The Brazilian Cardioprotective Nutritional Program to reduce events and risk factors in secondary prevention for cardiovascular disease: study protocol (The BALANCE Program Trial).

This article reports the rationale for the Brazilian Cardioprotective Nutritional Program (BALANCE Program) Trial. This pragmatic, multicenter, nationwide, randomized, concealed, controlled trial was designed to investigate the effects of the BALANCE Program in reducing cardiovascular events. The BALANCE Program consists of a prescribed diet guided by nutritional content recommendations from Brazilian national guidelines using a unique nutritional education strategy, which includes suggestions of affordable foods. In addition, the Program focuses on intensive follow-up through one-on-one visits, group sessions, and phone calls. In this trial, participants 45 years or older with any evidence of established cardiovascular disease will be randomized to the BALANCE or control groups. Those in the BALANCE group will receive the afore mentioned program interventions, while controls will be given generic advice on how to follow a low-fat, low-energy, low-sodium, and low-cholesterol diet, with a view to achieving Brazilian nutritional guideline recommendations. The primary outcome is a composite of death (any cause), cardiac arrest, acute myocardial infarction, stroke, myocardial revascularization, amputation for peripheral arterial disease, or hospitalization for unstable angina. A total of 2468 patients will be enrolled in 34 sites and followed up for up to 48 months. If the BALANCE Program is found to decrease cardiovascular events and reduce risk factors, this may represent an advance in the care of patients with cardiovascular disease.

Effects of Brazilian Cardioprotective Diet Program on risk factors in patients with coronary heart disease: a Brazilian Cardioprotective Diet randomized pilot trial.

OBJECTIVE: To evaluate the effectiveness of the Brazilian Cardioprotective Diet Program in reducing blood pressures, fasting glucose levels and body mass indices in patients with established atherothrombotic disease. METHOD: This randomized controlled pilot trial included outpatients who were over 45 years of age with atherothrombotic cardiovascular disease. Group A, who received the Brazilian Cardioprotective Diet Program, had weekly sessions with dietitians. Groups B and C received the usual dietary therapy that is given to patients with cardiovascular diseases as proposed by the Brazilian guidelines. This diet had the same nutrient profile as that given to Group A, but it was customized by the integration of typical Mediterranean foods. The difference between Groups B and C was the number of sessions with the dietitian. Group B received weekly sessions, while group C only had monthly sessions. ClinicalTrials.gov: NCT 01453166. RESULTS: There was a greater reduction in systolic (7.8%) and diastolic (10.8%) blood pressures in Group A compared with Group B (2.3% and 7.3%), and Group C (3.9% and 4.9%, respectively). Fasting glucose decreased by 5.3% and 2% in Groups A and B, respectively. Fasting glucose increased by 3.7% in Group C. The BMIs decreased by 3.5% and 3.3% in Groups A and B, respectively. Group C did not present with any changes in BMI. However, none of these data showed statistical differences between the groups, which is methodologically acceptable in pilot trials. CONCLUSIONS: The Brazilian Cardioprotective Diet Program seems to be more effective in reducing blood pressures, fasting glucose levels, weights and BMIs in patients with previous cardiovascular disease compared with the diet that has been proposed by the Brazilian guidelines.

Impact of actions of food and nutrition education program in a population of adolescents / Impacto das ações de um programa de educação alimentar e nutricional em uma população de adolescentes

ABSTRACT Objective: To evaluate changes in food intake after adolescents attended a food and nutrition education program at a non-profit institution. Methods: Fifty-four adolescents aged 16 to 19 years, of low socioeconomic level, enrolled in an non-governmental organization in São Paulo, underwent a nutritional intervention of six months consisting of six meetings with dieticians, as well as strategic communication and relationship actions. Body weight, height, body mass index, questionnaire on knowledge on nutrition and feeding practices, 24-hour recall, and diet quality assessment using the Diet Quality Index associated with the Digital Food Guide were collected at baseline and after the intervention. Dietary pattern improvement was defined as an increase of at least 5 points in Diet Quality Index associated with the Digital Food Guide. Results: Understanding of food labels increased, and the dietary patterns on weekdays and weekends improved by 33 and 37%, respectively. The intake of legumes, milk, dairy products, fruits, and vegetables increased (adequacy components). However, intakes of nuts and whole grains were low, and intake of moderation components was high. Conclusion: The program improved the dietary patterns of adolescents, making it a viable and inexpensive method to prevent disease and improve health and quality of life. In addition, the Diet Quality Index associated with the Digital Food Guide has proven to be a good nutritional tool for assessing changes in food intake and for guiding future counseling and nutritional intervention actions for this population.

RESUMO Objetivo: Avaliar as mudanças no consumo alimentar após aplicação de um programa de educação alimentar e nutricional com adolescentes de uma instituição do terceiro setor. Métodos: Cinquenta e quatro adolescentes com idade entre 16 e 19 anos, de baixo nível socioeconômico, matriculados em uma organização não governamental de São Paulo foram submetidos à intervenção nutricional de seis meses, que consistiu de seis encontros com nutricionistas e ações estratégicas de comunicação e relacionamento. Massa corporal, estatura, índice de massa corporal, questionário sobre conhecimento de nutrição e práticas alimentares, recordatório de 24 horas e qualidade da dieta pelo Índice de Qualidade da Dieta associado ao Guia Alimentar Digital foram avaliados no início e no final da intervenção. Considerou-se como melhora no padrão alimentar o aumento de no mínimo cinco pontos no Índice de Qualidade da Dieta associado ao Guia Alimentar Digital. Resultados: Observaram-se maior conhecimento sobre as informações disponibilizadas no rótulo dos alimentos e melhora no padrão da dieta de 33% dos alunos durante a semana e 37% aos finais de semana. Verificou-se aumento na ingestão de alimentos dos grupos leguminosas, leites e derivados, frutas e hortaliças (componentes de adequação). Entretanto, houve baixa ingestão de oleaginosas e cereais integrais e elevada ingestão dos componentes de moderação. Conclusão: O programa promoveu melhoras no padrão alimentar dos adolescentes, tornando-se um método viável, de baixo custo e aplicável para a prevenção de doenças e melhoria da qualidade de vida e da saúde. Além disso, o Índice de Qualidade da Dieta associado ao Guia Alimentar Digital mostrou ser uma boa ferramenta nutricional para avaliar mudanças no consumo alimentar e nortear futuras orientações e ações de intervenção nutricional nessa população.

Avaliação da aquisição de gêneros alimentíciosprovenientes da agricultura familiar para aalimentação escolar / Evaluation of the acquisition of food items from family farmingfor school meals

O Prêmio Gestor Eficiente da Merenda Escolar, realizado pela Organização Não Governamental Ação Fome Zero, identificae premia prefeituras com boas práticas de gestão pública municipal do Programa Nacional de Alimentação Escolar(PNAE). O estudo teve por objetivo avaliar a aquisição de gêneros alimentícios da Agricultura Familiar pelos municípiosque se inscreveram e foram selecionados para receber a premiação. Foram utilizados dados da 8ª edição do Prêmio 2011referente ao relato do município sobre o percentual da compra da Agricultura Familiar e os tipos de gêneros alimentíciosadquiridos. De 1.082 inscritos, 22 municípios foram premiados. Dos municípios premiados, 19 realizaram a compra daAgricultura Familiar, e 18 declararam a porcentagem de compra e citaram os alimentos que são adquiridos. Desses, 8municípios alcançaram a meta dos 30% de compra da Agricultura Familiar. Os grupos alimentícios mais adquiridos por83% dos municípios foram frutas / polpas e hortaliças, o grupo dos doces foi adquirido por 67% dos municípios. Apesardo grupo dos cereais, tubérculos e raízes ocupar a 4o posição, somente 2 municípios declararam a compra de arroz, sendoque os alimentos mais adquiridos desse grupo foram a batata e a mandioca. De acordo com os resultados, os municípiospremiados estão adquirindo produtos da Agricultura familiar de acordo com a Lei n. 11.947/2009 – Programa Nacional deAlimentação Escolar –, no entanto, a variedade dos tipos de alimentos adquiridos necessita ser expandida, com o intuitode contribuir para a formação de hábitos alimentares saudáveis dos escolares.

The Efficient Manager of School Meals Prize organized by the non-governmental organization Ação Fome Zero, identifies and rewardsmunicipalities with good municipal public administration of the National School Feeding Program (PNAE). The purpose of thisstudy was to evaluate the acquisition of food items from family farming by municipalities that registered and were selected to receivethe prize. The study used data from the 8th edition of the 2011 Prize regarding the report given by municipalities about the percentageof food purchased from family farming and the types of food items purchased. From the 1.082 municipalities registered, 22 wereawarded. From these, 19 purchased from family farming, and 18 municipalities declared the percentage and mentioned the foodsthat are purchased. From these, eight municipalities achieved the goal of 30% of purchase from family farming. The food groups mostcommonly bought by 83% of municipalities were fruits / fruit pulps and vegetables; the sweets group was purchased by 67% of municipalities.Despite the group of cereals, tubers and roots occupies the 4th position, only 2 municipalities reported buying rice. Themost purchased food of this group were potatoes and cassava. According to the results, the municipalities awarded are purchasingproducts from family farming in accordance with the Law 11.947/2009 – National School Feeding Program; however, the varietyof types of food purchased needs to be expanded in order to contribute to the formation of healthy eating habits of school children.

Effects of Brazilian Cardioprotective Diet Program on risk factors in patients with coronary heart disease: a Brazilian Cardioprotective Diet randomized pilot trial

OBJECTIVE: To evaluate the effectiveness of the Brazilian Cardioprotective Diet Program in reducing blood pressures, fasting glucose levels and body mass indices in patients with established atherothrombotic disease. METHOD: This randomized controlled pilot trial included outpatients who were over 45 years of age with atherothrombotic cardiovascular disease. Group A, who received the Brazilian Cardioprotective Diet Program, had weekly sessions with dietitians. Groups B and C received the usual dietary therapy that is given to patients with cardiovascular diseases as proposed by the Brazilian guidelines. This diet had the same nutrient profile as that given to Group A, but it was customized by the integration of typical Mediterranean foods. The difference between Groups B and C was the number of sessions with the dietitian. Group B received weekly sessions, while group C only had monthly sessions. ClinicalTrials.gov: NCT 01453166. RESULTS: There was a greater reduction in systolic (7.8%) and diastolic (10.8%) blood pressures in Group A compared with Group B (2.3% and 7.3%), and Group C (3.9% and 4.9%, respectively). Fasting glucose decreased by 5.3% and 2% in Groups A and B, respectively. Fasting glucose increased by 3.7% in Group C. The BMIs decreased by 3.5% and 3.3% in Groups A and B, respectively. Group C did not present with any changes in BMI. However, none of these data showed statistical differences between the groups, which is methodologically acceptable in pilot trials. CONCLUSIONS: The Brazilian Cardioprotective Diet Program seems to be more effective in reducing blood pressures, fasting glucose levels, weights and BMIs in patients with previous cardiovascular disease compared with the diet that has been proposed by the Brazilian guidelines.

Alimentação escolar no Brasil e nos Estados Unidos / School lunch programs in Brazil and the United States / Alimentación escolar en Brasil y los Estados Unidos

Este artigo tem o objetivo de descrever dois dos maiores programas de alimentação escolar no mundo, o Programa Nacionalde Alimentação Escolar (PNAE), do Brasil, e o National School Lunch Program, dos Estados Unidos. Esta revisão aborda algumas de suas diferenças e similaridades com respeito ao histórico, população atendida, tipo de administração e principais avanços ocorridos nos últimos10 anos. Iniciados quase no mesmo tempo na história (nas décadas 40 e 50), os dois programas foram criados com objetivos similares, mas diretrizes e sistemas de gestão diferentes. O relato histórico desses programas demonstra que ambos necessitaram de reformulações ao longo de suas existências no ambiente político-econômico-social.

This paper aims to describe two of the broader world school lunch programs, the Programa Nacional de Alimentação Escolar [National School Lunch Program], from Brazil, and the National School Lunch Program, from the United States. This review discussessome of their differences and similarities regarding history, people included, the kind of management system, and the most importantadvances in the last 10 years. Began almost at the same time (the 40’s and 50’s), the programs were created with similar goals but distinct guidelines and management systems. The historical report of the programs shows the necessity these programs had of changing their characteristics according to the political, economic and social environment.

Este artículo intenta describir dos de los más grandes programas mundiales de alimentación escolar, el Programa Nacionalde Alimentação Escolar, de Brasil, y el National School Lunch Program, de los Estados Unidos. Esta revisión discute algunas de sus diferencias y similitudes respecto el histórico, la población asistida, el tipo de gestión y los avanzos principales de los últimos diez años.Iniciados casi al mismo tiempo (las décadas de 40 y 50), se crearan esos programas con metas similares pero directrices y sistemas degestión distintos. El relato histórico de los programas muestra que se han necesitado reformularlos en su recorrido según el ambientepolítico, económico y social.

Desenvolvimento e aplicação de um questionário semiquantitativo de freqüência alimentar on-line para estimar a ingestão de cálcio e ferro / Development and use of an on-line semiquantitative food-frequency questionnaire to evaluate calcium and iron intake

OBJETIVO: Desenvolver um questionário semiquantitativo de freqüência alimentar on-line para a avaliação de ingestão de cálcio (Ca) e de ferro (Fe). METODOLOGIA: O site de acesso à pesquisa foi o jornal eletrônico Folha Online. Trinta internautas, de ambos os sexos, residentes no estado de São Paulo, com idades de 21 a 45 anos foram selecionados. Informações obtidas de Registros Alimentares de 4 dias em dois meses consecutivos foram comparadas com as do questionário semiquantitativo de freqüência alimentar preenchido pelos participantes no terceiro mês. Para a análise estatística foram calculados coeficientes de correlação de Pearson. Os dados dietéticos foram ajustados pela energia e pela variância. RESULTADOS: O coeficiente de correlação entre os resultados obtidos por meio dos dois métodos, após o ajuste pela energia e da correção pela variância, foi de 0,52 para Ca e r = -0,02 para Fe. CONCLUSÃO: Os resultados indicam que o QSFA on-line pode ser utilizado para avaliar médias de ingestão de Ca nesse grupo. No entanto, as condições (n, nível de ingestão) não foram adequadas para a avaliação da média de ingestão de Fe.

A utilização da World Wide Web como ferramenta para a educação nutricional: uma revisão / The use of the World Wide Web as a tool to promote the nutritional education: a review

A partir dos anos noventa, o desenvolvimento da informática, as diversas alternativas de comunicação mediadas pela Internet (rede internacional de computadores) têm se configurado como um importante instrumento para pesquisas em populações. Suas possibilidades estão associadas fundamentalmente com a rapidez de troca de informação e com o grande número de usuários que acessam esse meio. O principal objetivo dessa revisão foi verificar como a World Wide Web (rede mundial de computadores) está sendo utilizada na promoção da educação nutricional e na obtenção de dados sobre o consumo alimentar populacional e assinalar as vantagens e desvantagens apresentadas por esse canal.