BACKGROUND:Postoperative care protocols vary among bariatric surgery centers, potentially affecting patient adherence to supplementation and follow-up care. Standardizing these protocols may improve treatment adherence and patient outcomes. OBJECTIVES:To assess the impact of implementing a standardized postoperative care protocol on patients' adherence to vitamin and mineral supplementation, multidisciplinary team follow-up, and health-related quality-of-life (HRQoL) during the first year after Roux-en-Y gastric bypass (RYGB). METHODS:This ambispective cohort study included patients undergoing RYGB at a Brazilian university hospital. Two groups were compared: those receiving the usual postoperative care (UC) and those managed under the new standardized protocol (SP). Adherence to supplementation and multidisciplinary appointments were assessed at 3, 6, and 12 months postsurgery. HRQoL was measured using a validated questionnaire at 12 months. RESULTS:Mean age was 42.3 ± 10.1 years and preoperative body mass index was 48.8 ± 8.3 kg/m². Adherence to multidisciplinary team follow-up was 81.7% in the UC and 96.9% in the SP (p = 0.003). The SP group showed higher vitamin D serum levels at 3, 6, and 12 months (p < 0.001). Overall, the percentage of multivitamin, calcium, vitamin D, and vitamin B12 use was remarkably lower in the UC group compared to the SP group, from 30 days to 1 year postoperative (p < 0.005). At 12 months, the SP group also showed higher scores of general health (p < 0.001) and social functioning (p = 0.004) in HRQoL. CONCLUSIONS:Implementing a standardized postoperative care protocol can improve patient adherence to treatment and quality of life after RYGB. This suggests that long-term outcomes for bariatric surgery patients could be optimized.

Objective: The current cross-sectional study aimed to examine the association between childhood trauma, impulsivity, binge eating symptoms, and body mass index (BMI) in a sample of males and females. We also aimed to investigate the indirect association of childhood trauma with binge eating through impulsivity while controlling for BMI.Method: Participants were 410 young adults (mean age = 20.9 years, range 18-24; female = 73.9%) who completed online measures of childhood trauma, impulsivity, binge eating symptoms, and self-reported height and weight. Mediation models were tested using multi-group structural equation modelling.Results: Childhood trauma and impulsivity were associated with an increased risk of binge eating symptoms in females but not males, corroborating previous studies. There was a significant difference in the binge eating symptoms index between sexes, but not regarding the index of childhood trauma and impulsivity. Additionally, adverse childhood experiences were associated with impulsivity and the association of childhood trauma with binge eating was mediated by impulsivity in the female sample.Conclusions: Our results suggest sex-dependent patterns and risk factors that may impact binge eating symptoms. The implications of our results suggest that impulsivity might be a vulnerability factor for binge eating, especially for females.

Attentional bias (AB) to food after bariatric surgery might be a cognitive marker for weight regain. The visual probe task (VPT) is commonly used to capture AB at automatic, pre-conscious, and conscious orientation of attention. The aim of this study was to investigate how the preoperative BMI of patients submitted to Roux-en-Y gastric bypass (RYGB) impacts AB to food. We assessed patients who had preoperative BMI>50 (n = 28) or preoperative BMI<50 (n = 31) months after the RYGB procedure. Participants underwent clinical, psychological, and VPT evaluations. In VPT, pairs of food and matching non-food images were shown for 100 ms, 500 ms or 2000 ms and AB for food was assessed for each exposure time. A significant AB to food was observed at 2000 ms for all patients in this study, suggesting that the overall sample were consciously orienting their attention toward food cues after surgery, a finding that might be relevant for understanding weight control. When groups with preoperative BMI higher and lower than 50 kg/m2 were compared, a significant difference on AB to food stimuli at 500 ms was observed, controlling for excess weight lost since surgery and postoperative time. Subjects with preoperative BMI>50 had a positive and reliable AB to food while subjects with preoperative BMI<50 had a negative AB. This suggests that food stimuli have a higher incentive salience even after surgery for those with BMI>50, which might explain why subjects with higher preoperative weight have higher risks for weight regain. These results may indicate that RYGB can impact incentive salience for food cues in a differential manner, increasing conscious AB in all patients and decreasing pre-conscious AB only in those with BMI<50 kg/m2.

“Pandemic”, “health crisis”, “global health threat”, “social and economic burden”. Obesity has been called by many different names. No matter what name you choose, obesity is still a growing issue, globally. Over the last five or six decades, the amount of individuals suffering from this condition has not ceased to increase. Non-surgical treatment options are still scarce, and the outcomes are often disappointing. One of the main reasons for the frustrating panorama is our poor understanding of the underlying mechanisms [...]

Aims: We hypothesized that critically ill patients with SARS-CoV-2 infection and insulin resistance would present a reduced Heat Shock Response (HSR), which is a pathway involved in proteostasis and anti-inflammation, subsequently leading to worse outcomes and higher inflammation. In this work we aimed: (i) to measure the concentration of extracellular HSP72 (eHSP72) in patients with severe COVID-19 and in comparison with noninfected patients; (ii) to compare the HSR between critically ill patients with COVID-19 (with and without diabetes); and (iii) to compare the HSR in these patients with noninfected individuals. Methods: Sixty critically ill adults with acute respiratory failure with SARS-CoV-2, with or without diabetes, were selected. Noninfected subjects were included for comparison (healthy, n = 19 and patients with diabetes, n = 22). Blood samples were collected to measure metabolism (glucose and HbA1c); oxidative stress (lypoperoxidation and carbonyls); cytokine profile (IL-10 and TNF); eHSP72; and the HSR (in vitro). Results: Patients with severe COVID-19 presented higher plasma eHSP72 compared with healthy individuals and noninfected patients with diabetes. Despite the high level of plasma cytokines, no differences were found between critically ill patients with COVID-19 with or without diabetes. Critically ill patients, when compared to noninfected, presented a blunted HSR. Oxidative stress markers followed the same pattern. No differences in the HSR (extracellular/intracellular level) were found between critically ill patients, with or without diabetes. Conclusions: We demonstrated that patients with severe COVID-19 have elevated plasma eHSP72 and that their HSR is blunted, regardless of the presence of diabetes. These results might explain the uncontrolled inflammation and also provide insights on the increased risk in developing type 2 diabetes after SARS-CoV-2 infection.

Online experiments are an alternative for researchers interested in conducting behavioral research outside the laboratory. However, an online assessment might become a challenge when long and complex experiments need to be conducted in a specific order or with supervision from a researcher. The aim of this study was to test the computational validity and the feasibility of a remote and synchronous reinforcement learning (RL) experiment conducted during the social-distancing measures imposed by the pandemic. An additional feature of this study was to describe how a behavioral experiment originally created to be conducted in-person was transformed into an online supervised remote experiment. Open-source software was used to collect data, conduct statistical analysis, and do computational modeling. Python codes were created to replicate computational models that simulate the effect of working memory (WM) load over RL performance. Our behavioral results indicated that we were able to replicate remotely and with a modified behavioral task the effects of working memory (WM) load over RL performance observed in previous studies with in-person assessments. Our computational analyses using Python code also captured the effects of WM load over RL as expected, which suggests that the algorithms and optimization methods were reliable in their ability to reproduce behavior. The behavioral and computational validation shown in this study and the detailed description of the supervised remote testing may be useful for researchers interested in conducting long and complex experiments online.

Background: Uncoupling protein 2 (UCP2) plays an important role in energy expenditure regulation. Previous studies have associated the common -8 66G/A (rs659366) and Ins/Del polymorphisms in the UCP2 gene with metabolic and obesity-related phenotypes. However, it is still unclear whether these polymorphisms influence weight loss after bariatric surgery. Objectives: To investigate whether UCP2 -866G/A and Ins/Del polymorphisms are associated with weight loss outcomes after bariatric surgery. Setting: Longitudinal study in a university hospital. Methods: We retrospectively evaluated 186 patients who underwent Roux-en-Y gastric bypass (RYGB) surgery for clinical and laboratory characteristics in the preoperative period, 6, 12, and 18 months after RYGB. The-866G/A (rs659366) polymorphism was genotyped using real-time PCR, while the Ins/Del polymorphism was genotyped by direct separation of PCR products in 2.5% agarose gels. Results: Patients with the-866A/A genotype showed higher body mass index (BMI) after 6, 12, and 18 months of surgery and excess body weight after 6 and 12 months compared with G/G patients. They also showed lower excess weight loss (EWL%) after 6 and 12 months of surgery. Ins allele carriers (Ins/Ins + Ins/Del) had lower delta (D) BMI 12 months after surgery compared with Del/Del patients. Accordingly, patients carrying haplotypes with >2 risk alleles of these polymorphisms had higher BMI and excess weight and lower EWL% during follow-up. Conclusion: UCP2-866A/A genotype is associated with higher BMI and excess weight and lower EWL% during an 18-month follow-up of patients who underwent RYGB, while the Ins allele seems to be associated with lower DBMI 12 months after surgery. Further studies are needed to confirm the associations of the-866G/A and Ins/Del polymorphisms with weight loss after bariatric surgery. (C) 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Abstract STUDIES ASSESSING SENSITIVITY TO ENVIRONMENTAL STIMULI INDICATE THAT SUBJECTS WITH BINGE EATING DISORDER (BED) ARE MORE PRONE TO REACT TO STRESSFUL SITUATIONS, AND MORE WILLING TO PURSUE IMMEDIATE REWARDS IN COMPARISON TO SUBJECTS WITHOUT BED. UNPREDICTABILITY OF FAMILY RESOURCES RELEVANT TO CHILD DEVELOPMENT INCREASES THE CHANCES OF EXTERNALIZING BEHAVIORS IN CHILDHOOD AND, COUPLED WITH PERSONALITY PROFILES LINKED TO BED, MAY INCREASE THE ODDS OF MANIFESTING BINGE EATING (BE) IN ADULTHOOD. THIS STUDY AIMED TO INVESTIGATE WHETHER PERSONALITY AND UNPREDICTABILITY OF RESOURCES INTERACT TO PREDICT BE SYMPTOMS IN YOUNG ADULTS, EVEN BEFORE THE ONSET OF OBESITY. THE SAMPLE CONSISTED OF 257 ADULTS (AGES 20.73 ± 1.78 YEARS, MEAN ± SD), MOSTLY WHITE (N = 233), UNDERGRADUATES (N = 236), AND WITH A BMI OF 21.84 ± 1.68 KG/M². PERSONALITY WAS STUDIED USING THE BIS AND BAS SCALES THAT ASSESS, RESPECTIVELY, AVOIDANCE OF AVERSIVE STIMULI AND CONFLICT SITUATIONS, AND APPROACH TO AND DESIRE OF REWARD STIMULI. UNPREDICTABILITY OF NURTURE AND CARE, FINANCIAL RESOURCES, AND MEAL AVAILABILITY WERE ASSESSED USING THE FAMILY UNPREDICTABILITY SCALE (FU). BE SYMPTOMS WERE ASSESSED USING THE BINGE EATING SCALE (BES). A PATH ANALYSIS MODEL WAS USED TO ANALYZE THE DATA. PERSONALITY FACTORS WERE TREATED AS PRINCIPAL PREDICTORS, FU AS MEDIATORS, AND BE SYMPTOMS AS THE DEPENDENT/OUTCOME VARIABLE. GENDER, BMI, AND SOCIOECONOMIC STATUS WERE INCLUDED IN THE MODEL AS COVARIATES. AN EXCELLENT MODEL FIT WAS OBTAINED, [χ² (31) = 26.588, P = 0.692; RMSEA < 0.01; CFI = 1.000; TFI = 1.041], AND THE FINAL MODEL EXPLAINED 20.1% OF BE VARIANCE. THE POSITIVE EFFECTS OVER BE VARIANCE SUGGEST THAT FEMALE PARTICIPANTS (β = 0.180) WITH A HIGHER TENDENCY TO SEEK FOR IMMEDIATE REWARDS (BAS SUBSCALE, β = 0.205) AND AVOID CONFLICT SITUATIONS (BIS SCALE, β = 0.304), AND WITH A BMI CLOSER TO 25 KG/M² (β = 0.130) SCORED HIGHER IN BES. ONLY ONE FU FACTOR WAS RELATED TO BE, WITH MARGINAL SIGNIFICANT RESULTS (NURTURE AND CARE, β = 0.145, P = 0.056). HIGHER POSITIVE REACTIONS TO BRIEF REWARDS - ANOTHER BAS SUBSCALE - WERE NEGATIVELY (β = − 0.123) RELATED TO BE SYMPTOMS, REPRESENTING A PROTECTIVE FACTOR. THE OBSERVED EFFECTS OF PERSONALITY AND GENDER ARE CONSONANT WITH THE AFFECT REGULATION THEORY OF EATING DISORDERS, AS BE MIGHT BE AN IMPULSIVE STRATEGY TO REGULATE EMOTION IN FEMALE PATIENTS WITH GENETICALLY INFLUENCED PERSONALITY TRAITS LINKED TO STRESS VULNERABILITY AND REWARD SENSITIVITY. RESPONSIVENESS TO BRIEF REWARDS IS A PROTECTIVE FACTOR FOR DEPRESSIVE SYMPTOMS LINKED ALSO TO HEALTHY BEHAVIORS, AND IT MAY HELP PATIENTS TO PLAN AND ENGAGE IN STRATEGIES TO PREVENT BE. LONGITUDINAL MONITORING OF THESE PARTICIPANTS MAY ANSWER WHETHER PERSONALITY PROFILES IMPACT WEIGHT GAIN AND ADHERENCE TO WEIGHT REDUCTION INTERVENTIONS IN THE FUTURE.

Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport’s governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete’s unique makeup.

Introduction and objectives: Obesity represents a major global public health problem. Its etiology is multifactorial and includes poor dietary habits, such as hypercaloric and hyperlipidic diets (HFDs), physical inactivity, and genetic factors. Regular exercise is, per se, a tool for the treatment and prevention of obesity, and recent studies suggest that the beneficial effects of exercise can be potentiated by the fasting state, thus potentially promoting additional effects. Despite the significant number of studies showing results that corroborate such hypothesis, very few have evaluated the effects of fasted-state exercise in overweight/obese populations. Therefore, the aim of this study was to evaluate the subacute effects (12 h after conclusion) of a single moderate-intensity exercise bout, performed in either a fed or an 8 h fasted state, on serum profile, substrate-content and heat shock pathway–related muscle protein immunocontent in obese male rats. Methods: Male Wistar rats received a modified high-fat diet for 12 weeks to induce obesity and insulin resistance. The animals were allocated to four groups: fed rest (FER), fed exercise (FEE), fasted rest (FAR) and fasted exercise (FAE). The exercise protocol was a 30 min session on a treadmill, with an intensity of 60% of VO2max. The duration of the fasting period was 8 h prior to the exercise session. After a 12 h recovery, the animals were killed and metabolic parameters of blood, liver, heart, gastrocnemius and soleus muscles were evaluated, as well as SIRT1 and HSP70 immunocontent in the muscles. Results: HFD induced obesity and insulin resistance. Soleus glycogen concentration decreased in the fasted groups and hepatic glycogen decreased in the fed exercise group. The combination of exercise and fasting promoted a decreased concentration of serum total cholesterol and triglycerides. In the heart, combination fasting plus exercise was able to decrease triglycerides to control levels. In the soleus muscle, both fasting and fasting plus exercise were able to decrease triglyceride concentrations. In addition, heat shock protein 70 and sirtuin 1 immunocontent increased after exercise in the gastrocnemius and soleus muscles. Conclusions: An acute bout of moderate intensity aerobic exercise, when realized in fasting, may induce, in obese rats with metabolic dysfunctions, beneficial adaptations to their health, such as better biochemical and molecular adaptations that last for at least 12 h. Considering the fact that overweight/obese populations present an increased risk of cardiovascular events/diseases, significant reductions in such plasma markers of lipid metabolism are an important achievement for these populations.

Abstract Obesity is the result of a positive energy balance. Cognitive biases have been shown to co-occur with obesity, highlighting the hypothesis that certain cognitive functions increase the risk for obesity. Attentional bias (AB) to food stimuli is one of the cognitive components that seem to contribute to the onset and course of obesity. The treatment of obesity still represents a major health challenge. The most effective treatment for severe obesity is bariatric surgery (BS). Patients with higher degrees of adiposity – the so-called “superobese” (SO), whose body mass index (BMI) is ≥ 50 kg/m2 - seem to lose more weight after BS than the non-SO patients. On the other hand, SO patients are more likely to regain weight. Differences in behavior and cognition before and after BS may explain weight regain differences. The aim of this study was to assess food AB in a sample (n = 59) submitted to Roux-en-Y gastric bypass (RYGB) and to compare food AB between the subjects who were SO before surgery, and those who were non-SO. 59 patients underwent anthropometric assessment, clinical interview, psychometric questionnaires, and AB behavioral assessment. Participants were mostly white (n = 46, 78%), had incomplete elementary school (n = 23, 39%), did not work (n = 31, 52.5%), and were in socioeconomic class C1 (n = 24, 40.7%). BMI before BS was 49.70 ± 1.25 kg/m² (mean ± S.D.). The last available BMI after surgery (assessed within 30 days from the assessments) was 33.60 ± 7.31 kg/m². The mean postoperative follow-up time at assessment was 47.76 ± 3.04 months. Most participants were above the cutoff points for binge eating disorder (n = 54, 91.5%) and impulsivity (n = 45, 76.3%). The overall sample showed food AB ​​(16.30 ± 7.09) when food stimuli were exposed during 2000 msec, suggesting a conscious attention towards food stimuli (t (58) = 2.303, p = .025, d = 0.29). SO and non-SO were compared using post-operative time as a covariate. Food AB was significantly higher in SO (24.06, SEM 8.55) than in non-SO (-12.98, SEM 8.11) when food stimuli were exhibited during 500 msec, indicating a pre-conscious attention to food stimuli in SO (F (2, 106) = 5.124, p = .008, η²partial = .083). At 500 msec, AB value was significantly different from 0 only in SO (t= 2,763, p = .010, d = 0.53, n=27), indicating an AB to food stimuli when attention orientation was less possible. Overall, the food AB observed in the whole sample indicates that all patients show a conscious attention toward food stimuli after BS, which may influence weight maintenance. Notwithstanding, the result was different when SO and non-SO were compared considering the post-operative time. The longer the time elapsed since surgery, the higher the food AB at 500 msec in SO. Given that SO patients have a higher risk of weight regain, these data suggest that a non-conscious AB after bariatric surgery may be one of the inductors of food ingestion, thus predisposing to weight regain.

Background & aims: To compare groups of bariatric patients with preoperative scores of Binge Eating Scale (BES) above and below the clinical cut off value on weight outcomes up to 60 months following surgery. Methods: This is a prospective observational study involving 108 Brazilian patients (follow-up rate: 48.1%) operated by Roux-en-Y gastric bypass. In the preoperative period, they were clinically evaluated, and BES was applied. Based on the scores, patients were categorized as high or low according to established cut off 17 for binge eaters. Follow-up weight loss was obtained (3, 6, 12, 24, 36, 48, and 60 months) using data from medical records. The percentage of total weight loss (%TWL) was examined by generalized linear model. Results: 41.7% of patients had BES scores higher than 17 at baseline. Weight loss was significant up to 12 months. The greatest weight loss was at 24 months of follow-up, ranging from 2.7 to 110.4 kg (mean 42.9 +/- 17.8 kg). In the short postoperative period (3, 24, and 36 months), %TWL was significantly different between groups. At 24 months, patients with higher scores lost more %TWL than those with lower scores (35.1 +/- 0.8% vs 31.6 +/- 0.7%, p = 0.029). However, this difference was not fount at 60 months postoperatively (mean 28.9 +/- 9.6%). In a multivariate analysis, the presence of depression, age, and BES score were not associated with %TWL at 24 and 60 months. Conclusions: The results suggest that preoperative BES scores point to a similar weight loss after bariatric surgery. Further studies with long-term follow-up are necessary to evaluate this finding. (C) 2020 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

INTRODUCTION:Persistent episodes of postprandial hyperlipemia (PPL) and hyperglycemia (PPG) are considered risk factors for coronary heart disease (CHD) and premature death; whereas physical exercise improves lipid profile and glucose tolerance thus decreasing cardiovascular risks. OBJECTIVE:To investigate the effects of low-intensity fasted aerobic exercise on the magnitude of the PPL and PPG responses to meals with different energy content, in normal and obese subjects. METHODS:The study used a randomized crossover design. Twenty-one male (Lean: n = 9, BMI: 24.3 ± 2.2; and obese: n = 12, BMI 32.31 ± 2.1) volunteers aged 20-30 years, performed three interventions, separated by 7 days each: (i) 45 min at rest and isocaloric high-fat meal (60% lipids, 30% carbohydrates and 10% protein); (ii) fasted low-intensity aerobic exercise (50% VO2max) for 45 min followed by an isocaloric or (iii) calorie deficit high-fat meal. Subjects were serially assessed for blood triglycerides, and glucose levels. RESULTS AND CONCLUSIONS:Low-intensity fasted aerobic exercise had no acute effect on PPL in lean and obese subjects. Glucose concentrations were reduced only in lean subjects. There is a significant difference in PPL values when comparing lean to obese subjects, implying that the nutritional status influences lipid and carbohydrate after fasted low-intensity aerobic exercise. Registered under ClinicalTrials.gov Identifier no. NCT00929890.

Chronic inflammation is involved in the pathogenesis of several metabolic diseases, such as obesity and type 2 diabetes mellitus (T2DM). With the recent worldwide outbreak of coronavirus disease (SARS-CoV-2), it has been observed that individuals with these metabolic diseases are more likely to develop complications, increasing the severity of the disease and a poorer outcome. Coronavirus infection leads to the activation of adaptive and innate immune responses, resulting in massive inflammation (to so called cytokine storm), which in turn can lead to damage to various tissues, septic shock and multiple organ failure. Recent evidence suggests that the common link between metabolic diseases and SARS-CoV-2 is the inflammatory response (chronic/low-grade for metabolic diseases and acute/intense in coronavirus infection). However, the ability of the infected individuals to resolve the inflammation has not yet been explored. The heat shock response (HSR), an important anti-inflammatory pathway, is reduced in patients with metabolic diseases and, consequently, may impair inflammation resolution and control in patients with SARS-CoV-2, thus enabling its amplification and propagation through all tissues. Herein, we present a new hypothesis that aims to explain the increased severity of SARS-CoV-2 infection in people with metabolic diseases, and the possible benefits of HSR-inducing therapies to improve the inflammatory profile in these patients.

AbstractObjectiveTo evaluate the reproducibility and validity of a previously constructed FFQ to assess the usual diet of patients with type 2 diabetes mellitus (T2DM).DesignCross-sectional survey using two quantitative FFQ (1-month interval) supported by a food photograph portfolio, a 3 d weighed diet record (WDR) and urinary N output measurement (as a biomarker of protein intake).SettingGroup of Nutrition in Endocrinology, southern Brazil.SubjectsOut-patients with T2DM.ResultsFrom a total of 104 eligible T2DM patients, eighty-eight were included in the evaluation of FFQ reproducibility and seventy-two provided data for the validity study. The intakes estimated from the two FFQ did not differ (P> 0·05) and the correlation coefficients were significant (P< 0·01) for energy and nutrients, ranging from 0·451 (soluble fibre) to 0·936 (PUFA). Regarding the validity evaluation, data from the FFQ were higher than those from the WDR for total (28·3 %), soluble (27·4 %) and insoluble fibres (29·1 %), and SFA (13·5 %), MUFA (11·1 %) and total lipids (9·2 %; allP< 0·05). There were significant correlation coefficients between the FFQ and WDR for most nutrients, when adjusted for energy intake and de-attenuated. Also, the Bland–Altman plots between the FFQ and WDR for energy and macronutrient intakes showed that the FFQ may be used as alternative method to the WDR. The validity coefficient (using the method of triads) for the FFQ protein intake was 0·522 (95 % CI 0·414, 0·597).ConclusionsThis quantitative FFQ was valid and precise to assess the usual diet of patients with T2DM, according to its validity and reproducibility.