	49.14	42.27	39.40
Cheese	7.85	6.57	8.43
Milk	155.17	8.22	67.97
Fried egg	11.66	14.65	11.97
Vitamin, juices, yogurt and Mina’s cheese	161.57	155.72	148.59
Egg and potato (boiled)	42.70	44.14	37.89
Farofa, Tapioca, Oats and Peanuts	46.83	32.41	28.90
Soup with vegetables and meat	47.76	43.48	37.89
Seasonings	4.72	6.03	2.64
Pequi	21.31	9.96	7.87

Food Groups	Commonality
	Case	Endoscopic Control	Hospital Control
Tubers and vegetable	0.669	0.674	0.647
Fruit	0.630	0.557	0.658
Coffee and tea	0.742	0.629	0.585
Sweets in general	0.562	0.527	0.658
Vegetables and cruciferous	0.607	0.599	0.688
Dark green vegetables	0.690	0.595	0.632
Meat and fish (fried and baked)	0.497	0.546	0.547
Oil and butter	0.664	0.657	0.659
Pizza. snacks (fried and baked). french fries. popcorn and snacks	0.661	0.657	0.541
Ketchup. industrialized pepper sauce. ramen noodles and cream soup	0.668	0.586	0.639
Sweet drinks	0.681	0.593	0.581
Beans and lentils	0.787	0.752	0.727
Pasta	0.639	0.467	0.498
Sausages in general	0.680	0.640	0.597
Rice and brown rice	0.785	0.686	0.727
French bread and whole meal bread	0.674	0.653	0.749
Cheese	0.675	0.571	0.515
Milk	0.685	0.586	0.677
Fried egg	0.677	0.737	0.439
Fruit smoothies. yogurt. natural fruit juices. Mina’s cheese	0.569	0.575	0.618
Egg and potato (boiled)	0.737	0.636	0.465
Farofa. tapioca. oats and peanuts	0.792	0.598	0.521
Soup with vegetables and meat	0.668	0.514	0.399
Spices	0.582	0.474	0.407
Pequi	0.653	0.566	0.748
KMO	0.648	0.728	0.661
Sphericity	<0.001	<0.001	<0.001
Explained Variance (%)	66.699	60.303	59.685

Case	Pattern			Endoscopic Control	Pattern			Hospitalar Control	Pattern
	S	NS	P		NS	S	P		S	NS	P
Tubers and vegetables	0.788			Tubers and vegetables	0.752			Tubers and vegetables	0.764
Vegetables and cruciferous	0.755			Vegetables and cruciferous	0.722			Vegetables and cruciferous	0.759
Fruits	0.675			Fruits	0.694			Dark green vegetables	0.699
Vitamin, juice, yogurt and Minas cheese	0.646			Vitamin, juice, yogurt and Minas cheese	0.694			Fried egg	0.439
Soup with vegetables and meat	0.627			Soup with vegetables and meat	0.527			Soup with vegetables and meat	0.374
Dark green vegetables	0.568			Dark green vegetables	0.516			Ketchup, industrialized chili sauce, instant noodles, soup		0.714
Cheese	0.372			Cheese		0.775		Pasta		0.654
Sweet drinks		0.794		Sweet drinks		0.735		Pizza, snacks, french fries and popcorn		0.541
Sausages		0.754		Sausages		0.625		Sausages		0.46
Pizza, snacks, french fries and popcorn		0.529		Pizza, snacks, french fries and popcorn		0.567		Spices		0.333
Oil and butter			0.777	Oil and butter			0.849	Fried and roasted meat, fish, shrimp and pirarucu		0.355
French and wholemeal bread			0.762	French and wholemeal bread			0.808	Vitamin, juice, yogurt and Minas cheese			0.755
Sweets in general			0.428	Sweets in general			0.455	Fruits			0.728
				Tubers and vegetables			0.361	Boiled egg and potato			0.429
								Farofa, tapioca, oats, and peanuts			0.379
KMO		0.648				0.728				0.661
Accumulated variance		34.87%				35.41%				33.25%
Bartllet’s sphericity test P<0.001

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[1] Corresponding author: Mônica Santiago Barbosa. E-mail: santiago@ufg.br