Nutritional status and metabolic risk in adults: association with diet quality as assessed with ESQUADA

Silva, Danilla Michelle Costa e; Santos, Thanise Sabrina Souza; Conde, Wolney Lisboa; Slater, Betzabeth

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Revista Brasileira de Epidemiologia

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 24 • 2021 • https://doi.org/10.1590/1980-549720210019 copy

Nutritional status and metabolic risk in adults: association with diet quality as assessed with ESQUADA

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Objective:

To analyze the association between diet quality assessed with the Diet Quality Scale (ESQUADA) and the nutritional status and metabolic risk in adults.

Methods:

The data included 1,147 adults aged 20 to 59, from the population-based study with complex sampling. Weight, height, tricipital (TSF) and subscapular (SSF) skinfolds, and waist (WC) and mid-arm (MAC) circumferences were measured. Body mass index (BMI) and mid-arm muscle circumference (MAMC) were calculated. Nutritional status and metabolic risk were classified considering BMI and WC values, respectively. Diet quality was assessed with ESQUADA. Data were collected at household using the Epicollect5 application. Diet quality (in scores) was analyzed as continuous data and later categorized. The confidence interval was used for comparison between groups, Fisher’s exact test for an association study. Adjusted multiple linear regression models were also estimated. P < 0.05 was adopted for statistical significance.

Results:

Overweight prevailed in 60.33% of individuals, especially among women (60.73%). High or very high metabolic risk was more frequent among women with “very good or excellent” diet quality. Higher diet quality score was associated with a reduction in TSF (β = -0.07; 95%CI -0.13 - -0.01) and an increase in MAMC (β = 0.09; 95%CI 0.00 - 0,18) in men and the reduction in weight (β = -0.04; 95%CI -0.07 - -0.01), SSF (β = -0.07; 95%CI -0.13 - -0,00) and WC in women (β = -0.06; 95%CI -0.09 - -0.02).

Conclusion:

A better diet quality is positively associated with lean mass in men, and negatively with fat mass in men and women.

Keywords:
Adult; Anthropometry; Overweight; Food consumption; Psychometrics

LEVEL	SCALE (250.50)	DESCRIPTION
Poor or very poor	Less than or equal to 200	- Individuals consume ultra-processed foods and replace meals with snacks up to two days a week. They eat fruits and vegetables in less than one day a week.
Good	Greater than 200, and less than or equal to 275	Individuals replace meals with snacks in less than one day a week. They do not consume some ultra-processed foods, but consume sugar sweetened beverages in less than one day a week. They eat fruits and vegetables on one to four days a week; and oats, rye, quinoa, nuts, walnuts, and brown rice/whole-grain pasta in less than one day a week. They have breakfast on at least one day a week.
Very good or excellent	Greater than 275	- Individuals do not substitute meals for snacks. They do not consume any ultra-processed food. They have breakfast on at least one day a week. They eat fruits and vegetables on one to four days a week; and oats, rye, quinoa, nuts, walnuts, and brown rice/whole-grain pasta on one or more days a week.

	Men			Women
	Mean ± SD	Minimum-Maximum	95%CI	Mean ± SD	Minimum-Maximum	95%CI
Body weight (kg)	76.92 ± 16.55	44.60 - 150.00	75.36 - 78.48	65.29 ± 13.26	33.60 - 128.10	64.31 - 66.26
Tricipital skinfold (mm)	16.06 ± 8.64	3.00 - 57.50	15.24 - 16.87	25.88 ± 8.46	6.50 - 55.00	25.26 - 26.50
Subscapular skinfold (mm)	19.22 ± 8.24	5.00 - 59.50	18.45 - 20.00	22.69 ± 8.82	5.00 - 60.00	22.04 - 23.34
Mid-arm muscle circumference (cm)	26.95 ± 3.38	17.36 - 41.36	26.63 - 27.27	22.17 ± 3.00	11.91 - 36.36	21.95 - 22.39
Waist circumference (cm)	91.24 ± 12.74	64.50 - 136.50	90.03 - 92.44	84.51 ± 11.65	56.20 - 128.50	83.65 - 85.37
Body mass index (kg/m²)	26.80 ± 5.17	16.07 - 54.76	26.31 - 27.29	26.88 ± 5.33	13.71 - 49.88	26.49 - 27.27

Score/Level	Men (n = 434)
Score/Level	Poor or very poor		Good		Very good or excellent
Minimum-Maximum	114.72 - 199.73		201.94 - 274.58		275.18 - 364.46
n	18		273		143
Weight (Kg)	73.6 ± 17.7	64.77 - 82.42	77.5 ± 17.1	75.50 - 79.58	76.2 ± 15.2	73.65 - 78.68
TSF (mm)	17.2 ± 8.0	13.24 - 21.20	16.5 ± 9.2	15.38 - 17.59	15.1 ± 7.4	13.88 - 16.31
SSF (mm)	18.4 ± 8.9	13.99 - 22.84	19.5 ± 8.6	18.47 - 20.52	18.8 ± 7.4	17.58 - 20.03
MAMC (cm)	26.3 ± 2.6	25.02 - 27.58	26.9 ± 3.4	26.45 - 27.27	27.2 ± 3.4	26.63 - 27.76
WC (cm)	87.4 ± 15.0	79.93 - 94.83	91.1 ± 13.3	89.56 - 92.73	91.9 ± 11.2	90.03 - 93.75
BMI (kg/m²)	26.0 ± 5.2	23.37 - 28.54	26.7 ± 5.2	26.06 - 27.32	27.1 ± 5.0	26.29 - 27.94
Score/Level	Women (n = 713)
Score/Level	Poor or very poor		Good		Very good or excellent
Minimum-Maximum	131.99 - 198.82		200.21 - 274.88		275.01 - 402.83
N	26		327		360
Weight (Kg)	66.1 ± 13.8	60.57 - 71.72	65.2 ± 13.2	63.72 - 66.61	65.3 ± 13.2	63.96 - 66.71
TSF (mm)	24.3 ± 8.7	20.75 - 27.78	26.0 ± 8.7	25.05 - 26.95	25.8 ± 8.2	25.05 - 26.74
SSF (mm)	21.1 ± 7.9	17.86 - 24.29	23.0 ± 9.1	22.03 - 24.01	22.5 ± 8.6	21.62 - 23.40
MAMC (cm)	22.0 ± 3.6	20.56 - 23.51	21.9 ± 2.9	21.62 - 22.27	22.4 ± 3.0	22.08 - 22.70
WC (cm)	82.1 ± 11.4	77.47 - 86.71	83.5 ± 11.7	82.25 - 84.80	85.6 ± 11.5	84.39 - 86.78
BMI (kg/m²)	25.7 ± 5.0	23.72 - 27.75	26.4 ± 5.3	25.84 - 27.00	27.4 ± 5.3	26.83 - 27.94

	Total		Men (n = 434)						Total		Women (n = 713)
	Total		Poor or very poor		Good		Very good or excellent		Total		Poor or very poor		Good		Very good or excellent
	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%
Nutritional status	p = 0.152*								p = 0.095*
Thinness	9	2.07	0	0	7	77.78	2	22.22	24	3.37	0	0	15	62.50	9	37.50
Eutrophy	166	38.25	10	6.02	111	66.87	45	27.11	256	35.90	14	5.47	126	49.22	116	45.31
Overweight	162	37.33	5	3.09	93	57.41	64	39.51	265	37.17	9	3.40	116	43.77	140	52.83
Obesity	97	22.35	3	3.09	62	63.92	32	32.99	168	23.56	3	1.79	70	41.67	95	56.55
Metabolic risk	p = 0.832*								p = 0.014*
No risk	257	59.22	13	5.06	161	62.65	83	32.30	256	35.90	15	5.86	129	50.39	112	43.75
High	98	22.58	2	2.04	62	63.27	34	34.69	201	28.20	3	1.49	93	46.27	105	52.24
Very high	79	18.20	3	3.80	50	63.29	26	32.95	256	35.90	8	3.13	105	41.02	143	55.86

	Men (n = 434)						Women (n = 713)
	Gross model			Adjusted model^b			Gross model			Adjusted model^b
	β^a	95%CI	p	β	95%CI	p	β^a	95%CI	p	Β	95%CI	p
Weight (Kg)	0.02	-0.07 - 0.12	0.638	0.02	-0.02 - 0.06	0.335	0.00	-0.07 - 0.07	0.987	-0.04*	-0.07 - -0.01	0.018
TSF (mm)	-0.05	-0.12 - 0.03	0.215	-0.07*	-0.13 - -0.01	0.032	0.02	-0.03 - 0.08	0.418	-0.03	-0.07 - 0.01	0.201
SSF (mm)	-0.01	-0.11 - 0.08	0.767	-0.05	-0.11 - 0.02	0.158	0.00	-0.07 - 0.08	0.907	-0.07*	-0.13 - -0.00	0.033
MAMC (cm)	0.06	-0.03 - 0.14	0.182	0.09*	0.00 - 0.18	0.041	0.05	-0.01 - 0.11	0.115	-0.01	-0.05 - 0.03	0.647
WC (cm)	0.12*	0.02 - 0.22	0.023	-0.02	-0.07 - 0.03	0.378	0.11*	0.03 - 0.18	0.008	-0.06**	-0.09 - -0.02	0.001
BMI (kg/m²)	0.09*	0.01 - 0.17	0.028	0.01	-0.10 - 0.11	0.893	0.10*	0.03 - 0.18	0.009	0.01	-0.08 - 0.10	0.798

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[1] Corresponding author: Danilla Michelle Costa e Silva. Rua Antonieta Rodrigues Araújo, 325, Canto da Várzea, CEP: 64600-171, Picos, PI, Brazil. E-mail: dmcsilva@ufpi.edu.br