Impact of a Cooking Intervention on the Cooking Skills of Adult Individuals with Type 2 Diabetes Mellitus: A Pilot Study.

OBJECTIVE: To investigate the impact of the Nutrition and Culinary in the Kitchen (NCK) Program on the cooking skills of Brazilian individuals with type 2 diabetes mellitus (T2DM). METHODS: A randomized controlled intervention study was performed, with intervention and control groups. The intervention group participated in weekly sessions of the NCK Program for six weeks (including two in-person practical cooking and three online cooking workshops). The cooking recipes were adapted by replacing high glycemic index ingredients with low and medium glycemic index alternatives. Of note, the recipes did not contain added sugars or sweeteners, were based on the use of fresh or minimally processed foods, herbs, and spices, and were sensorially tested by individuals with T2DM before use in the intervention. The study outcomes were participant score changes on the seven scales. A validated online instrument was administered to the control and intervention groups at baseline (T1) and post-intervention (T2). Parametric and non-parametric tests were used to assess the differences between the T1 and T2 parameters. RESULTS: Of the 60 individuals enrolled, 44 answered the questionnaire at both times. The findings revealed a 45.37% ± 93.57% increase in Knowledge of Cooking Terms in the intervention group, whereas the control group showed a 3.82% ± 16.17% reduction (p = 0.008). There was an increase in all the other cooking skills and healthy eating scales from T1 to T2 in the intervention group, but the differences were not significant. CONCLUSIONS: The development of cooking skills can contribute to increasing culinary knowledge and the availability of time to cook at home. The results contribute to the planning of health actions aimed at individuals with DM2 through culinary interventions and public food and nutrition policies.

Market-driven fortification of vitamins and minerals in packaged foods targeted at children in Brazil.

This study aimed to characterise the market-driven fortification of vitamins and minerals in packaged foods targeted at children in Brazil. We analysed 535 food labels using data collected in a census-type method (n = 5620) of food labels in a Brazilian supermarket in 2013. Micronutrients declared in nutrition claims and the ingredients list (synthetic compounds) were considered to be added for commercial purposes. Analysis of the ingredients list and nutrition claims showed that market-driven fortification of vitamins and minerals was present in 27.1% of foods. The main vitamins and minerals were vitamins A, B complex, C, D, calcium, iron and zinc. The food groups 'Milk and dairy products' and 'Sugars, sugary foods and snacks' had the highest frequencies of micronutrients declared in the ingredients list. Calcium, iron, phosphorus, zinc and all vitamins, except B7, were found to be added for commercial purposes. Micronutrients were found to be commonly added to packaged foods as a marketing strategy directed at parents and their children. Future studies should assess the amount of vitamins and minerals added to packaged foods targeted at children and whether intakes of vitamins and minerals in children are potentially excessive.

Adaptação de receitas culinárias de um programa de intervenção em habilidades culinárias para indivíduos com diabetes tipo 2: um estudo de viabilidade / Culinary recipes adaptation to a cooking skills intervention program for individuals with type 2 diabetes: a feasibility study

Introdução: Hábitos alimentares saudáveis e habilidades culinárias podem contribuir no tratamento de diabetes mellitus tipo 2. Objetivo: Este estudo visou adaptar nutricionalmente, testar e avaliar qualitativamente as características sensoriais de receitas culinárias para sua aplicação em um programa de intervenção culinária para indivíduos com diabetes tipo 2, denominado Nutrição e Culinária na Cozinha. Método: O programa Nutrição e Culinária na Cozinha é uma intervenção com oficinas culinárias práticas focadas na promoção das habilidades culinárias. As modificações das receitas foram baseadas no índice glicêmico dos ingredientes, depois testadas e discutidas por especialistas em nutrição por meio de oficinas de consenso. Realizaram-se grupos focais com indivíduos com diabetes tipo 2 para avaliar e discutir as características sensoriais das receitas culinárias. Resultados: As adaptações das receitas para atender à população com diabetes tipo 2 incluíram a substituição de arroz por couve-flor e macarrão por abobrinha, além do uso de frutas e especiarias em receitas doces em substituição a ingredientes com açúcares de adição e/ou edulcorantes Essas mudanças foram aprovadas pelos indivíduos com diabetes tipo 2. Conclusão: As receitas culinárias adaptadas poderão ser utilizadas em orientações dietéticas e em intervenções culinárias para promover hábitos alimentares que contribuam para o controle glicêmico.

Introduction: Healthy eating habits and cooking skills can contribute to the treatment of type 2 diabetes mellitus (T2DM). Objective: This study aimed to adapt, test, and qualitatively evaluate the sensory characteristics of food recipes for their application in a culinary intervention program for individuals with type 2 diabetes, called Nutrition and Culinary in the Kitchen. Methods: Nutrition and Culinary in the Kitchen is an intervention program with hands-on cooking classes focused on promoting cooking skills. Recipes' modifications were based on the glycemic index of ingredients, then tested and discussed by nutrition experts in consensus workshops. Individuals with type 2 diabetes assessed and discussed the sensory characteristics of recipes in focus groups. Results: Recipes adaptations to suit type 2 diabetes population included replacement of rice by cauliflower and pasta by zucchini, and the use of fruits and spices in sweet recipes instead of using added sugar ingredients and/or non-caloric sweeteners. Those changes were positively accepted by the individuals with type 2 diabetes. Conclusion: The adapted culinary recipes can be used in dietary guidelines and in cooking interventions to promote eating habits that contribute to glycemic control.

Use of the term whole grain on the label of processed and ultra-processed foods based on cereals and pseudocereals in Brazil.

There has been an increasing consumption of processed and ultra-processed foods, accompanied by growing concerns about the relationship between diet quality and health. Whole-grain foods, composed of cereals and pseudocereals, are recommended as part of a healthy diet, and food labeling is an important tool for consumers to identify the presence of whole grains in packaged foods. This study aimed to analyze the use of the term whole grain on the label of processed and ultra-processed foods based on cereals and pseudocereals (amaranth, quinoa, and buckwheat) in Brazil. Data were collected by a census of all food labels in a Brazilian supermarket. Foods were classified into eight groups according to Brazilian legislation and according to the presence or absence of the term whole grain. The prevalence of foods displaying the term whole grain or related expressions on the front label was assessed, and differences between groups were analyzed using Pearson's chi-squared test. Comparisons were also made in relation to the position of whole-grain ingredients in the ingredients list, given that Brazilian food labeling regulations require that ingredients be listed in descending order of weight on packaged foods. The level of significance was defined as p < 0.05. The sample included 1,004 processed and ultra-processed foods based on cereals and pseudocereals, 156 (15.6%) of which displayed the term whole grain and/or similar expressions on the front label. Of these, 98 (9.8%) contained the term whole grain, 25 (2.5%) displayed analogous expressions, and 33 (3.3%) contained the term whole grain concomitantly with analogous terms, identified in foods of the groups Bakery goods, bread, cereals, and related products and Sugars, sugary foods, and snacks. Half of the food products displaying the term whole grain or related expressions on the front label did not have a whole-grain ingredient listed in the first position of the ingredients list. The frequency of whole grains was even lower when analyzing the second and third ingredients. These findings reveal the existence of inaccurate information regarding the term whole grain or analogous expressions on the front label of cereal- and pseudocereal-based packaged foods. It is expected that these results will contribute to stimulating the food industry and regulatory bodies to improve the use of the term whole grain and related expressions on packaged food labels, given that, up to the moment of data collection, there were no regulatory requirements for these statements. Furthermore, the findings might contribute to improving the clarity of information available on food labels, thereby preventing consumer deception at the time of purchase.

Consumers' Response to Sugar Label Formats in Packaged Foods: A Multi-Methods Study in Brazil.

Providing information about the sugar content of packaged foods on product labels is an important strategy to lower consumers' sugar intake. This study assessed the effect of exposure to different sugar labels on consumers' understanding of the sugar content of foods and their food choices. In the first phase, five focus groups were conducted with a convenience sample of Brazilian adults to explore their perceptions about food labelling in general and sugar labelling in particular. Based on the qualitative results, four sugar label formats were developed and subsequently tested in a five-arm study on 1,277 adults via a randomised controlled online survey. The formats were: (i) no sugar information-control, (ii) total and added sugar content displayed in the Nutrition Information Panel (NIP), (iii) a front-of-package (FoP) octagonal warning for "high-in-sugar" products, (iv) a FoP magnifying glass warning for "high-in-sugar" products, and (v) a "high-in-sugar" warning text embedded on the NIP. Participants from the focus groups reported being confused about the meaning of "sugar" and "added sugar" on food labels and indicated that more interpretive labels, such as the FoP warnings, would help them choose products with low sugar content. In the experiment, all intervention sugar label formats improved participants' understanding of the sugar content of the tested food products, with the FoP warnings (iii and iv) showing the best results. While non-significant differences among label conditions were observed for food choices, the FoP octagonal warning prompted participants to choose high-in-sugar products less often. Given current public policy agendas aiming to reduce added sugar intake, there is a need to strengthen food labelling policies and nutrition disclosure policies that target the display of added sugar and build consumer awareness in using these tools to avoid high-in-sugar products.

Trans-Fat Labeling in Packaged Foods Sold in Brazil Before and After Changes in Regulatory Criteria for Trans-Fat-Free Claims on Food Labels.

Consumption of industrially produced trans-fat acids (TFA) is a public health concern. Therefore, it is important that information on TFA in packaged foods be clearly informed to consumers. This study aimed to assess the evolution of TFA information presented in packaged foods sold in Brazil in 2010 and 2013, before and after the introduction of stricter regulatory requirements for TFA-free claims on food labels. A repeated cross-sectional study was performed through food label censuses of all packaged foods available for sale in two stores from the same supermarket chain, totaling 2,327 foods products in 2010 and 3,176 in 2013. TFA-free claims and information indicating TFA in the ingredients list and nutrition facts label were analyzed by descriptive statistics and Pearson's chi-square test. There was a 14% decrease in the use of ingredients containing or potentially containing industrially produced TFA (i-TFA), according to analysis of the ingredients list. However, when analyzing foods by groups, it was found that this decrease was significant only for group A (bakery goods, bread, cereals, and related products; from 59 to 35%, p < 0.001). By contrast, food group F (gravies, sauces, ready-made seasonings, broths, soups, and ready-to-eat dishes) showed a 5% increase in i-TFA. The use of specific terms for i-TFA decreased between 2010 and 2013, but there was an increase in the use of alternative terms, such as vegetable fat and margarine, which do not allow consumers to reliably identify whether a food product is a possible source of i-TFA. There was an 18% decrease in the use of TFA-free claims in products containing or potentially containing i-TFA. However, almost one-third of foods sold in 2013 were false negatives, that is, foods reported to contain 0 g of TFA in the nutrition facts label or with TFA-free claims but displaying specific or alternative terms for i-TFA in the ingredients list. The results indicate that adoption of stricter requirements for TFA-free claims on food labels in Brazil helped reduce the prevalence of such claims but was not sufficient to decrease i-TFA in industrialized foods sold in supermarkets.

University Students' Knowledge and Perceptions About Concepts, Recommendations, and Health Effects of Added Sugars.

It is recommended to limit added sugars to below 10% of the daily energy intake, as excessive consumption has been associated with several chronic non-communicable diseases. This exploratory qualitative study used focus groups to investigate the knowledge and perception of Brazilian university students about added sugars concepts, consumption recommendations, and health effects. Focus groups were led by a moderator using a semi-structured discussion guide. The focus groups were recorded, transcribed verbatim, and subjected to thematic analysis. Five focus groups were conducted with a total of 32 participants (50% women, mean age 23 years). Participants could not distinguish added sugars from sugars naturally present in foods and were unaware of the health impacts associated with excessive added sugar consumption, except for the risk of diabetes. Although most participants reported limiting sugar consumption, they had no knowledge of official consumption recommendations. Given that current public policy agendas aim to reduce added sugar intake, there is a need to strengthen strategies for disseminating information on added sugar concepts, recommendations, health effects and how to identify them in the foods products.

Food additives in childhood: a review on consumption and health consequences.

OBJECTIVE: To discuss the context of scientific publications on the consumption of food additives by children and the possible health consequences in this age group. METHODS: A literature review, with a search carried out between April 2020 and April 2021 in the Web of Science, Scopus, PubMed and Google Scholar databases, as well as in websites of Brazilian and foreign official bodies. Official documents and studies published since 2000 were selected. Keywords related to food additives, children, food consumption, and health were used for the search. RESULTS: Food additives are substances intentionally added to foods for technological purposes. Processed foods are the main sources of additives in food and their consumption occurs since childhood. It is observed, however, that there are limitations inherent to the scientific method regarding the analysis of consumption and toxicity of food additives in humans, causing scarcity of data in the scientific literature. Additionally, existing data suggest that the additives have a higher toxic potential in children, considering that the body weight in this age group is lower than in adults. This context emphasizes the need to observe the precautionary principle, according to which risks of harm must be prevented. CONCLUSIONS: This is a scenario in which the literature points to a risk to people's health and, in particular, to children, about whom the duty of protection must be even greater, with absolute priority. Thus, the relevance of an expanded technical-scientific debate regarding the establishment of specific and stricter parameters for children is considered, regarding the consumption and toxicity of additives, as well as the different sources of exposure to these substances.

Food additives in childhood: a review on consumption and health consequences / Aditivos alimentares na infância: uma revisão sobre consumo e consequências à saúde

ABSTRACT OBJECTIVE To discuss the context of scientific publications on the consumption of food additives by children and the possible health consequences in this age group. METHODS A literature review, with a search carried out between April 2020 and April 2021 in the Web of Science, Scopus, PubMed and Google Scholar databases, as well as in websites of Brazilian and foreign official bodies. Official documents and studies published since 2000 were selected. Keywords related to food additives, children, food consumption, and health were used for the search. RESULTS Food additives are substances intentionally added to foods for technological purposes. Processed foods are the main sources of additives in food and their consumption occurs since childhood. It is observed, however, that there are limitations inherent to the scientific method regarding the analysis of consumption and toxicity of food additives in humans, causing scarcity of data in the scientific literature. Additionally, existing data suggest that the additives have a higher toxic potential in children, considering that the body weight in this age group is lower than in adults. This context emphasizes the need to observe the precautionary principle, according to which risks of harm must be prevented. CONCLUSIONS This is a scenario in which the literature points to a risk to people's health and, in particular, to children, about whom the duty of protection must be even greater, with absolute priority. Thus, the relevance of an expanded technical-scientific debate regarding the establishment of specific and stricter parameters for children is considered, regarding the consumption and toxicity of additives, as well as the different sources of exposure to these substances.

RESUMO OBJETIVO Discutir o contexto das publicações científicas sobre consumo de aditivos alimentares por crianças e as possíveis consequências à saúde nessa faixa etária. MÉTODOS Revisão de literatura, com busca realizada entre abril de 2020 e abril de 2021 nas bases de dados Web of Science, Scopus, PubMed e Google Acadêmico, bem como em sites de órgãos oficiais brasileiros e estrangeiros. Foram selecionados documentos oficiais e estudos publicados a partir do ano 2000. Para a busca, foram utilizados unitermos relacionados a aditivos alimentares, crianças, consumo alimentar e saúde. RESULTADOS Aditivos alimentares são substâncias adicionadas intencionalmente aos alimentos para fins tecnológicos. Os alimentos industrializados são as principais fontes de aditivos na alimentação e seu consumo ocorre desde a infância. Observa-se, contudo, que há limitações inerentes ao método científico no que tange à análise de consumo e de toxicidade de aditivos alimentares em humanos, ocasionando escassez de dados na literatura científica. Adicionalmente, dados existentes sugerem que os aditivos apresentam potencial tóxico maior em crianças, considerando que o peso corporal nessa faixa etária é menor em relação ao adulto. Esse contexto ressalta a necessidade de se observar o princípio da precaução, segundo o qual devem-se prevenir os riscos de dano. CONCLUSÕES Trata-se de cenário no qual a literatura aponta risco à saúde das pessoas e, em especial, das crianças, cujo dever de proteção deve ser ainda maior, com absoluta prioridade. Assim, pondera-se a relevância de um debate técnico-científico ampliado quanto ao estabelecimento de parâmetros específicos e mais rígidos para crianças, considerando consumo e toxicidade de aditivos, bem como as diversas fontes de exposição a essas substâncias.

How was the cooking skills and healthy eating evaluation questionnaire culturally adapted to Brazil?

The study described the cross-cultural adaptation process of the American Cooking Skills and Healthy Eating questionnaire to Brazil. Six stages were followed: Translation; Synthesis of translations; Back-translations; Expert Committee; Synthesis of final version; and the Pretest (self-administered online questionnaire in a Brazilian University). Participants responded to the translated questionnaire twice for test-retest. Conceptual, item, semantic, operational and measurement equivalences were evaluated between original and translated questionnaires, as well as the internal consistency and test-retest reliability. Item, conceptual, semantic equivalences between original and Brazilian questionnaires were reached before the Expert Committee stage. Specific cooking techniques and terms were adapted. Forty-eight students answered the questionnaire in the pre-test stage, achieving the operational and measurement equivalences with kappa's agreement from moderate to substantial, and satisfactory to excellent correlations between measures. Only two measures showed low internal consistency. The combination of stages and equivalences approaches used in this cross cultural adaptation study provided lessons for further Nutrition's researches, disclosing the complexity of cooking skills concepts.