Roteiro para Elaboração de Ato Normativo para a Categorização dos Serviços de Alimentação Prático / Script for the Elaboration of a Normative Act for the Categorization of Practical Food Services

A Categorização dos serviços de alimentação possibilita que os consumidores escolham os serviços de alimentação que se preocupam com a qualidade sanitária. A Agência Nacional de Vigilância Sanitária (Anvisa) decidiu criar um sistema semelhante para os serviços de alimentação no Brasil. Este sistema teve a preocupação de minimizar o risco para Doenças Transmitidas por Alimentos (DTA). Para o projeto-piloto de Categorização da Copa do Mundo FIFA® em 2014, foi desenvolvido um instrumento chamado de lista de avaliação. Esta lista tem como base a RDC nº216/2004 e dos 177 itens de verificação ficaram 51 itens de verificação com foco no risco sanitário para DTA. Esta lista foi aplicada na avaliação dos serviços de alimentação, de forma voluntária, em 11 cidades-sede dos jogos da Copa do Mundo FIFA®/2014. Para realizar a Categorização dos serviços de alimentação, como um projeto de governo, faz-se necessário um ato normativo que oficialize e oriente não somente a adesão a Categorização, mas todas as etapas de sua implantação. Este roteiro não tem caráter normativo e sim orientativo. As informações nele contidas são proposições com a finalidade de orientar e subsidiar estados e municípios na atuação regulatória para a Categorização de serviços de alimentação, podendo ser utilizado na íntegra ou parcialmente.

The Best of Times.

I came of age as a nutrition scientist during the best of times-years that spanned a rapidly changing world of food and nutrition science, politics, and policy that greatly broadened the specialty and its influence on public affairs. I followed the conventional route in academe, working my way up the academic ladder in Boston from a base first in a school of public health and later in a teaching hospital and medical school, interspersed with stints in Washington, DC. Thus I tell a tale of two cities. Those were the best of times because nutrition science and policy converged and led to important policies and programs that shaped the field for the next 50 years.

Have the Answers to Common Legal Questions Concerning Nutrition Support Changed Over the Past Decade? 10 Questions for 10 Years.

Clinical nutrition specialists (CNSs) are often confronted with technological, ethical, and legal questions, that is, what can be done technologically, what should be done ethically, and what must be done legally, which conflict at times. The conflict represents a "troubling trichotomy" as discussed in the lead article of this issue of Nutrition in Clinical Practice (NCP). During Clinical Nutrition Week in 2006, a symposium covering these 3 topics was presented, and later that year, an article covering the same topic was published in NCP In this article, we revisit several legal questions/issues that were raised 10 years ago and discuss current answers and approaches. Some of the answers remain unchanged. Other answers have been modified by additional legislation, court decisions, or regulations. In addition, new questions/issues have arisen. Some of the most common questions regarding nutrition support involve the following: liability, informed consent, medical decisional incapacity vs legal competence, advance directive specificity, surrogate decision making, physician orders for life-sustaining treatment and electronic medical orders for life-sustaining treatment, legal definition of death, patient vs family decision making, the noncompliant patient, and elder abuse obligations. In the current healthcare environment, these questions and issues are best addressed via a transdisciplinary team that focuses on function rather than form. The CNS can play a pivotal role in dealing with these challenges by applying the acronym ACT: being Accountable and Communicating with all stakeholders while actively participating as an integral part of the transdisciplinary Team.

The Troubling Trichotomy 10 Years Later: Where Are We Now?

A decade ago, "Nutrition Support and The Troubling Trichotomy: A Call To Action" was published in this journal, identifying existing conflicts among technological, ethical, and legal aspects of nutrition support therapy, particularly in terminal or end-of-life situations. Over the past 10 years, the American Society for Parenteral and Enteral Nutrition and others have responded to the action call. A "state of the trichotomy" reveals that while much has been achieved, differences in all 3 aspects will continue to exist due to their dynamic and ever-changing states. The technology arena has made it possible to increase the delivery of nutrition support in alternative settings with the use of telemedicine and social media. Critical/crucial conversations and earlier declarations of individual wishes for care and treatment while having decision-making capacity have been enhanced with the focus on patient-centered and family-centered care. The definition of death as brain death has been challenged in at least one instance. Conflicts between the state's interests and the individual's interests have added to recent legal controversies. Notwithstanding the progress made over the past 10 years, several challenges remain. The future challenges presented by the Troubling Trichotomy can be best confronted if we ACT-Accountability, Communication, and Teamwork. The focus of teamwork should move from multidisciplinary and interdisciplinary teams to transdisciplinary teams, reflecting the shift to function rather than form presented by the new healthcare environment. The transdisciplinary team will be able address the opportunities of the Troubling Trichotomy in the next decade by incorporating the 12 Cs, as detailed in the article.

Nutrition and health ­ transforming research traditions.

In this contribution, we show that current scientific methodologies used in nutrition science and by regulatory agencies, such as the randomized control trial, limit our understanding of nutrition and health as they are to crude to capture the subtle pleiotropic nature of most nutrients. Thereby, regulatory agencies such as the European Food Safety Authority curb the development of scientific knowledge and industrial innovations within the nutritional field. In order to develop insights into the health impact of certain food and food-components, we need to realize that health is adaptation set within a homeostatic range. Increased performance of health, i.e., the maximum stimulation of health, typically seems 30-60% greater than the control group, with a width of no more than about a factor of ten, clarifying the difficulty of documenting responses of food-endogenous components within the homeostatic range of healthy people. A strategy to record subtle responses of food components is the summation of procentual effects of relevant health outcomes. We illustrate this approach with the action of flavanols on vascular health, specifically endothelial function.

Boundary development in the field of international nutrition science.

Using a sociological approach that elaborates on key observations of institutional entrepreneurs in international nutrition, this paper explores institutional boundaries and boundary work in international nutrition. Sociological concepts of "boundary making" and "situated knowledge" are applied to the boundaries between the nutrition sciences and lay nutrition knowledge in nutrition intervention. These concepts allow an analysis of how nutrition science creates boundaries between its field and other sciences and between nutrition as a science and other nutrition practices, providing additional perspective on current challenges in global food security and malnutrition. Analysis of boundary processes in international nutrition can also illuminate the development of "implementation" or "delivery science" in the field of international nutrition as it attempts to strengthen effectiveness of global efforts to reduce malnutrition. Although some risk taking in the academic world is rewarded, the analysis indicates that there are underlying processes that may inhibit full partnership with local people in the course of intervention work that builds scientific nutrition knowledge. As nutrition science becomes increasingly central to development, the boundaries that are reinforced by digging in heels over the implementation of programs with little local input or softened by inviting local stakeholders to publicly consider the problems in global nutrition together are important to consider in helping to create directions that favor viable solutions.

Expanding the frontiers of population nutrition research: new questions, new methods, and new approaches.

Nutrition research, ranging from molecular to population levels and all points along this spectrum, is exploring new frontiers as new technologies and societal changes create new possibilities and demands. This paper defines a set of frontiers at the population level that are being created by the increased societal recognition of the importance of nutrition; its connection to urgent health, social, and environmental problems; and the need for effective and sustainable solutions at the population level. The frontiers are defined in terms of why, what, who, and how we study at the population level and the disciplinary foundations for that research. The paper provides illustrations of research along some of these frontiers, an overarching framework for population nutrition research, and access to some of the literature from outside of nutrition that can enhance the intellectual coherence, practical utility, and societal benefit of population nutrition research. The frontiers defined in this paper build on earlier forward-looking efforts by the American Society for Nutrition and extend these efforts in significant ways. The American Society for Nutrition and its members can play pivotal roles in advancing these frontiers by addressing a number of well-recognized challenges associated with transdisciplinary and engaged research.

USDA food and nutrient databases provide the infrastructure for food and nutrition research, policy, and practice.

The USDA food and nutrient databases provide the basic infrastructure for food and nutrition research, nutrition monitoring, policy, and dietary practice. They have had a long history that goes back to 1892 and are unique, as they are the only databases available in the public domain that perform these functions. There are 4 major food and nutrient databases released by the Beltsville Human Nutrition Research Center (BHNRC), part of the USDA's Agricultural Research Service. These include the USDA National Nutrient Database for Standard Reference, the Dietary Supplement Ingredient Database, the Food and Nutrient Database for Dietary Studies, and the USDA Food Patterns Equivalents Database. The users of the databases are diverse and include federal agencies, the food industry, health professionals, restaurants, software application developers, academia and research organizations, international organizations, and foreign governments, among others. Many of these users have partnered with BHNRC to leverage funds and/or scientific expertise to work toward common goals. The use of the databases has increased tremendously in the past few years, especially the breadth of uses. These new uses of the data are bound to increase with the increased availability of technology and public health emphasis on diet-related measures such as sodium and energy reduction. Hence, continued improvement of the databases is important, so that they can better address these challenges and provide reliable and accurate data.

The science and regulations of probiotic food and supplement product labeling.

Presented by the New York Academy of Sciences, the U.S. Food and Drug Administration (FDA), and the U.S. Office of Dietary Supplements of the National Institutes of Health, the symposium "Probiotic Foods and Supplements: The Science and Regulations of Labeling," was held on June 12, 2010 at the New York Academy of Sciences, New York, NY, the goals of which were to facilitate the exchange of ideas regarding labeling and substantiation of claims for probiotics among academic, industry, and regulatory professionals, and to discuss ways to translate and communicate research results in a truthful way to the consumer and to such health professionals as physicians, pharmacists, and dieticians. The target audience for this symposium included academicians interested in conducting research on the health benefits of probiotics; scientists; communications personnel, and regulatory specialists from companies involved in, or interested in, the marketing of probiotics; U.S. government regulatory experts tasked with oversight of probiotic foods and dietary supplement products; and other experts in the field interested in the development of probiotics for the U.S. market.

Incarceration, restitution, and lifetime debarment: legal consequences of scientific misconduct in the Eric Poehlman case: Commentary on: "Scientific forensics: how the office of research integrity can assist institutional investigations of research misconduct during oversight review".

Following its determination of a finding of scientific misconduct the Office of Research Integrity (ORI) will seek redress for any injury sustained. Several remedies both administrative and statutory may be available depending on the strength of the evidentiary findings of the misconduct investigation. Pursuant to federal regulations administrative remedies are primarily remedial in nature and designed to protect the integrity of the affected research program, whereas statutory remedies including civil fines and criminal penalties are designed to deter and punish wrongdoers. This commentary discusses the available administrative and statutory remedies in the context of a specific case, that of former University of Vermont nutrition researcher Eric Poehlman, and supplies a possible rationale for the legal result.

[The "Fight over the Protein Minimum". The conflict between scientific nutrition teaching and food reform in 19th and 20th century Germany]. / Der "Kampf ums Eiweissminimum". Zum Konflikt zwischen wissenschaftlicher Ernährungslehre und Ernährungsreform--in Deutschland im 19. und 20. Jahrhundert.

In 1877 the German physiologist and nutritionist Carl von Voit published diet parameters which included minimum intakes of carbohydrates, proteins and fats. As a minimum daily intake of protein Voit arrived at a figure of 118 g. This figure was questioned mainly by supporters of the so-called food reform, because the required protein intake would hardly be feasible without substantial meat consumption. To disprove this claim and to show that the vegetarian way of life was justified, reformers such as Mikkel Hindhede and Carl Röse conducted experiments demonstrating that the long-term adherence to diets with a daily protein intake of less than 30 g was possible without causing a negative protein balance. It was, however, only after the famines of the First World War that the concepts of the diet reformers met with greater interest. As they promised a better, from imports independent supply of food, the national socialist regime after 1933 made it the centre of a new food policy that aimed at autarky. Thus, the history of the "protein minimum" provides insights into effects and limits of nutrition research under the restrictions of economic requirements, moral considerations and prevailing traditions.