Natacha Toral

A desnutrição e obesidade no Brasil: o enfrentamento com base na agenda única da nutrição

Brazil, like other developing countries, is currently experiencing a nutritional transition that is often determined by poor eating. Population-based surveys have shown a continuing downward trend in undernutrition in this country, together with increases in excess weight at different stages of life. Monitoring the nutritional profile helps generate an attitude of surveillance and orientation of health promotion activities. The Family Health Strategy, together with various situational aspects in Brazil, has shown tangible results in the reduction of undernutrition; still, poor eating has played a major role in the increased prevalence of obesity and other chronic non-communicable diseases, besides having a heavy impact on individual quality of life and placing a significant burden on the Unified National Health System. Intervening in this contemporary public health dilemma requires prioritizing a unified nutritional agenda focused on the entire course of life, breaking the vicious circle that begins during the intrauterine period and lasts throughout life.

Consumo de doces, refrigerantes e bebidas com adição de açúcar entre adolescentes da rede pública de ensino de Piracicaba, São Paulo

OBJETIVO: Descrever as praticas alimentares de adolescentes quanto a ingestao energetica, distribuicao de macronutrientes na dieta e porcoes consumidas de doces, refrigerantes e bebidas com adicao de acucar. METODOLOGIA: Foi avaliada uma amostra de adolescentes matriculados em escolas da rede publica de ensino de Piracicaba, Sao Paulo. O consumo alimentar foi avaliado por um Questionario de Frequencia Alimentar. Para a comparacao do consumo com a recomendacao de ingestao de energia e de macronutrientes, utilizaram-se as Dietary Reference Intakes. A analise do consumo de doces baseou-se nas recomendacoes do guia alimentar norte-americano. Dados de consumo de refrigerantes e bebidas com adicao de acucar foram avaliados em comparacao com outros estudos. RESULTADOS: O estudo incluiu 390 adolescentes. Apenas 6,2% destes apresentaram consumo energetico em conformidade com o intervalo preconizado e 83,8% revelaram ingestao energetica acima dos valores propostos. Expressiva parcela apresentou consumo de carboidratos e proteinas de acordo com o recomendado, mas foi verificado consumo alto de lipidios em 36,7% da amostra. Comprovou-se um consumo medio de 3,8 porcoes diarias de doces, sendo que 78,2% dos entrevistados ultrapassaram a recomendacao maxima. O consumo medio diario alcancou aproximadamente 230ml e 550ml de refrigerante e bebidas com adicao de acucar, respectivamente. CONCLUSAO: Devido a alarmante inadequacao das praticas alimentares observadas entre os adolescentes, devem ser adotadas estrategias educativas que enfatizem a reducao do consumo de acucares e os beneficios da adocao de uma dieta equilibrada.

Comportamento alimentar de adolescentes em relação ao consumo de frutas e verduras

Observou-se baixa prevalencia de desvios nutricionais entre os 234 participantes: 3,8% foram classificadoscomo baixo peso e 12,4% apresentavam excesso de peso. Apenas 12,4% e 10,3% consumiam frutas everduras, respectivamente, conforme o recomendado pela Pirâmide Alimentar. Cerca de um terco da amostrafoi classificada tanto em pre-contemplacao como em manutencao. Observou-se uma discrepância entre oconsumo referido e a percepcao alimentar, tendo em vista que 79,7% e 83,7% dos adolescentes acreditavam,erroneamente, que seu consumo de frutas e verduras, respectivamente, era saudavel.

Abordagem do modelo transteórico no comportamento alimentar

The study of eating behavior has been much interest, as this is an essential element for the success of dietary interventions. In view of the complexity of the subject and the countless influences to which it is subject, it is suggested that an in-depth exploration of eating behavior determinants enhances the impact of programs promoting healthy dietary practices. Increasingly more frequent, the adoption of inadequate diets in Brazil and elsewhere in the world leads to questions about the impact of dietary interventions traditionally applied to population groups. Many nutritional education strategies are currently described in the literature; however, motivating people to change their eating habits is still a major public health challenge. Applying the transtheoretical model seems to have a promising role for an enhanced understanding of changes in eating habits that are targeted by dietary interventions. Strategies that are tailored to each step in these changes, as identified by this theory, can motivate people more effectively to adopt healthier eating habits.

A alimentação saudável na ótica dos adolescentes: percepções e barreiras à sua implementação e características esperadas em materiais educativos

The aim of this study was to evaluate perceptions, barriers, and characteristics of teaching materials to promote healthy eating, as described by teenagers. Four focus groups were conducted with 25 adolescents, including questions on: perceptions regarding diet and motivations to change; concepts of (and barriers to) healthy eating; and characteristics needed for teaching materials to promote healthy eating. The teens were often undecided when attempting to classify a diet as healthy. They generally reported feeling insecure about making dietary changes, but showed adequate notions of healthy eating. The main barriers involved personal and social characteristics: temptation, food flavors, parental influence, and lack of time and options for healthy snacks at school. According to these teenagers, educational materials for promotion of healthy eating should emphasize the immediate benefits and emphasize high-impact messages on the health risks of unhealthy diet.

A organização da Vigilância Alimentar e Nutricional no Sistema Único de Saúde: histórico e desafios atuais

The National Food and Nutrition Policy emphasizes the importance of the Food and Nutritional Surveillance System (SISVAN), which has the purpose of determining descriptive and analytical diagnoses of the food and nutritional status of the Brazilian population. It thus contributes towards providing knowledge on the nature and magnitude of the countrys nutritional problems. The present paper aimed to present the history of food and nutritional surveillance actions in Brazil, from the time of concept design to current practice. The surmounting limitations encountered over the years, strengthening obtained through legal milestones and challenges currently faced are highlighted. The view taken is that SISVAN can only be managed today through a combination of strategies. Of these, the main ones are the SISVAN information technology system, population-based surveys, Nutrition Days, and analysis of national healthcare databases, along with access to scientific production and funding for research on the topic.

Perception of eating practices and stages of change among Brazilian adolescents.

OBJECTIVE To evaluate the perception of eating practices and the stages of change among adolescents. METHODS Cross-sectional study involving a representative sample of 390 adolescents from 11 public schools in the city of Piracicaba, Brazil, in 2004. Food consumption was identified by a food frequency questionnaire and the perception of eating practices evaluation was conducted by comparing food consumption and individual classification of healthy aspects of the diet. The participants were classified within stages of change by means of a specific algorithm. A reclassification within new stages of change was proposed to identify adolescents with similar characteristics regarding food consumption and perception. RESULTS Low consumption of fruit and vegetables and high consumption of sweets and fats were identified. More than 44% of the adolescents had a mistaken perception of their diet. A significant relationship between the stages of change and food consumption was observed. The reclassification among stages of change, through including the pseudo-maintenance and non-reflective action stages was necessary, considering the high proportion of adolescents who erroneously classified their diets as healthy. CONCLUSION Classification of the adolescents into stages of change, together with consumption and perception data, enabled identification of groups at risk, in accordance with their inadequate dietary habits and non-recognition of such habits.

Perfil da alimentação oferecida em instituições geriátricas do Distrito Federal

OBJECTIVE: To evaluate institutional feeding, meal production facilities and the inclusion of healthcare professionals in elderly homes of Distrito Federal. METHODS: This is a descriptive and cross-sectional study that was carried out in five elderly homes. Two hundred forty-four seniors were included, corresponding to 25% of the institutionalized seniors in Distrito Federal in 2002. The meal production facility was evaluated based on its hygienic and environmental-structural conditions. The inclusion of healthcare professionals among the staff of the elderly homes, the number of meals offered daily, the meal consistency options and the presence of a printed weekly menu were investigated. A qualitative evaluation of the nutritional adequacy of the institutional feeding was done based on the Food Guide Pyramid recommendations. RESULTS: Precarious hygienic and environmental-structural conditions were identified. Healthcare professionals were scarce in all homes. Most homes offered five daily meals with two consistency options: normal and semi-liquid. Only two homes had a printed weekly menu. The nutritional evaluation of meals showed that the most inadequate percentages of food groups offered were vegetables, with a median offer of only 53% of the recommendation, followed by fruits, with 60% of the recommendation. The offered percentage of the oil and fat group was considered excessive (120% of the recommendation). CONCLUSION: Abundant inadequate factors in meal production facilities, the poor inclusion of healthcare professionals and the imbalance in the food groups offered point to a worrying situation for the quality of life of institutionalized seniors in Distrito Federal.

Validity and reliability of self-reported weight and height measures for the diagnoses of adolescent's nutritional status

PURPOSE: To assess the validity and reliability of self-reported height, weight, and Body Mass Index (BMI) to diagnose the nutritional status of adolescents. METHODS: The study included 360 public school students of both genders, with ages ranging from 10 to 15 years. Adolescents self-reported their weight and height, and these values were later obtained directly by interviewers. The validity of BMI based on self-reported measures was calculated using sensitivity and specificity indexes, and positive predictive value (PPV). Agreement between self-reported and measured BMI was evaluated using Kappas weight coefficient, the Lin correlation coefficient, and Bland-Altman and Lins plots. RESULTS: Both girls and boys underestimated their weight (-1.0 girls and boys) and height (girls - 1.2 and boys - 0.8) (p < 0.001). BMI presented moderate agreement between measured and self-reported values. Sensitivity of estimated BMI based on reported measures to classify obese subjects was higher for boys (87.5%) than it was for girls (60.9%), whereas specificity was higher for girls (92.7%) than it was for boys (80.6%). PPV was high only for classification of normal-weight adolescents. CONCLUSIONS: Self-reported measures of weight and height in adolescents do not present valid measures; therefore, they should not be used to replace measured values. Additionally, we observed that 10% of obese boys and 40% of obese girls could have remained unidentified if we had used only self-reported measures, emphasizing the effects of the low reliability of self-reporting.

Maternal perception of children's nutritional status in the Federal District, Brazil

Maternal perception of childs nutritional status has a potential impact on the identification, prevention, and treatment of childhood overweight. Thus, the aim of this study was to evaluate the prevalence of misperception and factors associated with maternal perception of the nutritional status of first- to third-grade elementary school students from private schools in the Federal District, Brazil. This cross-sectional study was conducted with 554 mother-child pairs. Childrens nutritional status was assessed by measuring their weight and height. The mothers completed an online questionnaire about sociodemographic data, maternal nutritional status, maternal perception of her own nutritional status (silhouette scale for female adults), and maternal perception of childs nutritional status (silhouette scale for children). Only 30.0% of the mothers were successful in choosing the most appropriate silhouette to represent childs nutritional status. Highly educated mothers (Adjusted OR = 1.51) and mothers of male children (Adjusted OR = 2.53) or of non-overweight children (Adjusted OR = 1.65) were more likely to underestimate childs nutritional status. Conversely, mothers below 35 years of age (Adjusted OR = 1.85) and mothers of female children (Adjusted OR = 2.24) or of overweight children (Adjusted OR = 1.94) were more likely to overestimate childs nutritional status. There was a high prevalence of misperception, which shows the need for interventions for children that take into account the relevance of mothers role and the adequate recognition of childs nutritional status.