Grain foods with d10:1 carbohydrate-to-fiber ratio in the population of São Paulo: analysis of effects of changes in diet on cardiometabolic risk factors

Abstract

Considering the significant burden of diseases associated with low consumption of whole cereals, including cardiovascular diseases and Type 2 Diabetes Mellitus, there is need for robust estimated regarding the potential effects of increase in the intake of these foods to promote evidence-based actions and policies in health. Thus, the present study proposes assessment of changes in consumption of cereals that fulfill the d10:1 carohydrate-fiber ratio (ratio d10:1) in São Paulo inhabitants, based on cross-sectional study representative at populational level conducted in 2003, 2008 and 2015. The assessment will be performed in three dimensions: (1) estimation of the amount required to obtain effects on cardiometabolic risk factors related to insulin resistance; (2) direct costs of diet changes in the context of populational food consumption; and (3) effects on costs due to morbidities associated with insulin resistance at the health system level. Diet was assessed using two 24-hour dietary recalls for estimation of consumption of cereals with carbohydrate-fiber ratio d10:1. Food prices will be obtained from microdata of the Brazilian Household Budget Survey for estimation of diet costs and effects of substitution of refined by whole grain foods on diet costs. Dose-response models will be adopted for evaluation of differences between individuals, as well as estimation of health outcomes due to substitution of foods, according to cardiometabolic risk factors associated with insulin resistance. Costs in the health system due to morbidities related to insulin resistance attributable to low consumption of grain foods with carbohydrate-fiber ratio d10:1 will be projected using population attributable fraction, through genetic risk score for insulin resistance phenotype. (AU)