Jonas Augusto Cardoso da Silveira

Effectiveness of school-based nutrition education interventions to prevent and reduce excessive weight gain in children and adolescents: a systematic review.

OBJECTIVE To evaluate the effectiveness of school-based nutrition education in reducing or preventing overweight and obesity in children and adolescents. SOURCES Systematic search in 14 databases and five systematic reviews for randomized controlled trials conducted in schools to reduce or prevent overweight in children and adolescents. Body mass index and fruit and vegetable intake were used as primary and secondary measures of outcome, respectively. There was no restriction by date of publication or language, except for languages with structured logograms. We excluded studies on specific populations presenting eating disorders, dyslipidemia, diabetes, and physical or mental disabilities, as well as studies that used drugs or food supplements as components of the intervention. The assessment by title and abstract and the quality assessment were performed independently by two researchers. We used the Centre for Reviews and Disseminations guidance for undertaking reviews in health care and the software EPPI-Reviewer 3. SUMMARY OF THE FINDINGS From the initially retrieved 4,809 references, 24 articles met the inclusion criteria. The extracted data show that there is evidence of positive effects on anthropometry and of increase in fruit and vegetable consumption. Characteristics of the interventions that demonstrated effectiveness are: duration > 1 year, introduction into the regular activities of the school, parental involvement, introduction of nutrition education into the regular curriculum, and provision of fruits and vegetables by school food services. CONCLUSION Interventions in schools to reduce overweight and obesity, as well as to increase fruits and vegetable consumption, have demonstrated effectiveness in the best-conducted studies.

The effect of participation in school-based nutrition education interventions on body mass index: a meta-analysis of randomized controlled community trials

OBJECTIVE The aim of this study was to evaluate the effectiveness of school-based nutrition education interventions in reducing or preventing overweight and obesity among children and adolescents. METHODS We conducted a systematic search of 14 databases until May 2010 and cross-reference check in 8 systematic reviews (SRs) for studies published that described randomized controlled trials conducted in schools to reduce or prevent overweight in children and adolescents. An additional search was carried out using PubMed for papers published through May 2012, and no further papers were identified. Body mass index (BMI) was the primary outcome. The title and abstract review and the quality assessment were performed independently by two researchers. The software EPPI-Reviewer3 was used to store, manage and analyze all data. This SR is registered at ClinicalTrials.gov (NCT00985972). RESULTS From the 4888 references initially retrieved, only 8 met the eligibility criteria for a random-effects meta-analysis. The total population consisted of 8722 children and adolescents. Across the studies, there was an average treatment effect of -0.33 kg/m(2) (-0.55, -0.11 95% CI) on BMI, with 84% of this effect explained by the highest quality studies. CONCLUSION This systematic review provides evidence that school-based nutrition education interventions are effective in reducing the BMI of children and adolescents.

The effect of school-based physical activity interventions on body mass index: a meta-analysis of randomized trials

This study reviewed the effectiveness of school-based physical activity interventions aimed at reducing overweight, obesity and hypertension in children. We searched 14 databases and analyzed studies published between April 2009 and September 2012. Only randomized controlled trials performed at the school level that included elements of physical activity but did not include nutritional co-interventions were analyzed. Studies were assessed by two recommended tools (EPHPP and GRADE), and the standardized mean differences with 95% confidence intervals were collected for a random-effect meta-analysis. A total of 12 papers were included in the meta-analysis, and these were divided according to three outcomes: body mass index (11 trials, n  =  4,273, −0.02, 95% CI: −0.13 to 0.17, p  =  0.8); body weight (5 trials, n  =  1,330, −0.07, 95% CI: −0.18 to 0.04, p  =  0.2); and blood pressure (6 trials, n  =  1,549), including systolic (0.11, 95% CI: −0.10 to 0.31, p  =  0.3) and diastolic pressure (−0.00, 95% CI: −0.10 to 0.10, p  =  0.9). This meta-analysis of data from 11 randomized, school-based physical activity interventions suggests that, regardless of the potential benefits of physical activity in the school environment, the interventions did not have a statistically significant effect. However, it is difficult to generalize from these results because the duration, intensity and type of physical activity used in the interventions varied greatly.

Secular trends and factors associated with overweight among Brazilian preschool children: PNSN-1989, PNDS-1996, and 2006/07

Objective to describe the secular trends in overweight among preschool children in the years 1989, 1996, and 2006, and to identify risk factors associated with this condition in 2006.OBJECTIVE to describe the secular trends in overweight among preschool children in the years 1989, 1996, and 2006, and to identify risk factors associated with this condition in 2006. METHODS anthropometric data from three surveys (1989, 1996, and 2006) with a representative sample of the population were analyzed. Overweight was defined as the weight-for-height Z-score. The multivariable models of overweight association with risk factors were generated by Poisson regression, and the estimates were shown as prevalence ratios with their respective 95% confidence intervals (PR [95% CI]). RESULTS throughout the 17-year period studied, the relative prevalence of overweight in preschoolers increased by 160% in Brazil, representing an increase of 9.4% per year. Based on data from the National Survey on Demography and Health of Women and Children - 2006/07, four multivariable models were created (macro-environmental, maternal, individual, and final model) assuming hierarchy among the risk factors. In the final model, only the following remained associated with overweight: regions South/Southeast (1.55 [1.17 to 2.06]), middle-class (1.35 [1.02 to 1.77]), maternal obesity (1.66 [1.22 to 2.27]), birth weight ≥ 3.9kg (1.87 [1.31 to 2.67]), and being an only child or having only one sibling (1.81 [1.31 to 2.49]). CONCLUSION the prevalence of overweight among preschool children in Brazil has increased dramatically over the past 17 years, and it was higher in the 1996-2006 period. Future strategies for prevention and control of overweight in public health should focus or intensify actions in communities that are characterized by the presence of the risks identified in the present study.

Original articleSecular trends and factors associated with overweight among Brazilian preschool children: PNSN-1989, PNDS-1996, and 2006/07Tendência secular e fatores associados ao excesso de peso entre pré-escolares brasileiros: PNSN-1989, PNDS-1996 e 2006/07☆

Objective to describe the secular trends in overweight among preschool children in the years 1989, 1996, and 2006, and to identify risk factors associated with this condition in 2006.OBJECTIVE to describe the secular trends in overweight among preschool children in the years 1989, 1996, and 2006, and to identify risk factors associated with this condition in 2006. METHODS anthropometric data from three surveys (1989, 1996, and 2006) with a representative sample of the population were analyzed. Overweight was defined as the weight-for-height Z-score. The multivariable models of overweight association with risk factors were generated by Poisson regression, and the estimates were shown as prevalence ratios with their respective 95% confidence intervals (PR [95% CI]). RESULTS throughout the 17-year period studied, the relative prevalence of overweight in preschoolers increased by 160% in Brazil, representing an increase of 9.4% per year. Based on data from the National Survey on Demography and Health of Women and Children - 2006/07, four multivariable models were created (macro-environmental, maternal, individual, and final model) assuming hierarchy among the risk factors. In the final model, only the following remained associated with overweight: regions South/Southeast (1.55 [1.17 to 2.06]), middle-class (1.35 [1.02 to 1.77]), maternal obesity (1.66 [1.22 to 2.27]), birth weight ≥ 3.9kg (1.87 [1.31 to 2.67]), and being an only child or having only one sibling (1.81 [1.31 to 2.49]). CONCLUSION the prevalence of overweight among preschool children in Brazil has increased dramatically over the past 17 years, and it was higher in the 1996-2006 period. Future strategies for prevention and control of overweight in public health should focus or intensify actions in communities that are characterized by the presence of the risks identified in the present study.

Physical activity and nutrition education at the school environment aimed at preventing childhood obesity: evidence from systematic reviews

OBJECTIVE To organize the main findings and list the most frequent recommendations from systematic reviews of interventions developed at the school environment aimed at reducing overweight in children and adolescents. DATA SOURCE Searches for systematic reviews available until December 31, 2014 were conducted in five electronic databases: Cochrane, PubMed, SciELO, SPORTDiscus, and Web of Science. Manual search for cross-references were also performed. SUMMARY OF THE FINDINGS Of the initial 2139 references, 33 systematic reviews adequately met the inclusion criteria and were included in the descriptive summary. In this set, interventions with periods of time greater than six months in duration (nine reviews), and parental involvement in the content and/or planned actions (six reviews) were identified as the most frequent and effective recommendations. Additionally, it was observed that boys respond more effectively to structural interventions, whereas girls respond to behavioral interventions. None of the included reviews was able to make inferences about the theoretical basis used in interventions as, apparently, those in charge of the interventions disregarded this component in their preparation. CONCLUSIONS Although the summary identified evidence with important applications in terms of public health, there are still gaps to be filled in this field of knowledge, such as the effectiveness of different theoretical models, the identification of the best strategies in relation to gender and age of participants and, finally, the identification of moderating variables to maximize the benefits provided by the interventions.

The role of exclusive breastfeeding and sugar-sweetened beverage consumption on preschool children's weight gain.

Sugar‐sweetened beverages (SSBs) and breastfeeding practices have been recognized as important factors linked to childrens weight status. However, no other studies have simultaneously investigated the role of each factor on childrens conditional weight gain (CWG).

Insegurança alimentar em domicílios brasileiros com crianças menores de cinco anos

This article analyzes food insecurity and hunger in Brazilian families with children under five years of age. This was a nationally representative cross-sectional study using data from the National Demographic and Health Survey on Women and Children (PNDS-2006), in which the outcome variable was moderate to severe food insecurity, measured by the Brazilian Food Insecurity Scale (EBIA). Prevalence estimates and prevalence ratios were generated with 95% confidence intervals. The results showed a high prevalence of moderate to severe food insecurity, concentrated in the North and Northeast regions (30.7%), in economic classes D and E (34%), and in beneficiaries of conditional cash transfer programs (36.5%). Multivariate analysis showed that the socioeconomic relative risks (beneficiaries of conditional cash transfers), regional relative risks (North and Northeast regions), and economic relative risks (classes D and E) were 1.8, 2.0 and 2.4, respectively. Aggregation of the three risks showed 48% of families with moderate to severe food insecurity, meaning that adults and children were going hungry during the three months preceding the survey.This article analyzes food insecurity and hunger in Brazilian families with children under five years of age. This was a nationally representative cross-sectional study using data from the National Demographic and Health Survey on Women and Children (PNDS-2006), in which the outcome variable was moderate to severe food insecurity, measured by the Brazilian Food Insecurity Scale (EBIA). Prevalence estimates and prevalence ratios were generated with 95% confidence intervals. The results showed a high prevalence of moderate to severe food insecurity, concentrated in the North and Northeast regions (30.7%), in economic classes D and E (34%), and in beneficiaries of conditional cash transfer programs (36.5%). Multivariate analysis showed that the socioeconomic relative risks (beneficiaries of conditional cash transfers), regional relative risks (North and Northeast regions), and economic relative risks (classes D and E) were 1.8, 2.0 and 2.4, respectively. Aggregation of the three risks showed 48% of families with moderate to severe food insecurity, meaning that adults and children were going hungry during the three months preceding the survey.

Association between socioeconomic and biological factors and infant weight gain: Brazilian Demographic and Health Survey – PNDS-2006/07

OBJECTIVE To examine the associations between socioeconomic and biological factors and infant weight gain. METHODS All infants (0-23 months of age) with available birth and postnatal weight data (n = 1763) were selected from the last nationally representative survey with complex probability sampling conducted in Brazil (2006/07). The outcome variable was conditional weight gain (CWG), which represents how much an individual has deviated from his/her expected weight gain, given the birth weight. Associations were estimated using simple and hierarchical multiple linear regression, considering the survey sampling design, and presented in standard deviations of CWG with their respective 95% of confidence intervals. Hierarchical models were designed considering the UNICEF Conceptual Framework for Malnutrition (basic, underlying and immediate causes). RESULTS The poorest Brazilian regions (-0.14 [-0.25; -0.04]) and rural areas (-0.14 [-0.26;-0.02]) were inversely associated with CWG in the basic causes model. However, this association disappeared after adjusting for maternal and household characteristics. In the final hierarchical model, lower economic status (-0.09 [-0.15; -0.03]), human capital outcomes (maternal education < 4th grade (-0.14[-0.29; 0.01]), higher maternal height (0.02[0.01; 0.03])), and fever in the past 2 weeks (-0.13[-0.26; -0.01]) were associated with postnatal weight gain. CONCLUSION The results showed that poverty and lower human capital are still key factors associated with poor postnatal weight gain. The approach used in these analyses was sensitive to characterize inequalities among different socioeconomic contexts and to identify factors associated with CWG in different levels of determination.

Food Insecurity and the Negative Impact on Brazilian Children's Health-Why Does Food Security Matter for Our Future Prosperity? Brazilian National Survey (PNDS 2006/07).

Background: Food insecurity (FI) refers to limited or uncertain access to food resulting from financial constraints. Numerous studies have shown association between FI and adverse health outcomes among adults and children around the world, but in Brazil, such information is scarce, especially if referring to nationally representative information. Objective: To test for an independent association between FI and health outcomes. Methods: Most recent Brazilian Demographic and Health Survey using nationally representative complex probability sampling. Participants were 3923 children <5 years of age, each representing a household. Data from the validated Brazilian Food Insecurity Scale were dichotomized as food secure (food security/mild FI) or food insecure (moderate FI/severe FI). Poisson regression was used to test for associations between FI and various health indicators. Results: Models adjusted for socioeconomic and demographic variables showed that children hospitalized for pneumonia or diarrhea were 30% more prevalent in FI households (adjusted prevalence ratio [aPR]: 1.3; 1.1-1.6). Underweight children were 40% more prevalent in FI households (aPR: 1.4; 1.1-1.7). Children who didn’t eat meat and fruits and vegetables every day were 20% and 70% more prevalent in FI households (aPR: 1.2; 1.1-1.4 and aPR: 1.7; 1.3-2.3), respectively. Conclusion: Children who grow up in food-insecure households have been shown to have worse health conditions than those in food-secure households. Consequently, their human capital accumulation and work–life productivity are likely to be reduced in the future, leading them into adulthood less capable of generating sufficient income, resulting in a cycle of intergenerational poverty and FI.