Fabio da Silva Gomes

Associação entre fatores socioeconômicos e insegurança alimentar: estudo de base populacional na Região Metropolitana do Rio de Janeiro, Brasil

OBJECTIVE: This work aims to evaluate the prevalence of food insecurity among families from Duque de Caxias, in the Rio de Janeiro Metropolitan Area and the association between socioeconomic indicators and food insecurity. METHODS: A population-based cross-sectional study investigated a probabilistic sample composed of 1,085 households from the district of Campos Eliseos, in the municipality of Duque de Caxias, Rio de Janeiro, Brazil. Information on socioeconomic condition was obtained using a structured questionnaire. Food insecurity was assessed by the Brazilian Food Insecurity Scale, which allows classifying the families into food security, or mild, moderate or severe food insecurity. The analyses took into account the sampling design effect. The food insecurity prevalence was estimated and its association with socioeconomic variables was assessed using the chi-square test (p<0.05). RESULTS: Food insecurity prevalence was 53.8%. The following variables were inversely and significantly associated with food insecurity: family monthly per capita income, head of family educational level, socioeconomic level (classified according to the Brazilian Association of Market Research criteria), number of family members, and having a water filter in the household. CONCLUSION: Family income was the variable that discriminated both food security and insecurity.

Frutas, legumes e verduras: recomendações técnicas versus constructos sociais

Goal recommendations and prescriptions addressed to the population are often constructed based exclusively on technical-scientific definitions, ignoring social constructive processes of the risk that involves values, perceptions and experiences. Thus, important barriers may impair the advancement of policies that aim to implement these recommendations. This article presents multidisciplinary contributions to the construction of prescribed recommendations and goals, especially concerning the consumption of fruits and vegetables. It discusses some psychosocial and macro-structural barriers for the consumption of these foods and their implications for population-based interventions. With the objective of inducing reflection, the article conducts a critical review analyzing the problem under the light of structuralist theories on the social construction of risk. Recommendations and prescriptions of goals were analyzed considering the risk, its social determinants, components and concepts aggregated as multidimensional factors. Important lessons drawn from the review include: 1) the need to incorporate popular contributions to the definition, content, strategies of communication and implementation of the food policy agenda; 2) the vital need to recover the non-nutritional aspects of the foods, such as taste, as indispensable components to value and promote the consumption of fruits and vegetables; and 3) the need to adopt a concept of healthy eating that follows the broadness of the concept of health. The analysis indicates that the messages need to approach and value culture and tradition, avoiding references to healthy eating that are essentially or exclusively based on nutrients, diseases, longevity and sophistication.

Antropometria como ferramenta de avaliação do estado nutricional coletivo de adolescentes

Anthropometry is considered the most appropriate tool for assessing the nutritional status of groups of people. The nutritional assessment of adolescents has a very peculiar dynamic because adolescence is a period of intense physiological and psychosocial changes which are directly related to the nutritional dynamic of this group. The monitoring of this dynamic and its intervening and interactive variables is an extremely relevant discussion theme. This review aims to present the applications of anthropometric indicators in the assessment of the nutritional status of adolescents. While ways to determine body composition are not readily available for epidemiological studies, the use of body mass index alone or associated with skin fold thicknesses and circumferences of body segments is convenient. Despite the difficulties and limitations, it seems essential to incorporate information on sexual maturation in the nutritional status assessment of adolescents. Furthermore, investigations need to pay closer attention to the parameters of definition for the population that will be assessed, so that studies can be compared properly.

Carotenóides: uma possível proteção contra o desenvolvimento de câncer

This study is a literature review that discusses the likelihood of dietary carotenoids offering protection against cancer. Carotenoids have been demonstrating a protective action against carcinogenesis both in vitro and in vivo, in animals and humans. Among them, beta-cryptoxanthin, fucoxanthin, astaxanthin, capsanthin, crocetin and phytoene have been little explored and literature is still very lacking and little conclusive. Experimental studies with humans have shown beta-carotene to have no effect or reverse effect; however, they have never included intervenient and interactive variables that should have been controlled. Scientific evidence based on epidemiological studies and recent experimental assays and the elucidation of phytochemical activity mechanisms associated with greater protection against cancer, a diet rich in carotenoids from fruits and vegetables may protect against carcinogenesis.

The Fraction of Cancer Attributable to Ways of Life, Infections, Occupation, and Environmental Agents in Brazil in 2020

Many human cancers develop as a result of exposure to risk factors related to the environment and ways of life. The aim of this study was to estimate attributable fractions of 25 types of cancers resulting from exposure to modifiable risk factors in Brazil. The prevalence of exposure to selected risk factors among adults was obtained from population-based surveys conducted from 2000 to 2008. Risk estimates were based on data drawn from meta-analyses or large, high quality studies. Population-attributable fractions (PAF) for a combination of risk factors, as well as the number of preventable deaths and cancer cases, were calculated for 2020. The known preventable risk factors studied will account for 34% of cancer cases among men and 35% among women in 2020, and for 46% and 39% deaths, respectively. The highest attributable fractions were estimated for tobacco smoking, infections, low consumption of fruits and vegetables, excess weight, reproductive factors, and physical inactivity. This is the first study to systematically estimate the fraction of cancer attributable to potentially modifiable risk factors in Brazil. Strategies for primary prevention of tobacco smoking and control of infection and the promotion of a healthy diet and physical activity should be the main priorities in policies for cancer prevention in the country.

Influence of different body mass index cut-off values in assessing the nutritional status of adolescents in a household survey

The purpose of this study was to evaluate the anthropometric nutritional status of the adolescent population of Niterói, Rio de Janeiro State, Brazil, and the influence of changes in the adopted body mass index (BMI) cut-offs in the nutritional status assessment of the adolescent population. A population-based survey conducted in 2003 obtained data from a probabilistic sample of 1,734 households and 523 adolescents. The multiple proportions test and prevalence ratios were used to analyze differences between estimates obtained from different BMI cut-offs. Changes in cut-off values from the old to the new recommendation of the World Health Organization (WHO) resulted in a significant increase in overweight prevalence among total, male and female adolescent population (25%, 27% and 23%, respectively) (p < 0.05). There were significant increases in the prevalence of low-BMI-for-age among the total (29% increase) and male (39%) adolescent populations when the proposal of the International Obesity Task Force was compared to current WHO BMI-for-age cut-offs (p < 0.05). It is shown that a simple change in cut-off values used to define the anthropometric nutritional status can significantly modify the nutritional profile of an adolescent population.

Associação entre o estado nutricional antropométrico e a situação sócio-econômica de adolescentes em Niterói, Rio de Janeiro, Brasil

This study focused on the relationship between nutritional and socioeconomic status among adolescents in Niteroi, Rio de Janeiro State, Brazil. Data from 523 adolescents living in 1,734 households were collected from January to December 2003, from a total of 71,922 adolescents living in Niteroi. Subjects were selected through a probabilistic household sample. The analyses included the estimation of confidence intervals for prevalence ratios and proportional distributions and independence tests between categories of nutritional status and per capita family income and number of residents per household. There was a significant positive association between underweight/thinness and number of residents in the same household (male: p < 0.05; female: p < 0.001). Number of residents in the same household was positively associated with prevalence of underweight/thinness in adolescents. Overweight/obesity was positively associated with per capita family income.

Conflitos de interesse em alimentação e nutrição

The existence of conflicts of interest in the field of food and nutrition is not new, but has intensified and has been better documented during the past decade, in terms of both knowledge production and dissemination, and of policy formulation and management. Since the 1970s, more than eight thousand articles about conflicts of interest were published in health sciences reference databases (MEDLINE and LILACS). In contrast, only a few dozen food and/or nutrition-related articles were published during the past 20 years, three fourths of which in the last decade alone. The recent increase in documenting food and nutrition-related conflicts of interest is proportionally higher than what was observed for the overall publications in the same databases. This indicates that the conflicts intensified or that the recognition of conflicts as such expanded, and/or there was stronger motivation to make them visible. Both in knowledge production and dissemination and in the formulation of food and nutrition policies, the growth, intensification and increased visibility of the conflicts of interest, and lack of compliance with them are partially based on the increase of flaws in food systems, which prevent them from fulfilling their purpose of ensuring suitable, healthy food to the population. Therefore, in order to move forward in facing conflicts of interest in this field, it is necessary to recognize nutritional problems as expressions of flaws in the food system 1,2. It is thus possible to identify common, structural causes that account for different problems, such as obesity, micronutrient deficiencies, and other forms of malnutrition, therefore avoiding ineffective or palliative solutions. Moreover, it is necessary to identify and characterize the responsible for such flaws. There is broadly documented evidence that these dramatic changes in the food systems and in the feeding of populations have been imposed globally by large transnational corporations 1,2,3. Such changes affect the way food is produced, supplied, prepared and eaten, with the ultimate goal of generating wealth for these corporations and increasing their market share in a concentrated way (Table 1). Therefore, in addition to the nutritional problems they trigger, these corporations also cause an important negative effect on inequity, starting from the corporate environment itself. A study conducted in 2013 revealed that an employee of the McDonald’s Corporation in the United States needs to work 1,196 hours to receive the equivalent of one hour’s work of the company’s CEO 4. The socioeconomic, environmental and cultural impact 5,6 of this model imposed by such corporations also favors an increase in the recognition of conflicts that previously were not acknowledged as such. Therefore, the intensifi-

Políticas de promoção da saúde e potenciais conflitos de interesses que envolvem o setor privado comercial

This study analyzed potential conflicts of interest regarding the commercial private sector and health promotion policies, particularly their interface with the food and nutrition field in Brazil. The paper addresses the influence of international ideas in this process. The study analyzed the two separate publications of the Brazilian National Health Promotion Policy – of 2006, and of 2014 – and the international agreements that supported them. The method used was analysis of documents, with a categorization into the following dimensions and categories: In the dimension of the Ideas of health promotion, the focus items were the principles and the strategies proposed; In the dimension of conflicts of interest, these aspects were identified: the approach in the documents, relationships with the commercial private sector, and proposals referred to as ‘public-private partnerships’. It was concluded that these policies still adopt a fragile approach in terms of conflict of interest. The debate is de-politicized when the asymmetries of power between the sectors involved in the public-private relationships are not made explicit, or when the practices of the commercial private sector that harm objectives, principles and values of health promotion policies are left out of account.This study analyzed potential conflicts of interest regarding the commercial private sector and health promotion policies, particularly their interface with the food and nutrition field in Brazil. The paper addresses the influence of international ideas in this process. The study analyzed the two separate publications of the Brazilian National Health Promotion Policy – of 2006, and of 2014 – and the international agreements that supported them. The method used was analysis of documents, with a categorization into the following dimensions and categories: In the dimension of the Ideas of health promotion, the focus items were the principles and the strategies proposed; In the dimension of conflicts of interest, these aspects were identified: the approach in the documents, relationships with the commercial private sector, and proposals referred to as ‘public-private partnerships’. It was concluded that these policies still adopt a fragile approach in terms of conflict of interest. The debate is de-politicized when the asymmetries of power between the sectors involved in the public-private relationships are not made explicit, or when the practices of the commercial private sector that harm objectives, principles and values of health promotion policies are left out of account.

Lifestyle among former cancer patients in Brazil in 2013

People who have been diagnosed with cancer tend to adopt healthier lifestyles. This study analyzes the prevalence of smoking, eating fruits and vegetables, exercise and the use of alcoholic beverages among individuals who reported to have been diagnosed with cancer in the PNS (Pesquisa Nacional de Saúde or National Health Survey). The prevalence and corresponding 95% confidence intervals were calculated for consuming fruits and vegetables, sedentary lifestyle (no exercise), use of alcoholic beverages, being overweight and tobacco use. The associa-tion between having received a diagnosis of cancer and the risk and protection factors was analyzed using a Poisson regression, adjusted by sociodemographic variables and other chronic comorbidities. The analyses were stratified by time since the diagnosis and the type of cancer related to the factors analyzed. The types of cancer most often reported were breast and cervix in women, and prostate and stomach in men. Among those who had cancer diagnoses, there was a higher consumption of fruits and vegetables, higher proportion of ex-smokers, however, increased use of alcohol. There was no difference in the frequency of exercise or incidence of being overweight between the two groups. Measures to promote health and prevent chronic diseases should be implemented in the follow-up of people who have had cancer, in an effort to ensure integrated healthcare.