Mindful eating questionnaire: Validation and reliability in Brazilian adults with type 2 diabetes mellitus.

OBJECTIVE: The objective was to evaluate the psychometric properties of the Mindful Eating Questionnaire (MEQ) in Brazilian subjects with type 2 diabetes mellitus (T2DM) and validate a Brazilian version of the MEQ for adults with T2DM (MEQ-DM). METHODOLOGY: Baseline data from the multicentre Nutritional Strategy for Glycaemic Control in Patients with Type 2 Diabetes Mellitus (NUGLIC) trial were used. Construct validity was assessed using exploratory factor analysis (EFA). The root mean square error of approximation (RMSEA), comparative fit index (CFI) and Tucker‒Lewis index (TLI) fit indices indicated the adequacy of the model. The reliability of the questionnaire was evaluated considering the different factor loadings. Criterion validity was tested by correlating the MEQ-DM with sociodemographic variables, body mass index (BMI) and physical activity levels. RESULTS: A total of 370 participants were included, who were mostly female (60.8 %) and had a median age of 61 (54-67) years. The EFA results supported the two-factor structure of the 25-item MEQ-DM: disinhibition and awareness. The results of the fit indices (RMSEA = 0.04; CFI = 0.95 and TLI = 0.94) and composite reliability (disinhibition = 0.84 and awareness = 0.81) were consistent. The criterion validity analysis indicated a significant association between MEQ-DM scores and age, sex, civil status, education level, BMI and physical activity (p < 0.05). CONCLUSION: When explored with Brazilian adults with T2DM, the MEQ-DM presented a factorial model with two dimensions: disinhibition and awareness. This model must be confirmed in future studies with Brazilians with T2DM.

[Brazilian government proposals for actions to prevent and control overweight and obesity from a local perspective]. / Propostas governamentais brasileiras de ações de prevenção e controle do sobrepeso e obesidade sob perspectiva municipal.

The article analyzes actions in the prevention and control of overweight and obesity that have been developed in the 92 municipalities (counties) in the state of Rio de Janeiro, Brazil, based on underlying principles in the typology of public policies developed by Lowi and Line of Care for Overweight and Obesity, according to the following analytical dimensions: program actions in prevention and control of obesity, characterization of macro policies according to the Lowi typology, and characterization of macro policies according to the Line of Care for Overweight and Obesity. The study is part of a research project from 2014 to 2018 that aimed to identify the strategies and challenges in the consolidation of the actions planned in the Line of Care for Overweight and Obesity, based on analysis of secondary data and government documents; searches in the municipalities' official websites; interviews; focus groups; and online questionnaires with health professionals and managers. The documents point to a series of actions such as individual consultations, support groups, health gyms, school health programs, and others, reinforced by the interviewees' narratives. Even with so many initiatives, the municipalities in the state of Rio de Janeiro face challenges with limited human resources and precarious infrastructure and equipment in the health units. To achieve mobilization in the actions to deal with obesity, the issue should be addressed specifically on the state and local agendas and not diluted among other activities and programs.

O presente artigo analisa as ações de prevenção e controle do sobrepeso e da obesidade que vêm sendo desenvolvidas nos 92 municípios do Estado do Rio de Janeiro, Brasil, com base em princípios que fundamentam a tipologia clássica de políticas públicas desenvolvidas por Lowi e a Linha de Cuidado do Sobrepeso e Obesidade, valendo-se das seguintes dimensões de análise: programas e ações de prevenção e controle da obesidade, caracterização das macropolíticas segundo a tipologia de Lowi e caracterização das ações segundo princípios da Linha de Cuidado do Sobrepeso e Obesidade. O estudo é parte de uma pesquisa realizada entre 2014 e 2018 que teve como objetivo identificar as estratégias adotadas e os desafios enfrentados para consolidar as ações previstas na Linha de Cuidado do Sobrepeso e Obesidade, com base nos métodos de análise de dados secundários e documentos governamentais; busca nos sites oficiais dos municípios; entrevistas, grupos focais e questionários eletrônicos com profissionais e gestores de saúde. Os documentos apontam uma série de ações como a consulta individual, grupos de apoio, academia da saúde, programa saúde na escola, entre outros, que foram reforçadas pelas narrativas dos entrevistados. Mesmo diante de tantas iniciativas, os municípios do Estado do Rio de Janeiro passam por desafios como recursos humanos reduzidos e estrutura de unidades e equipamentos de saúde precários. Para que haja maior mobilização em relação às ações frente à obesidade, o tema deve ser tratado de forma particular nas agendas estaduais e municipais, e não dissolvido dentro de outras ações e programas.

Este artículo analiza las acciones de prevención y control del sobrepeso y de la obesidad que se están desarrollando en 92 municipios del estado de Río de Janeiro, Brasil, basándose en los principios que fundamentan la tipología clásica de políticas públicas, desarrollada por Lowi, y la Línea de Cuidado del Sobrespeso y de la Obesidad, a partir de las siguientes dimensiones de análisis: programas y acciones de prevención y control de la obesidad, caracterización de macropolíticas, según la tipología de Lowi, y caracterización de las acciones, según los principios de la Línea de Cuidado del Sobrespeso y de la Obesidad. El estudio forma parte de una investigación, realizada entre 2014 y 2018, cuyo objetivo fue identificar las estrategias adoptadas y los desafíos enfrentados para consolidar las acciones previstas en la Línea de Cuidado del Sobrespeso y de la Obesidad, en base a los métodos de análisis de datos secundarios y documentos gubernamentales; búsqueda en sitios web oficiales de los municipios; entrevistas, grupos focales y cuestionarios electrónicos con profesionales y gestores de salud. Los documentos apuntan una serie de acciones como: consulta individual, grupos de apoyo, academia de salud, programa salud en la escuela, entre otros, que fueron reforzados por las narraciones de los entrevistados. Incluso ante tantas iniciativas, los municipios del estado do Río de Janeiro deben superar desafíos como: recursos humanos reducidos y estructura de unidades y equipamientos de salud precarios. Para que haya una mayor movilización en lo referente a las acciones frente a la obesidad, el tema debe ser tratado de forma particular en las agendas estatales y municipales, y no encontrarse diluido dentro de otras acciones y programas.

[Models of care for individuals with obesity in primary healthcare in the state of Rio de Janeiro, Brazil]. / Modelos de assistência ao indivíduo com obesidade na atenção básica em saúde no Estado do Rio de Janeiro, Brasil.

Brazil has developed policies for the prevention and control of obesity through the Brazilian Unified National Health System. This study analyzed the characteristics of proposed "models of care" reported by health professionals in primary care in the state of Rio de Janeiro. The methods included interviews and focus groups with professionals and managers in primary care and the thematic areas of food and nutrition in the 92 municipalities (counties) of Rio de Janeiro state and document analysis of federal and state legislation and guidelines. The analysis was oriented by the organizational and technical dimensions of care and the principles of comprehensive healthcare. The main challenges reported by health professionals pertained to adherence to the therapeutic process and feelings of frustration and powerlessness; multidisciplinary teamwork; and unpreparedness for dealing with the complexity of the health-disease process related to obesity. Some principles and guidelines based on the government policy documents are strategic for addressing these challenges, especially: shared responsibility between health professionals and users, which can help avoid the extremes of blaming and/or victimization; appreciation of other gains besides weight loss, which can redefine treatment adherence; and multidisciplinary teamwork to develop a contextualized understanding of the health-disease process and its multiple conditioning factors and for the health professionals to be able to cope with their own feelings and stigmas towards the person with obesity.

Propostas governamentais brasileiras de ações de prevenção e controle do sobrepeso e obesidade sob perspectiva municipal / Brazilian government proposals for actions to prevent and control overweight and obesity from a local perspective / Propuestas de acciones gubernamentales brasileñas para la prevención y control del sobrepeso y obesidad desde una perspectiva municipal

Resumo: O presente artigo analisa as ações de prevenção e controle do sobrepeso e da obesidade que vêm sendo desenvolvidas nos 92 municípios do Estado do Rio de Janeiro, Brasil, com base em princípios que fundamentam a tipologia clássica de políticas públicas desenvolvidas por Lowi e a Linha de Cuidado do Sobrepeso e Obesidade, valendo-se das seguintes dimensões de análise: programas e ações de prevenção e controle da obesidade, caracterização das macropolíticas segundo a tipologia de Lowi e caracterização das ações segundo princípios da Linha de Cuidado do Sobrepeso e Obesidade. O estudo é parte de uma pesquisa realizada entre 2014 e 2018 que teve como objetivo identificar as estratégias adotadas e os desafios enfrentados para consolidar as ações previstas na Linha de Cuidado do Sobrepeso e Obesidade, com base nos métodos de análise de dados secundários e documentos governamentais; busca nos sites oficiais dos municípios; entrevistas, grupos focais e questionários eletrônicos com profissionais e gestores de saúde. Os documentos apontam uma série de ações como a consulta individual, grupos de apoio, academia da saúde, programa saúde na escola, entre outros, que foram reforçadas pelas narrativas dos entrevistados. Mesmo diante de tantas iniciativas, os municípios do Estado do Rio de Janeiro passam por desafios como recursos humanos reduzidos e estrutura de unidades e equipamentos de saúde precários. Para que haja maior mobilização em relação às ações frente à obesidade, o tema deve ser tratado de forma particular nas agendas estaduais e municipais, e não dissolvido dentro de outras ações e programas.

Abstract: The article analyzes actions in the prevention and control of overweight and obesity that have been developed in the 92 municipalities (counties) in the state of Rio de Janeiro, Brazil, based on underlying principles in the typology of public policies developed by Lowi and Line of Care for Overweight and Obesity, according to the following analytical dimensions: program actions in prevention and control of obesity, characterization of macro policies according to the Lowi typology, and characterization of macro policies according to the Line of Care for Overweight and Obesity. The study is part of a research project from 2014 to 2018 that aimed to identify the strategies and challenges in the consolidation of the actions planned in the Line of Care for Overweight and Obesity, based on analysis of secondary data and government documents; searches in the municipalities' official websites; interviews; focus groups; and online questionnaires with health professionals and managers. The documents point to a series of actions such as individual consultations, support groups, health gyms, school health programs, and others, reinforced by the interviewees' narratives. Even with so many initiatives, the municipalities in the state of Rio de Janeiro face challenges with limited human resources and precarious infrastructure and equipment in the health units. To achieve mobilization in the actions to deal with obesity, the issue should be addressed specifically on the state and local agendas and not diluted among other activities and programs.

Resumen: Este artículo analiza las acciones de prevención y control del sobrepeso y de la obesidad que se están desarrollando en 92 municipios del estado de Río de Janeiro, Brasil, basándose en los principios que fundamentan la tipología clásica de políticas públicas, desarrollada por Lowi, y la Línea de Cuidado del Sobrespeso y de la Obesidad, a partir de las siguientes dimensiones de análisis: programas y acciones de prevención y control de la obesidad, caracterización de macropolíticas, según la tipología de Lowi, y caracterización de las acciones, según los principios de la Línea de Cuidado del Sobrespeso y de la Obesidad. El estudio forma parte de una investigación, realizada entre 2014 y 2018, cuyo objetivo fue identificar las estrategias adoptadas y los desafíos enfrentados para consolidar las acciones previstas en la Línea de Cuidado del Sobrespeso y de la Obesidad, en base a los métodos de análisis de datos secundarios y documentos gubernamentales; búsqueda en sitios web oficiales de los municipios; entrevistas, grupos focales y cuestionarios electrónicos con profesionales y gestores de salud. Los documentos apuntan una serie de acciones como: consulta individual, grupos de apoyo, academia de salud, programa salud en la escuela, entre otros, que fueron reforzados por las narraciones de los entrevistados. Incluso ante tantas iniciativas, los municipios del estado do Río de Janeiro deben superar desafíos como: recursos humanos reducidos y estructura de unidades y equipamientos de salud precarios. Para que haya una mayor movilización en lo referente a las acciones frente a la obesidad, el tema debe ser tratado de forma particular en las agendas estatales y municipales, y no encontrarse diluido dentro de otras acciones y programas.

Modelos de assistência ao indivíduo com obesidade na atenção básica em saúde no Estado do Rio de Janeiro, Brasil / Models of care for individuals with obesity in primary healthcare in the state of Rio de Janeiro, Brazil / Modelos de asistencia al individuo con obesidad en la atención básica de salud en el Estado de Río de Janeiro

Resumo: O Brasil vem instituindo políticas de prevenção e controle da obesidade por meio do Sistema Único de Saúde, e o estudo analisou as características dos "modelos assistenciais" propostos e referidos por profissionais da atenção básica no Estado do Rio de Janeiro. Os métodos incluíram entrevistas e grupos focais com profissionais e gestores da atenção básica e das Áreas Técnicas de Alimentação e Nutrição (ATAN) dos 92 municípios do Rio de Janeiro, e análise documental de normativas federais e estaduais. A análise foi norteada pelas dimensões organizativa e técnico assistencial, e considerou os princípios da atenção integral em saúde. Os principais desafios referidos pelos profissionais estão relacionados com: a adesão aos processos terapêuticos e consequente sentimento de frustração e impotência; a atuação em equipe multiprofissional; e a constatação de despreparo para lidar com a complexidade do processo saúde/doença relacionado com a obesidade. Alguns princípios e diretrizes pautados nos documentos de políticas governamentais são estratégicos para enfrentar esses desafios, especialmente: a corresponsabilização entre profissional e usuário, pois pode contribuir para evitar os extremos da culpabilização e/ou vitimização; a valorização de outros ganhos para além da perda de peso, que pode ressignificar a concepção de adesão ao tratamento; a atuação multiprofissional para que se desenvolva uma compreensão contextualizada do processo saúde/doença e seus múltiplos condicionantes, e para que os profissionais consigam lidar com os seus próprios sentimentos e estigmas em relação à pessoa com obesidade.

Abstract: Brazil has developed policies for the prevention and control of obesity through the Brazilian Unified National Health System. This study analyzed the characteristics of proposed "models of care" reported by health professionals in primary care in the state of Rio de Janeiro. The methods included interviews and focus groups with professionals and managers in primary care and the thematic areas of food and nutrition in the 92 municipalities (counties) of Rio de Janeiro state and document analysis of federal and state legislation and guidelines. The analysis was oriented by the organizational and technical dimensions of care and the principles of comprehensive healthcare. The main challenges reported by health professionals pertained to adherence to the therapeutic process and feelings of frustration and powerlessness; multidisciplinary teamwork; and unpreparedness for dealing with the complexity of the health-disease process related to obesity. Some principles and guidelines based on the government policy documents are strategic for addressing these challenges, especially: shared responsibility between health professionals and users, which can help avoid the extremes of blaming and/or victimization; appreciation of other gains besides weight loss, which can redefine treatment adherence; and multidisciplinary teamwork to develop a contextualized understanding of the health-disease process and its multiple conditioning factors and for the health professionals to be able to cope with their own feelings and stigmas towards the person with obesity.

Resumen: Brasil ha estado instaurando políticas de prevención y control de la obesidad mediante el Sistema Único de Salud. Este estudio analizó las características de los "modelos asistenciales" propuestos y referidos por profesionales de la atención básica en el Estado de Río de Janeiro. Los métodos incluyeron entrevistas y grupos focales con profesionales y gestores de la atención básica y de las Áreas Técnicas de Alimentación y Nutrición (ATAN) de 92 municipios del Río de Janeiro, así como el análisis documental de normativas federales y estatales. El análisis consideró la dimensión organizativa y técnica asistencial, así como los principios de la Atención Integral en Salud. Los principales desafíos señalados por los profesionales se relacionan con: adhesión a los procesos terapéuticos y consecuente sentimiento de frustración e impotencia; actuación en un equipo multiprofesional; constatación de la poca preparación para enfrentarse a la complejidad del proceso salud-enfermedad relacionado con la obesidad. Algunos principios y directrices pautados en los documentos de políticas gubernamentales son estratégicos para enfrentar estos desafíos, especialmente: la corresponsabilización entre el profesional y usuario, puesto que puede contribuir a evitar los extremos de culpabilización y/o victimización; la valoración de otros beneficios -además de la pérdida de peso-, que pueda volver a dar un significado a la concepción de adhesión al tratamiento; la actuación multiprofesional para que se desarrolle una comprensión contextualizada del proceso salud-enfermedad y sus múltiples condicionantes, con el fin de que los profesionales consigan enfrentarse a sus propios sentimientos y estigmas referentes a las personas con obesidad.

Intake of fibers and its association with cardiometabolic risk factors in individuals on a secondary prevention for cardiovascular diseases: a multicenter study.

INTRODUCTION: Among the non-pharmacologic measures for the prevention and treatment of cardiovascular diseases (CVD), which are the first cause of death worldwide, the adequate intake of dietary fibers (DF) has shown an important role. OBJECTIVE: To evaluate the association between the intake of DF and the cardio-metabolic risk factors in individuals on a secondary prevention for CVD. METHODS: Transversal study with basal data of the study's DICA Br participants belonging to collaborative centers in the states of Maranhão (MA), Bahia (BA) and Rio de Janeiro (RJ). Sociodemographic and clinical data were used, as well as the daily intake of DF in individuals of both sexes, with age ≥ 45 years and manifest evidence of arteriosclerosis. The association between the intake of dietary fibers and the cardio-metabolic risk factors was obtained through Poisson's regression model. RESULTS: With 141 evaluated individuals, high frequency of non-appropriateness of DF intake was observed. The participants in the centers of RJ (PR = 0.63; CI 95% = 0.49-0.80) and BA (PR = 0.79; CI 95% = 0.66-0.95), former smokers (PR = 0.59; CI 95% = 0.45-0.78) and non-smokers (PR = 0.62; CI 95% = 0.66-0.95) had fewer chances of having non appropriate intake of DF. On the other hand, overweight individuals showed 28.0% more chances of non-appropriate intake of DF. CONCLUSION: Results showed that the majority of the observed population presented non-appropriate intake of DF and that this low intake was significantly associated with overweight, smoking and location of the collaborative center.

Intake of fibers and its association with cardiometabolic risk factors in individuals on a secondary prevention for cardiovascular diseases: a multicenter study / Ingesta de fibras y su asociación con factores de riesgo cardiometabólico en individuos en prevención secundaria de enfermedades cardiovasculares: un estudio multicéntrico

Introduction: Among the non-pharmacologic measures for the prevention and treatment of cardiovascular diseases (CVD), which are the first cause of death worldwide, the adequate intake of dietary fibers (DF) has shown an important role. Objective: To evaluate the association between the intake of DF and the cardio-metabolic risk factors in individuals on a secondary prevention for CVD. Methods: Transversal study with basal data of the study’s DICA Br participants belonging to collaborative centers in the states of Maranhão (MA), Bahia (BA) and Rio de Janeiro (RJ). Sociodemographic and clinical data were used, as well as the daily intake of DF in individuals of both sexes, with age ≥ 45 years and manifest evidence of arteriosclerosis. The association between the intake of dietary fibers and the cardio-metabolic risk factors was obtained through Poisson’s regression model. Results: With 141 evaluated individuals, high frequency of non-appropriateness of DF intake was observed. The participants in the centers of RJ (PR = 0.63; CI 95% = 0.49-0.80) and BA (PR = 0.79; CI 95% = 0.66-0.95), former smokers (PR = 0.59; CI 95% = 0.45-0.78) and non-smokers (PR = 0.62; CI 95% = 0.66-0.95) had fewer chances of having non appropriate intake of DF. On the other hand, overweight individuals showed 28.0% more chances of non-appropriate intake of DF. Conclusion: Results showed that the majority of the observed population presented non-appropriate intake of DF and that this low intake was significantly associated with overweight, smoking and location of the collaborative center (AU)

Introducción: entre las medidas no farmacológicas para la prevención y el tratamiento de enfermedades cardiovasculares (ECV), que representan la principal causa de muerte en el mundo, la ingesta adecuada de fibra dietética (FD) ha mostrado desempeñar un papel importante. Objetivo: evaluar la asociación entre el consumo de FD y los factores de riesgo cardiometabólico en pacientes en prevención secundaria de ECV. Métodos: estudio transversal con datos de referencia de los participantes en el estudio DICA Br pertenecientes a los centros examinadores en los estados de Maranhão (MA), Bahía (BA) y Río de Janeiro (RJ). Se utilizaron medidas sociodemográficas, clínicas, conductuales, antropométricas y el consumo diario de FD de individuos de ambos sexos, con edades ≥ 45 años y manifiesta evidencia de aterosclerosis. La asociación entre en el consumo de FD y los factores de riesgo cardiometabólico se obtuvo por el modelo de regresión de Poisson. Resultados: fueron evaluados 141 sujetos y se observó alta frecuencia de consumo insuficiente de FA. Los participantes de los centros de RJ (RP = 0,63; IC 95% = 0,49-0,80), BA (RP = 0,79; IC 95%: 0,66-0,95), los ex fumadores (RP = 0,59; IC 95% = 0,78-0,45) y los no fumadores (OR = 0,62; IC 95%: 0,66-0,95) eran menos propensos a tener un consumo insuficiente FD. Las personas con sobrepeso mostraron un 28,0% más de probabilidades de tener una ingesta inadecuada de FD. Conclusión: los resultados indicaron que la mayoría de la población observada presentaba una ingesta inadecuada de FD y que el consumo bajo se asoció significativamente con el sobrepeso, el tabaquismo y el centro de desarrollo (AU)

Effects of oat bran and nutrition counseling on the lipid and glucose profile and anthropometric parameters of hypercholesterolemia patients / Efectos del salvado de avena y del asesoramiento nutricional en el perfil de lípidos y glucosa y en los parámetros antropométricos de los pacientes con hipercolesterolemia

Background: In order to prevent chronic, non communicable disease, it is essential that lifestyle is modified to include a diet high in fiber. Aim: To assess the effect oat bran (OB) in conjunction with nutrition counseling (NC) have on lipid and glucose profile, anthropometric parameters, quality of diet, and ingestion of ultraprocessed foods (UPF) and additives in hypercholesterolemia sufferers. Method: This was a 90-day, double-blind, placebo-controlled, block-randomized trial undertaken on 132 men and women with LDL-c ≥ 130 mg/ dL. The participants were sorted into two groups: OB Group (OBG) and Placebo Group (PLG), and were given NC and 40g of either OB or rice flour, respectively. Lipid and glucose profile were assessed, as were the anthropometric data, quality of diet (Diet Quality Index revised for the Brazilian population - DQI-R) and whether or not UPF or additives were consumed. Results: Both groups showed a significant decrease in anthropometric parameters and blood pressure, as well as a significant reduction in total and LDL cholesterol. There was also an improvement in DQI-R in both groups and a decrease in consumption of UPF. Blood sugar, HOMA-IR and QUICKI values were found to be significantly lower only in the OBG. Conclusion: Our findings in lipid profile and anthropometric parameters signify that NC has a beneficial effect, which is attributable to the improved quality of diet and reduced consumption of UPF. Daily consumption of 40 g of OB was found to be of additional benefit, in decreasing insulin-resistance parameters (AU)

Antecedentes: con el fin de prevenir la enfermedad crónica, no transmisible, es esencial que el estilo de vida se modifique para incluir una dieta alta en fibra. Objetivo: evaluar el efecto de la harina de avena (DE) en conjunto con consejos de nutrición (NC) sobre el perfil lipídico y glucémico, los parámetros antropométricos, la calidad de la dieta, y la ingestión de alimentos ultraprocesadas (UPF) y aditivos en los enfermos de hipercolesterolemia. Método: se realizó un ensayo de 90 días, doble ciego, controlado con placebo, aleatorizado realizado en 132 hombres y mujeres con c-LDL ≥ 130 mg / dl. Los participantes fueron clasificados en dos grupos: DE Group (OBG) y el grupo placebo (PLG), y se les dio NC y 40 g de DE o de harina de arroz, respectivamente. Se evaluó el perfil lipídico y la glucemia, así como los datos antropométricos, la calidad de la dieta (Índice de Calidad de la dieta revisada para la población brasileña ICD-R) y si se consumieron UPF o aditivos. Resultados: ambos grupos mostraron una disminución significativa en los parámetros antropométricos y la presión arterial, así como una reducción significativa en el colesterol total y LDL. También hubo una mejora en la ICD-R en ambos grupos y una disminución en el consumo de la UPF. La glucemia, HOMA-IR, y QUICKI fueron significativas en inferiores sólo en el grupo que consumió salvado de avena. Conclusión: nuestros hallazgos sobre las modificaciones en el perfil lipídico y en los parámetros antropométricos significan que los consejos nutricionales tienen un efecto beneficioso, que es atribuible a la mejoría en la calidad de la dieta y al menor consumo de alimentos ultraprocesados. El consumo diario de 40 g de salvado de avena proporciona un beneficio adicional, al disminuir los parámetros de resistencia insulínica (AU)