Rita de Cássia Akutsu

Adequação das boas práticas de fabricação em serviços de alimentação

Objective: classify a sample of 50 food producing establishments located in the Federal District (Brasilia, Brazil), according to their fulfillment of essential requisites contained in the sanitary regulation form published by the Agencia Nacional de Vigilância Sanitaria, Brazil’s National Agency for Sanitary Regulation. Methods: a metanalysis of two monographic studies on food production establishments (hotels and commercial restaurants) was performed, and associated to results of these authors’ research evaluating ten Foodservice and Nutrition Units led by nutritionists, and five commercial restaurants. The procedures for good manufacturing were evaluated according to the norms of the mentioned Agency; to this effect, the Agency’s specific forms were utilized to analyze the adequacy of requisites such as: construction, equipments, handling, production flow, and availability of the manual for good manufacturing procedures. Still according to the Agency’s norms, the establishments were further classified into three groups, respective to their fulfillment of the essential requisite items and procedures as defined in the form: in group I, were those establishments fulfilling more than 70% of the requisites; group II, fulfilling 30 to 69.9% of them; and group III, fulfilling less than 30% of the essential items and procedures. Results: according to the analyses, all the hotel foodservices were classified in group II, while the commercial restaurants were classified either in group II (33.3%) or in group III (66.7%). As for the Foodservice and Nutrition Units with a nutritionist, 80% were classified as group II, and 20%, as group I. Conclusion: the results indicate that the Nutrition and Foodservice Units, which had nutritionists available, were better classified in requisites such as equipments and availability of a manual of good manufacturing procedures. The hotels revealed better conditions on items such as construction, manipulation and production flow. The commercial restaurants obtained the worst results when compared to the other food production services.

Atitudes de risco do consumidor em restaurantes de auto-serviço

OBJECTIVE: The objective of this study is to evaluate the possible forms of food contamination by the costumer during the distribution period. METHODS: Data collection was performed in 10 food service units in Distrito Federal via direct observation of 12 risk attitudes (n=3,447) between October 2003 and September 2004. The risk attitudes were observed during the peak hour of each restaurant; the sample was systematized for each 5 consumers. The data collection instrument related the possible risk attitudes of the consumers while serving themselves. RESULTS: The obtained results demonstrate that there is a probability of contamination of the food by the consumers in restaurants, especially because 96% of the observed individuals did not wash their hands before serving themselves. Furthermore, 50% of the consumers were not concerned with the exclusive use of utensils, while 56% talked about the foods. CONCLUSION: The obtained data show that there is a need to improve the consumers awareness, especially in self-service restaurants. Food contamination by consumers needs to be prevented in order to avoid food intoxication.

A ficha técnica de preparação como instrumento de qualidade na produção de refeições

As profundas transformacoes nos metodos e tecnologias de trabalho tem gerado mudancas no processo de producao de refeicoes. A ficha tecnica de preparacao foi objeto de uma analise, na perspectiva de discuti-la como instrumento de qualidade na producao de refeicoes. Foram utilizadas bases de dados, livros e formas eletronicas de artigos para a pesquisa bibliografica. A compreensao de que o nutricionista, na condicao de profissional de saude, possui como atribuicao a atencao dietetica, e de que esta deve estar associada a racionalizacao e a otimizacao do processo de producao de refeicao, seguindo principios dieteticos, faz com que a Ficha Tecnica de Preparo seja um instrumento de promocao a saude. Sua construcao como ferramenta de atencao dietetica e, portanto, um dos desafios com vistas a necessaria mudanca de atitude dos profissionais, no que tange ao aprendizado e a aplicacao de novas tecnologias, e ao fornecimento de alimento seguro.As profundas transformacoes nos metodos e tecnologias de trabalho tem gerado mudancas no processo de producao de refeicoes. A ficha tecnica de preparacao foi objeto de uma analise, na perspectiva de discutila como instrumento de qualidade na producao de refeicoes. Foram utilizadas bases de dados, livros e formas eletronicas de artigos para a pesquisa bibliografica. A compreensao de que o nutricionista, na condicao de profissional de saude, possui como atribuicao a atencao dietetica, e de que esta deve estar associada a racionalizacao e a otimizacao do processo de producao de refeicao, seguindo principios dieteticos, faz com que a Ficha Tecnica de Preparo seja um instrumento de promocao a saude. Sua construcao como ferramenta de atencao dietetica e, portanto, um dos desafios com vistas a necessaria mudanca de atitude dos profissionais, no que tange ao aprendizado e a aplicacao de novas tecnologias, e ao fornecimento de alimento seguro. Termos de indexacao: ficha tecnica de preparacao, padronizacao, qualidade, servicos de alimentacao. A B S T R A C T

Development of a tool for quality control audits in hospital enteral nutrition

BACKGROUND AND AIMS Malnutrition is very prevalent in hospitals, causing physical capacity deterioration, increasing complications and raising mortality. This scenario overloads public health costs enormously. Enteral nutrition (EN) is the first option to fight against malnutrition. Nutrition support teams (NST) work combating such conditions, promoting humanization, but also analyzing the cost benefit of EN therapy. Brazil is one of the first Latin American countries to develop EN laws. Quality control it is in the core of this legal instrument, playing an essential role in NST`s task of providing care. Nowadays, tools to access quality control represent a gap in the area. The aim of this study was to develop a quality control tool, according to Brazilian law for EN Therapy regarding multidisciplinary approach, good practices, standard operating procedures, protocol implementation, proper registration and electronic health record. METHODS A content validation method was utilized in this four stages development process: bibliographic research, expert opinion (subjective), semantic evaluation and expert opinion (objective). In the latter stage ten specialists, expressed their opinion, evaluating the tools by four different attributes: utility, simplicity, objective and low cost on a 5-point Likert scale (1-5). RESULTS We elaborate three independent tools that together, represent the whole evaluation process, named: NST Activities, EN Preparation and EN Administration. Content Validation Index to the four different attributes ranged form 0,9 to 1. CONCLUSION This tool had positive approval from experts and is of great value guiding hospital audits, or even serving as checklist to implement a plan on EN therapy.

Validation of a quantitative food frequency questionnaire developed to under graduate students

A validity test of a Food Frequency Questionnaire was carried out using 50 students of health occupation in São Paulo, Brazil. Therefore, a three day dietary record was used as reference method and variables such as energy, macronutrients and dietary fiber were analyzed. The accordance between the Food Frequency Questionnaire and average data from dietary record was tested with kappa statistics and intra-class correlation coefficients (ICC). Limits of agreement were estimated by the Bland-Altmans method. Better results were found for calories (ICC 0.43; 95%CI 0.17 - 0.63) and non-energy-adjusted nutrients, except dietary fiber (ICC 0.34; 95%CI 0.07 - 0.56). The percentage of individuals classified in the same category of consumption was nearly half (49.8%), while only 16% of them were classified in opposite categories. With the exception of lipids, other analyzed variables tended to be overestimated by the Food Frequency Questionnaire. The Food Frequency Questionnaire is recommended as a method of assessing food intake of university students in studies which focus on calorie estimates and also intend to classify groups into intake categories.

Perfil e situação de insegurança alimentar dos usuários dos Restaurantes Populares no Brasil

This study aimed to characterize users of a government soup-kitchen program and the association with family food insecurity, using a cross-sectional design and random sample of 1,637 soup-kitchen users. The study used a questionnaire with socioeconomic variables and the Brazilian Food Insecurity Scale, and measured weight and height. The chi-square test was applied, and the crude and adjusted prevalence ratios (PR) were calculated using Poisson regression. Prevalent characteristics included per capita income ranging from one-half to one minimum wage (35.1%), complete middle school (39.8%), and food security (59.4%). Users in the North of Brazil showed the worst data: incomplete primary school (39.8%), per capita income up to one-half the minimum wage (50.8%), and food insecurity (55.5%). Prevalence ratios for food insecurity were higher among users with per capita income up to one-fourth the minimum wage (p < 0.05). Income was the only variable that remained associated with higher prevalence of food insecurity in the adjusted PR. Knowing the characteristics of soup-kitchen users with food insecurity can help orient the programs work, location, and operations.O objetivo foi identificar o perfil dos usuarios do programa Restaurantes Populares e suas associacoes com a situacao de inseguranca alimentar domiciliar. Trata-se de estudo transversal com amostra aleatoria de 1.637 usuarios. Foi utilizado um questionario com variaveis socioeconomicas, a Escala Brasileira de Inseguranca Alimentar e aferidos peso e altura. Foram aplicados o teste de qui- quadrado, calculo das razoes de prevalencia (RP) bruta e ajustada, utilizando-se o modelo de regressao de Poisson. Foram prevalentes a faixa de renda per capita entre ½ e 1 salario minimo (35,1%), o Ensino Medio completo (39,8%) e a seguranca alimentar (59,4%). Os usuarios da Regiao Norte apresentaram os piores dados: Ensino Fundamental incompleto (39,8%), faixa de renda per capita de ate ½ salario minimo (50,8%) e inseguranca alimentar (55,5%). Houve maior RP de inseguranca alimentar entre os usuarios que apresentaram renda per capita de ate ¼ do salario minimo (p < 0,05). Apenas renda manteve-se associada a maior prevalencia de inseguranca alimentar na RP ajustada. As caracteristicas dos usuarios em inseguranca alimentar podem orientar a melhoria desta acao, os criterios de localizacao e funcionamento do Programa Restaurantes Populares.

Conformity of food service units with legislation

ABSTRACT The objective of this study was to evaluate the conformity of Brazilian food service units (FSUs) to their adequacy to Brazilian legislation. Thirty-seven FSUs participating in a Brazilian public social program in 2010 and distributed proportionally among the five geographic regions of Brazil were the sample. An evaluation instrument was constructed to assess the adequacy of them to legislation. The data indicate that water supply and sewage had the highest percentage of satisfactory results (54%), followed by production and transport of food (35.1%). Buildings and procedures fell into the range of satisfactory with restrictions, while items related to hygiene, distribution area, documentation were classified as unsatisfactory. There was a significant difference between the group items when considering the management model. Of the managers, 56.8% stated that the legal obligation is very important. The FSUs did not meet the requirements for the implementation of food safety, although managers consider meals safe production important.

Acceptability of Reduced-Fat and Fried-Food-Free Menu in Self-Service Restaurant

ABSTRACT The main purpose of this study was to determine how the reduction of fat content in meals affects food acceptability in a self-service restaurant. Technical Preparation Files and combined ovens were used to modify the menu. The 14-month trial was divided in two phases, in which 75 clients evaluated the menu, without knowing the changes. Flavor, texture, appearance and global quality were measured using a 7-point hedonic scale. Principal and Hierarchical Factor Analysis as well as Fischer-test (? = .05) were used to test differences in acceptance proportion. The reduction of added fat (up to 2%) and the removal of fried food resulted in an equivalent/higher acceptance (from 71 ± 8 to 86 ± 7), whereas the rejection proportion decreased. The mean acceptance score, in both phases, was satisfactory for all dishes. Hence, it was concluded that the reduction of added fat and the use of combined ovens resulted in a better acceptance of the menu.

Regional Food Consumption in the Northeast of Brazil by the Low-Income Population

ABSTRACT Brazilian foods have been influenced by many cultures, colonizers, slaves, and native indians. Tracing the regional foods is important to analyze diets and discuss food culture. Objective: to evaluate the frequency and variety of regional foods consumed by Brazilians from the Northeast, users of a government program. Methods: This exploratory study analyzed food intake of low-income customers eating in community restaurants. 753 individuals participated, representing a sampling error smaller than 3.5% for national representativeness. The 24HR was used at the restaurants on two weekdays and one weekend day. Results Customers consumed 47 different regional preparations. The prefered ones were cuscuz, baião dois, and tapioca. Food intake was higher at dinner. An average of 1.3 regional preparations were consumed, for each 10 preparations. Conclusion: The mean consumption of regional foods was low. It may reveal higher intakes of ready-to-eat. Even this population does not take the time to prepare regional foods.

Socio-demographic and food insecurity characteristics of soup-kitchen users in Brazil

This study aimed to characterize users of a government soup-kitchen program and the association with family food insecurity, using a cross-sectional design and random sample of 1,637 soup-kitchen users. The study used a questionnaire with socioeconomic variables and the Brazilian Food Insecurity Scale, and measured weight and height. The chi-square test was applied, and the crude and adjusted prevalence ratios (PR) were calculated using Poisson regression. Prevalent characteristics included per capita income ranging from one-half to one minimum wage (35.1%), complete middle school (39.8%), and food security (59.4%). Users in the North of Brazil showed the worst data: incomplete primary school (39.8%), per capita income up to one-half the minimum wage (50.8%), and food insecurity (55.5%). Prevalence ratios for food insecurity were higher among users with per capita income up to one-fourth the minimum wage (p < 0.05). Income was the only variable that remained associated with higher prevalence of food insecurity in the adjusted PR. Knowing the characteristics of soup-kitchen users with food insecurity can help orient the programs work, location, and operations.O objetivo foi identificar o perfil dos usuarios do programa Restaurantes Populares e suas associacoes com a situacao de inseguranca alimentar domiciliar. Trata-se de estudo transversal com amostra aleatoria de 1.637 usuarios. Foi utilizado um questionario com variaveis socioeconomicas, a Escala Brasileira de Inseguranca Alimentar e aferidos peso e altura. Foram aplicados o teste de qui- quadrado, calculo das razoes de prevalencia (RP) bruta e ajustada, utilizando-se o modelo de regressao de Poisson. Foram prevalentes a faixa de renda per capita entre ½ e 1 salario minimo (35,1%), o Ensino Medio completo (39,8%) e a seguranca alimentar (59,4%). Os usuarios da Regiao Norte apresentaram os piores dados: Ensino Fundamental incompleto (39,8%), faixa de renda per capita de ate ½ salario minimo (50,8%) e inseguranca alimentar (55,5%). Houve maior RP de inseguranca alimentar entre os usuarios que apresentaram renda per capita de ate ¼ do salario minimo (p < 0,05). Apenas renda manteve-se associada a maior prevalencia de inseguranca alimentar na RP ajustada. As caracteristicas dos usuarios em inseguranca alimentar podem orientar a melhoria desta acao, os criterios de localizacao e funcionamento do Programa Restaurantes Populares.