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.

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.

Association of personal characteristics and cooking skills with vegetable consumption frequency among university students.

Most university students are transitioning to adulthood, and tend to adopt unhealthy eating habits characterised by a low intake of fruits and vegetables. Few studies have specifically addressed the consumption of vegetables, which have a high content of minerals, fibre, and active compounds. The aim of this investigation was to assess vegetable consumption frequency among university students in a Brazilian capital and examine associations with individual characteristics and cooking skills. This crosssectional study used a online questionnaire to collect data. Cooking skills were evaluated in eight dimensions. Vegetable consumption was recorded in five frequency groups and then categorised into daily and non-daily consumption. Data were subjected to Pearson's chi-squared or analysis of variance followed by Bonferroni post hoc test. Associations between cooking skill dimensions and daily vegetable consumption were identified by crude and adjusted logistic regression analyses.Adjustment was performed for sex, age, paternal education, and overweight/obesity.Results are expressed as odds ratios (p < 0.05). Less than half of the respondents (N = 237; 45%) reported consuming vegetables daily. Higher level of paternal education, not being overweight or obese, and higher scores on seven cooking skill dimensions were positively associated with daily vegetable consumption. Given the scarcity of research on the topic, the findings of this study make a significant contribution to knowledge and may support public health strategies for promoting vegetable consumption among university students.

The adaptation, validation, and application of a methodology for estimating the added sugar content of packaged food products when total and added sugar labels are not mandatory.

Nutrition policies recommend limiting the intake of added sugars. Information about added sugar content is not provided on packaged foods in Brazil, and even total sugar content information is often absent. This study aimed to (i) adapt a systematic methodology for estimating added sugar content in packaged foods when information on total and added sugar contents is not mandatory on labels, (ii) apply the adapted methodology to a Brazilian food composition database to estimate the extent of added sugar content in the national food supply, and (iii) assess the validity of the adapted methodology. We developed an 8-step protocol to estimate added sugar content using information provided on food labels. These steps included objective and subjective estimation procedures. Mean, median, and quartiles of the added sugar content of 4,805 Brazilian foods were determined and presented by food categories. Validity was assessed using a US database containing values of added sugar as displayed on the product labels. Objective estimation of added sugar content could be conducted for 3,119 products (64.9%), with the remainder 1,686 (35.1%) being assessed using subjective estimation. We found that 3,093 (64.4%) foods contained added sugar ingredients and the overall estimated median added sugar content was 4.7 g (interquartile range 0-29.3) per 100 g or 100 ml. The validity testing on US data for products with known added sugar values showed excellent agreement between estimated and reported added sugar values (ICC = 0.98). This new methodology is a useful approach for estimating the added sugar content of products in countries where both added and total sugar information are not mandated on food labels. The method can be used to monitor added sugar levels and support interventions aimed at limiting added sugar intake.

Cenário e perspectivas do sistema alimentar brasileiro frente à pandemia de Covid-19 / Scenario and perspectives of Brazilian food system in face of Covid-19 pandemic

Introdução. Sistemas alimentares resilientes são estratégicos para a soberania de uma nação, especialmente em crises sanitárias. Objetivo. Refletir sobre alguns aspectos do sistema alimentar hegemônico no Brasil frente à pandemia de Covid-19. Desenvolvimento. A partir de uma descrição do cenário pré-pandemia, são expostos alguns desdobramentos conhecidos sobre a qualidade de vida e do ambiente, bem como as consequências que potencialmente levaram a tal condição de fragilidade dos sistemas alimentares, que é fértil para o desencadeamento de crises como a atual. Finalmente, o artigo trata das possibilidades de transição para um sistema alimentar mais justo, localizado, inclusivo e regenerativo. Considerações finais. Não basta fomentar sistemas alimentares saudáveis; é necessário desinvestir de sistemas degenerativos, focados em beneficiar a arrecadação ou a balança comercial. Isso implica reconfigurar e redirecionar uma parte maior das políticas e recursos públicos relacionados com o uso da terra, liberando espaço e recursos financeiros, políticos e sociais para nutrir sistemas alimentares que resultem em benefícios mais sistêmicos.

Introduction. Resilient food systems are strategic to a nation's sovereignty, especially during a health crisis. Objective. To reflect on some aspects of the hegemonic food system in Brazil in the face of the COVID-19 pandemic. Development. On the basis of the description of the pre-pandemic scenario, we analyze and discuss aspects of quality of life and the environment that potentially determine the fragility of food systems and favor the emergence of a crisis such as the current one. Finally, the article deals with the possibilities of transition to a more just, inclusive, and regenerative food system. Final considerations. Fostering healthy food systems is not enough; it is necessary to disinvest from degenerative systems focused on benefiting private enrichment or the balance of trade. Such a change necessitates the reconfiguration and redirection of public policies and investments related to land use, liberating land and financial, political, and social resources to nourish food systems that result in more systemic benefits.

Impact of a nudging intervention and factors associated with vegetable dish choice among European adolescents.

PURPOSE: To test the impact of a nudge strategy (dish of the day strategy) and the factors associated with vegetable dish choice, upon food selection by European adolescents in a real foodservice setting. METHODS: A cross-sectional quasi-experimental study was implemented in restaurants in four European countries: Denmark, France, Italy and United Kingdom. In total, 360 individuals aged 12-19 years were allocated into control or intervention groups, and asked to select from meat-based, fish-based, or vegetable-based meals. All three dishes were identically presented in appearance (balls with similar size and weight) and with the same sauce (tomato sauce) and side dishes (pasta and salad). In the intervention condition, the vegetable-based option was presented as the "dish of the day" and numbers of dishes chosen by each group were compared using the Pearson chi-square test. Multivariate logistic regression analysis was run to assess associations between choice of vegetable-based dish and its potential associated factors (adherence to Mediterranean diet, food neophobia, attitudes towards nudging for vegetables, food choice questionnaire, human values scale, social norms and self-estimated health, country, gender and belonging to control or intervention groups). All analyses were run in SPSS 22.0. RESULTS: The nudging strategy (dish of the day) did not show a difference on the choice of the vegetable-based option among adolescents tested (p = 0.80 for Denmark and France and p = 0.69 and p = 0.53 for Italy and UK, respectively). However, natural dimension of food choice questionnaire, social norms and attitudes towards vegetable nudging were all positively associated with the choice of the vegetable-based dish. Being male was negatively associated with choosing the vegetable-based dish. CONCLUSIONS: The "dish of the day" strategy did not work under the study conditions. Choice of the vegetable-based dish was predicted by natural dimension, social norms, gender and attitudes towards vegetable nudging. An understanding of factors related to choosing vegetable based dishes is necessary for the development and implementation of public policy interventions aiming to increase the consumption of vegetables among adolescents.

Preferences for menu labelling formats of young adults in Brazil and in the United Kingdom / Preferências de adultos jovens por diferentes formatos de informações nutricionais em restaurantes no Brasil e Reino Unido

ABSTRACT Objective This pilot study was aimed at exploring preferences of young adults in two different contexts on restaurant menu labelling formats. Methods Five focus groups were conducted with 36 participants, two focus groups with 11 participants in Brazil and three focus groups with 25 in the United Kingdom. Themes originating from the content analysis of the transcriptions were organised around four possible menu labelling formats: 1) numerical information on calories; 2) numerical information on calories and nutrients; 3) traffic light system plus Guideline Daily Amounts; 4) food information with ingredients list plus highlighted symbols. Results In both countries, participants preferred the ingredients list plus symbols format, considered more comprehensive and useful to make an informed food choice. Organic food and vegetarian symbols were the ones considered most important to appear on restaurant menu labels with ingredients list. However, most participants in Brazil and in the United Kingdom rejected the information restricted to calories and calories plus nutrients formats, saying that these would not influence their own choices. Conclusion This is the first multicultural qualitative study exploring preferences of people living in different countries with different eating habits, but where menu labelling is voluntary. Results evidenced similarities in participants' likes and dislikes for menu labelling formats in these two different contexts. Discussions showed participants in both countries prefer qualitative information than numerical information, suggesting that ingredients list and symbols provide information that people want to see on the menu.

RESUMO Objetivo Este estudo piloto teve como objetivo explorar as preferências de adultos jovens em dois diferentes contextos, quanto a formatos de informações nutricionais em restaurantes. Métodos Cinco grupos focais foram conduzidos com 36 participantes, dois grupos focais com 11 participantes no Brasil e três grupos com 25 no Reino Unido. Os temas originados da análise de conteúdo das transcrições foram organizados em quatro possíveis formatos de informação nutricional em restaurante: 1) informação numérica de calorias; 2) informação numérica de calorias e nutrientes; 3) sistema de semáforo nutricional acrescido de valor diário de referência; 4) informação alimentar contendo lista de ingredientes e símbolos de destaque. Resultados Em ambos os países, os participantes preferiram o formato com lista de ingredientes e símbolos, considerando-o mais compreensível e útil para realizar escolhas alimentares informadas. Os símbolos de alimento orgânico e vegetariano foram considerados mais importantes para serem disponibilizados junto à lista de ingredientes nos restaurantes. Entretanto, a maioria dos participantes no Brasil e no Reino Unido rejeitou o formato contendo apenas a informação de calorias e de calorias mais nutrientes, afirmando que estes formatos poderiam não influenciar suas escolhas alimentares. Conclusão Esse é o primeiro estudo qualitativo multicultural a explorar as preferências de pessoas vivendo em diferentes países, com diferentes hábitos alimentares, mas onde a informação nutricional em restaurantes é voluntária. Os resultados evidenciaram similaridades nas preferências e rejeições quanto aos diferentes formatos de informação nutricional em restaurante, nesses dois diferentes contextos. O estudo mostrou que os participantes em ambos os países preferiram a informação qualitativa em detrimento à informação numérica, sugerindo que o formato contendo lista de ingredientes e símbolos fornece a informação que as pessoas querem ver nos cardápios em restaurantes.

Comparison of the nutritional content of products, with and without nutrient claims, targeted at children in Brazil.

Many children's food products highlight positive attributes on their front-of-package labels in the form of nutrient claims. This cross-sectional study investigated all retailed packaged foods (n 5620) in a major Brazilian supermarket, in order to identify the availability of products targeted at children, and to compare the nutritional content of products with and without nutrient claims on labels. Data on energy, carbohydrate, protein, fibre, Na and total and SFA content, along with the presence and type of nutrient claims, were obtained in-store from labels of all products. Products targeted at children were identified, divided into eight food groups and compared for their nutritional content per 100 g/ml and the presence of nutrient claims using the Mann-Whitney U test (P<0·05). Of the 535 food products targeted at children (9·5 % of all products), 270 (50·5 %) displayed nutrient claims on their labels. Children's products with nutrient claims had either a similar or worse nutritional content than their counterparts without nutrient claims. The major differences among groups were found in Group 8 (e.g. sauces and ready meals), in which children's products bearing nutrient claims had higher energy, carbohydrate, Na and total and SFA content per 100 g/ml than products without nutrient claims (P<0·05). This suggests that, to prevent misleading parents who are seeking healthier products for their children, the regulation on the use of nutrient claims should be revised, so that only products with appropriate nutrient profiles are allowed to display them.

Perceptions of university students regarding calories, food healthiness, and the importance of calorie information in menu labelling.

This study investigated Brazilian university students' perceptions of the concept of calories, how it relates to food healthiness, and the role of calorie information on menus in influencing food choices in different restaurant settings. Focus groups were conducted with 21 undergraduate students from various universities. Transcriptions were analysed for qualitative content, by coding and grouping words and phrases into similar themes. Two categories were obtained: Calorie concept and connection to healthiness; and Calorie information and food choices in restaurants. Calories were understood as energy units, and their excessive intake was associated with weight gain or fat gain. However, food healthiness was not associated to calorie content, but rather to food composition as a whole. Calorie information on restaurant menus was not considered enough to influence food choices, with preferences, dietary restrictions, food composition, and even restaurant type mentioned as equally or more important. Only a few participants mentioned using calorie information on menus to control food intake or body weight. Students' discussions were suggestive of an understanding of healthy eating as a more complex issue than calorie-counting. Discussions also suggested the need for more nutrition information, besides calorie content, to influence food choices in restaurants.

Hábitos alimentares e comportamento de consumo infantil: influência da renda familiar e do hábito de assistir à televisão / Children's eating habits and consumer behavior: influence of household income and television viewing habits

OBJETIVO: Comparar hábitos alimentares e comportamento de consumo de crianças de diferentes níveis de renda familiar de Florianópolis (SC), Brasil, relacionando-os com o hábito de assistir à televisão. MÉTODOS: Estudo qualitativo com análise de conteúdo de manuscritos originados de 23 grupos focais, realizados em uma escola pública e uma escola particular de Florianópolis (SC), compostos por 111 estudantes de 7 a 10 anos. Para verificar a renda familiar dos estudantes, dados sobre a ocupação dos pais foram classificados pela Classificação Brasileira de Ocupações. Os estudantes da escola particular pertenciam a famílias de maior renda em relação aos da escola pública. RESULTADOS: Nas duas escolas, a maioria das crianças entrevistadas referiu assistir à televisão sempre que possível, sem sentir controle dos pais sobre esse hábito. Além disso, afirmaram ter dinheiro para gastos independentes e vontade de comprar os produtos anunciados nas propagandas de televisão. Estudantes da escola pública relataram ingerir e adquirir guloseimas mais frequentemente e ter maior liberdade para fazer compras do que os estudantes da escola particular, que revelaram sentir-se controlados pelos pais em relação aos seus hábitos alimentares e compras realizadas. CONCLUSÃO: O fato de os estudantes da escola particular sentirem-se mais controlados por seus pais pode ter reduzido uma provável influência da televisão sobre seus hábitos alimentares e de compras. Evidencia-se a importância da formulação de estratégias para auxiliar os pais a reduzirem os efeitos da televisão sobre os hábitos de seus filhos e de políticas públicas que incentivem o consumo saudável, além da regulamentação do marketing de alimentos pouco nutritivos para o público infantil.

OBJECTIVE: This study compared the eating habits and consumer behavior of children from different socioeconomic levels from Florianópolis (SC), Brazil, and investigated their relationship with television viewing habits. METHODS: The present qualitative study analyzed the transcriptions taken during 23 focus groups done in one public and one private school of Florianópolis (SC). The groups consisted of 111 students aged 7 to 10 years. The students' household income was estimated by parental occupation and classified according to the Brazilian Occupation Classification. The households of private school students had higher income than those of public school students. RESULTS: In both schools, most interviewed children reported watching television whenever possible, not perceiving parental control over this habit. Children also mentioned having spending money and the wish to buy products advertised on television ads. The students from the public school reported buying and consuming sweet and savory snacks more often, and having greater freedom to shop than their private school counterparts, who reported feeling greater parental control on their eating and purchase habits. CONCLUSION: The perception of greater parental control may have reduced the influence of television on the spending and eating habits of private school children. The study highlights the importance of formulating strategies that help parents to reduce the impact of television on their children's habits and public policies that encourage healthy food choices. Advertising of unhealthy foods for children should also be regulated.