Indices for measurement of sustainable diets: A scoping review.

INTRODUCTION: The current food system is associated with negative impacts on health, food insecurity and environmental harm. Sustainable diets have attracted increasing interest and novel proposals with a global scope have emerged. This scoping review aims to give an overview of the analysis of all the available evidence related to the sustainable diet indices that have been developed based on the EAT-Lancet Commission. METHODS: Searches were conducted in the PubMed, Embase, Web of Science, Scopus and Science Direct databases. This review was conducted following the PRISMA-ScR guidelines. The target population were studies addressed the use of an index or metric for assessing sustainable diets based on the EAT-Lancet Commission Summary Report were included. PCC acronym was used in the design of the study to describe eligibility criteria: P (Population)-Indexes; C (Concept)-Sustainable diets; C (Context)-Knowledge on the structure and applicability of measurement indices of sustainable diets based on EAT-Lancet recommendations available in the literature. Study eligibility criteria were restricted to papers published in English, from January 2019 through October 2022, with no population restriction. RESULTS: A total of 1,458 papers were retrieved, 14 of which were included in the review. Seven measures of sustainable diets were identified as follow: EAT-Lancet diet score (ELD-I), New EAT-Lancet diet score (EAT), Planetary Health Diet Index (PHDI), Sustainable Diet Index (SDI), Sustainable-HEalthy-Diet (SHED), novel Nutrient-Based EAT index (NB-EAT) and World Index for Sustainability and Health (WISH). Most studies were conducted in developed countries, where greater adherence to this type of diet was found. Estimated greenhouse gas emissions was the most reported indicator of sustainability, followed by diet quality and the benefits of sustainable diets with regards to health outcomes. DISCUSSION: We identified barriers that hinder progress towards sustainable diets, including the difficulty of comparing different indices and the tendency to neglect social aspects and the lack of common definitions and metrics. Despite being challenge, we highlight the importance of using indices that assess sustainable diets that harmonize various indicators, as recommended by the EAT-Lancet Commission, in order to promote positive changes towards a more sustainable future.

Pro-Inflammatory Diet Is Correlated with High Veillonella rogosae, Gut Inflammation and Clinical Relapse of Inflammatory Bowel Disease.

Inflammatory bowel diseases (IBD) are chronic conditions arising from an intricate interplay of genetics and environmental factors, and are associated with gut dysbiosis, inflammation, and gut permeability. In this study, we investigated whether the inflammatory potential of the diet is associated with the gut microbiota profile, inflammation, and permeability in forty patients with IBD in clinical remission. The dietary inflammatory index (DII) score was used to assess the inflammatory potential of the diet. The fecal microbiota profile was analyzed using 16SrRNA (V3-V4) gene sequencing, while fecal zonulin and calprotectin levels were measured with enzyme-linked immunosorbent assays. We found a positive correlation between the DII score and elevated calprotectin levels (Rho = 0.498; p = 0.001), but not with zonulin levels. Although α- and ß-diversity did not significantly differ across DII quartiles, the most pro-inflammatory diet group exhibited a higher fecal abundance of Veillonella rogosae (p = 0.026). In addition, the abundance of some specific bacteria sequences showed an exponential behavior across DII quartiles and a correlation with calprotectin or zonulin levels (p ≤ 0.050). This included a positive correlation between sq702. Veillonella rogosae and fecal calprotectin levels (Rho = 0.419, p = 0.007). DII, calprotectin, and zonulin levels were identified as significant predictors of 6-month disease relapse (p ≤ 0.050). Our findings suggest a potential relationship of a pro-inflammatory diet intake with Veillonella rogosae and calprotectin levels in IBD patients in clinical remission, which may contribute to disease relapse.

Associação entre hipertensão arterial sistêmica e indicadores antropométricos em idosos do estudo brazuca / Association between systemic arterial hypertension and anthropometric indicators in the elderly in the brazuca study / Asociación entre hipertensión arterial sistémica y indicadores antropométricos en adultos mayores del estudio brazuca

Introdução:A Hipertensão Arterial Sistêmica é uma doença crônica que acometea maior parte idosos brasileiros, sendo uma das principais causas de mortes prematuras e incapacidades funcionais que causam complicações cardiovasculares e cerebrais, as quais podem estar associadas a diversos fatores predisponentes como a obesidade.Objetivo:Avaliar a associação entre hipertensão arterial sistêmica e indicadores antropométricos em idosos do estudo BrazucaNatal.Metodologia: Estudo transversal de base populacional com 191 idosos do município Natal-RN. Foram coletados dados sociodemográficos, econômicos e antropométricos (peso, estatura, perímetro da cintura e perímetro do quadril) e cálculo do Índice de Massa Corporal, Razão Cintura-Estatura e Razão Cintura Quadril. A hipertensão arterial foi auto referida. Os dados foram analisados pelo software SPSS versão 20.0. Teste t de Student foi utilizado para avaliar as diferenças entre médias das variáveis de acordo com o sexo e presença de hipertensão arterial. A associação entre a presença da doença e as variáveisfoi realizadapela Regressão de Poisson, comas razões de prevalência brutas e ajustadas e seus intervalos de confiança (95%).Resultados:A maioria dos idosos eram do sexo feminino (55%), com média de idade 69,48 anos (DP=7,38) e índice de massa corporalde 28,46 (DP=5,25), 59,4% possuíamexcesso de peso e 60,1% hipertensão. Ao comparar os sexos, registramos maiores médias de índice de massa corporal, perímetro do quadrile relação cintura estaturanas mulheres (p<0,05). Observamos maiores médias de idadee indicadores antropométricos entre os idosos com hipertensão (p<0,05). Constatamos que a presença de hipertensão estava associada a perímetro da cintura e índice de massa corporal no modelo bruto, mantendo-se apenas o perímetro da cinturano modelo ajustado. Conclusões:Indicadores antropométricos de fácil aplicação e baixo custo como o perímetroda cintura podeser eficientes para a detecção precoce da hipertensão arterial em idosos (AU).

Introduction:SystemicArterial Hypertension is a chronic disease that affects most Brazilian older adults and is one of the main causes of premature deaths and functional disabilities that cause cardiovascular and brain complications. Obesityis among the several predisposing factorsassociatedwithhypertension. Objective:To evaluate the association between SAHand anthropometric indicators in older adultsof the Brazuca Natal study.Methodology: Cross-sectional population-based study with 191 older adults in the city of Natal-RN.Sociodemographic, economic and anthropometric data (weight, height, waist circumference,and hip circumference),Body Mass Index, Waist-Height Ratio and Waist-Hip Ratio were collected. Hypertension was self-reported. Data were analyzed using the SPSS software, version 20.0. The Student's t-test was used to compare themeans of the variables according to sexand presence of hypertension. The association between the presence of the disease and the variables wasperformed by Poisson regression, with crude and adjusted prevalence ratios and respectiveconfidence intervals (95%).Results:The majority of the elderly were female (55%), with a mean age of 69.48 years (SD = 7.38) andBody Mass Indexof 28.46 (SD = 5.25), 59.4% were overweight and 60.1% had hypertension. Mean Body Mass Index, hip circumference and Waist-Height Ratiovalues were higher in women (p<0.05). The age and anthropometric indicators values were higher among the older adults with hypertension (p<0.05). We found that the presence of hypertension was associated with body weight and Body Mass Index,in the crude model and only with body weight in the adjusted model. Conclusions:Anthropometric indicators of easy application and lowcost such as waist circumference can be efficient todetect hypertension in older adults (AU).

Introducción:La Hipertensión Arterial Sistémica es una enfermedad crónica que afecta principalmente ancianos brasileños, siendo una de las principales causas de muertes prematuras ydiscapacidades funcionales que causan complicaciones cardiovasculares y cerebrales, las cuales pueden estar asociadas a diversos factores predisponentes como la obesidad. Objetivo:Evaluar la asociación entre la hipertensión arterial sistémica y los indicadores antropométricos en ancianos del estudio Brazuca Natal. Metodología:Estudio transversal de base poblacional con 191 ancianos del municipio Natal-RN. Se reconpilaron datos sociodemográficos, económicos y antropométricos (peso, estatura, perímetro de la cintura y perímetro de la cadera) y cálculo del Índice de Masa Corporal,Razón Cintura-Estatura y Razón Cintura Cadera. La hipertensión fue auto referida. Los datos fueron analizados por el software SPSSversión 20.0. Test t de Student fue realizado para evaluar las diferencias entre medias de las variables de acuerdo con el sexo y la presencia de hipertensión arterial. La asociación entre la presencia de la enfermedad y las variables fue realizada por la Regresión de Poisson, con las razones de prevalencia brutas y ayustadas y sus intervalos de confianza (95%). Resultados:La mayoría de los ancianos eran mujeres (55%), con una media de 69,48 años (DP= 7,38) y Índice de Masa Corporalde 28,46 (DP= 5,25), 59,4% poseían exceso de peso y 60,1% hipertensión. Observamos mayores medias de edady indicadores antropométricosentre los ancianos con hipertensión (p<0,05).Constatamos que la presencia de hipertensión estaba asociada al perímetro de la cinturae Índice de Masa Corporalen el modelo bruto, manteniendo solo el perímetro de la cinturaen el modelo ayustado. Conclusiones:Indicadores antropométricos de fácil aplicación y bajo costo como el perímetro de la cintura puede ser eficaz para la detección temprana de la hipertensión arterial en los ancianos (AU).

Associations of the consumption of unprocessed red meat and processed meat with the incidence of cardiovascular disease and mortality, and the dose-response relationship: A systematic review and meta-analysis of cohort studies.

OBJECTIVES: The aim of this study was to examine the associations of unprocessed red meat and processed meat consumption with cardiovascular disease (CVD) incidence and mortality, and the dose-response relationship. METHODS: Published literature was retrieved through a structured search of 10 electronic databases: MEDLINE/PubMed, Scopus, SciELO, LILACS, ScienceDirect, Web of Science, Cochrane (CENTRAL), WHOLIS, PAHO and Embase, without language or year of publication restrictions. In addition, we searched the references of published studies. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes: The PRISMA Statement. RESULTS: Twenty-one prospective cohort studies were included in the systematic review. The CVDs evaluated in the inserted studies were stroke, heart failure (HF) and coronary heart disease (CHD). Considering the heterogeneity found in the studies, for the meta-analysis, 9 articles were included. The results presented in the meta-analysis of the association of consumption of unprocessed red meat and CVD indicated that there was a significant association with total stroke incidence (RR 1.10; 95%; CI 1.01 to 1.19; p = 0.02). There was no association with Ischemic stroke incidence, nor CHD Mortality with consumption of unprocessed red meat. However, for Hemorrhagic Stroke Mortality the assessment in the consumption of unprocessed red meat showed an association of protection for women (RR 0.64; 95%; CI 0.45 to 0.91; p = 0.01). As for the results of the meta-analysis of the association between consumption of processed meat and CVD, they indicated that there was a significant association with total stroke incidence (RR 1.17; 95%; CI 1.08 to 1.26; p < 0.0001). There was no association with Ischemic stroke, nor with CHD Mortality with consumption of processed meat. Some studies that showed no association of risk, presented a significant linear trend dose response for the association of the consumption of unprocessed red meat (Bernstein et al. 2010; Nagao et al. 2012) or processed meat (Bernstein et al. 2012) and CVD. CONCLUSION: According to the results found in the meta-analysis, the consumption of unprocessed red meat and processed meat are associated with the incidence of stroke, however, no positive association was observed in relation to mortality from CVD. This systematic review and meta-analysis protocol was registered on the PROSPERO (number: CRD42019100914).

Dietary Environmental Footprints and Their Association with Socioeconomic Factors and Food Purchase Practices: BRAZUCA Natal Study.

The analysis of dietary environmental impacts has proven to be an important tool for guiding the adoption of healthier and more sustainable diets. This study aimed to estimate the dietary carbon (CF), water (WF), and ecological (EF) footprints of residents in the city of Natal, Brazil; the study also aimed to verify their association with socioeconomic factors and food purchase practices. This is a cross-sectional study that used dietary data from 411 adults and elderlies, which was collected via a questionnaire that applied to the respondents. The results showed that the dietary CF was 1901.88 g CO2 eq/day/1000 kcal, the WF was 1834.03 L/day/1000 kcal, and the EF was 14.29 m2/day/1000 kcal. The highest environmental footprint values showed an association (p ≤ 0.05) with the factors of male sex, white ethnicity, and higher income and schooling, whereas the lowest environmental footprint values were associated with social vulnerability variables such as female sex, non-white ethnicity, and lower income and schooling (p ≤ 0.05). Moreover, people with lower environmental footprints consumed less fast food, had fewer meals at snack bars, and used food delivery services less often than those with higher footprints. The foods that most contributed to the CFs and WFs were beef and chicken, while fish and beef contribute the most to the EFs. The data in the present study show that a diet with a lower environmental impact is not always equal to a sustainable diet. This relationship is paradoxical and relates to food justice, as people with lower environmental footprint values are the same ones with worse socioeconomic conditions. In this sense, is it essential to consider the influence of the social context when assessing dietary environmental impacts and when assessing actions that promote healthier and more sustainable diets.

Environmental footprints of food consumption: Protocol for a systematic literature review.

Environmental footprints are indicators that can be used to estimate the impacts of diet on the environment. Since contemporary dietary practices are related to negative environmental impacts, this paper aims to describe a systematic review protocol to investigate the environmental footprints of food consumption by adults and elderly individuals worldwide. This protocol was developed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Search strategies and records of evidence searched in previously defined electronic databases will be defined. Original, population-based articles investigating the environmental footprints of food consumption by adults and the elderly will be included. Two independent reviewers will conduct the study selection and data extraction steps. Critical appraisal of the included studies will be based on the Newcastle-Ottawa Scale. For data synthesis, a narrative synthesis and, if possible, also a meta-analysis will be performed. The systematic review produced from this protocol will provide evidence for data synthesis of the environmental impact through environmental footprints of food consumption of the adult and elderly population from different territories and the footprint assessment tools used around the world. Therefore, it is a gap that needs to be filled because knowing these impacts will be important to inform the development of public policies that encourage healthy and sustainable food in the face of climate and epidemiological changes. PROSPERO registration number: CRD42021281488.

Care actions for newborns and factors associated with longitudinality in the follow-up care in the neonatal period: Care actions for the newborn.

As newborns are highly vulnerable, they require essential care for adequate child development. This study aimed to assess the care provided to newborns during the first 28 days of life and identify factors associated with adequate care. This was a longitudinal study conducted with 415 mothers and full-term newborns from 4 public maternity hospitals in Natal, Brazil, in 2019. Assistance, socioeconomic, and demographic data were collected 3 times: 48 hours, 7 days, and 28 days after birth. Pearson's chi-square and Poisson regression tests were used with a confidence interval of 95%. Most mothers were between 20 and 29 years old (46.5%), had a high school or higher education (65.3%), a partner (79%), an income of ≤ 1 minimum wage (64, 6%), and were multiparous (62.9%). A total of 29 actions performed in maternity hospitals and 11 in primary healthcare were evaluated. Among the first, 8 (27.6%) were satisfactory; 11 (37.9%), partially satisfactory; and 10 (34.5%), unsatisfactory. In primary care, 2 actions (18.2%) were considered satisfactory; 3 (27.3%) partially satisfactory; and 6 (54.5%) unsatisfactory. In the multivariate analysis of the composite indicators related to adequacy of care, women undergoing vaginal delivery, those who are multiparous, and maternity hospitals at usual risk were associated with better adequacy of care indicators (P ≤ .05). Maternity hospitals accredited to the Baby-Friendly Hospital Initiative had lower chances of the adequacy of promotion to exclusive breastfeeding. The sample loss rate was 13.7% in the first week and 16.6% at the end of the study period. There was inadequacy in the performance of care actions for newborns regarding access and comprehensiveness of care. These weaknesses highlight the need for reassessing skills and coordinating actions in the child's healthcare network.

Dietary and Nutritional Profiles among Brazilian Adolescents.

(1) Background: The present study analyzed the prevalence of dietary and nutritional profiles among Brazilian adolescents and their associations with social determinants of health. (2) Methods: A population-based survey was administered to 16,409 adolescents assessed by the 2015 National School Health Survey. A multivariate model of dietary and nutritional profiles was estimated from correspondence analysis. (3) Results: The dietary and nutritional profiles more prevalent among Brazilian adolescents were "lower nutritional risk dietary pattern and eutrophic" (42.6%), "lower nutritional risk dietary pattern and overweight" (6.8%), and "higher nutritional risk dietary pattern and overweight" (6.0%). Healthier profiles were associated with less urbanized territories, health-promoting behaviors, and families with worse material circumstances. The less healthy profiles were associated with more urbanized environments, health risk behaviors, and families with better material circumstances. (4) Brazilian adolescents have different dietary and nutritional profiles that are characterized by sociopolitical and economic contexts, family material and school circumstances, and the behavioral and psychosocial health factors of the individuals. All of this points to the social determination of these health problems among adolescents in Brazil.

Chronic diseases and emotional disorders are associated with low perception of quality of life in food insecurity/security.

Understanding individual perception of Quality of Life (QoL) can help combat social and health inequalities. We aimed to identify factors associated with Low Perceived Quality of Life (LPQoL) in 295 adults and older adults with food security and food insecurity, in the city of Natal, Brazil. A cross-sectional study was conducted from June to December 2019, with collection of data on socioeconomic demographic status, lifestyle information, non-communicable diseases (NCDs) and risk factors, emotional disorders, food (in) security and quality of life. To assess food insecurity, the Brazilian Scale of Food Insecurity-EBIA was used, and the WHOQOL-Bref questionnaire was used to assess quality of life. Poisson's Regression was used to verify associations between variables and LPQoL, stratifying the sample into food secure (FS) and food insecure (FI) groups. In the FI group, being overweight, older adult, having no partner, drinking alcoholic beverages twice a week or more, and not having daily availability of water were associated with LPQoL, and in the FS group, having diabetes, monthly family income in the 1st and 2nd tertiles, and never having studied was associated with LPQoL. Reporting emotional disorders and sleeping < 7 h/day were associated with LPQoL in both FI and FS groups. LPQoL was associated with the occurrence of NCDs and risk factors, and emotional disorders, regardless of the food security measure. However, the lack of adequate access to water highlights the social vulnerability of the FI group.

Social Determinants of Obesity and Stunting among Brazilian Adolescents: A Multilevel Analysis.

(1) Background: The purpose of this study was to identify the prevalence of obesity and stunting among Brazilian adolescents and its associations with social determinants of health (individual, family, and school), grounded on the necessity of investigating the determinants of nutritional problems within this population. (2) Methods: A population-based survey was administered to 16,556 adolescents assessed by the 2015 National School Health Survey. Multivariate models of obesity and stunting were estimated from Multilevel Poisson Regressions. (3) Results: The prevalence of obesity among Brazilian adolescents (10.0%; 95% CI: 9.4-10.6) was associated directly with indifference or dissatisfaction with body image, with eating breakfast four or fewer days a week, living with up to four people in the household, studying in private schools, and being from the South region, and was inversely associated with being female, 15 years old or older, with having the highest nutritional risk eating pattern, dining at fast-food restaurants, and eating while watching television or studying. The prevalence of stunting (2.3%; 95% CI: 2.0-2.8) was directly associated with the age of 15 years or older, and inversely associated with the lower number of residents living in the household, maternal education-decreasing gradient from literate to college level education, studying in urban schools, and being from the South and Central-West regions. (4) Conclusions: Obesity in adolescence presented behavioral determinants. Stunting and obesity have structural social determinants related, respectively, to worse and better socioeconomic position among Brazilian adolescents.

A methodological proposal for assessing food insecurity from a multidimensional perspective. / Proposta metodológica para avaliação da insegurança alimentar sob a ótica de suas múltiplas dimensões.

The aim of this study was to develop a methodological proposal for the assessment of food and nutritional insecurity (FNiS) in adults and older adults (Vigi-FNiS). The proposal was developed using data from the BRAZUCA Natal survey, a cross-sectional study with 411 people living in Natal in the state of Rio Grande do Norte, Brazil. The association between sociodemographic, health and nutrition variables and food insecurity (FI) was tested using Poisson multiple regression. Overall prevalence of FI was 42.1% (37.4%-46.9%) and was higher in women (47.5%), adults (48.2%) and black people (52.7%). The following variables were included in the Vigi-FNiS: people aged <18 years living in the household (A) (AdjPR=1.3; 1.1-1.6); family income (B) in quintiles (Q1: AdjPR=5, 4; 2.5-11.7; Q2: AdjPR=4.8; 2.2-10.5; Q3: AdjPR=3.8; 1.8-8.5; Q4 AdjPR=2.2; 1.0-5.1); inadequate treatment of drinking water (C) (AdjPR=1.3; 1.1-1.5); presence of chronic non-communicable diseases (D) (AdjPR=1.3; 1.1-1.7); not eating fruit for breakfast (E) (AdjPR=1.7; 1.3-2.5);eating meals on the couch or in bed (F) (AdjPR=1.3; 1.1-1.6); and skipping either lunch or dinner or dinner (G) (AdjPR=1.4; 1.2-1.7). A cutoff point for FNiS of 2.3 was adopted (Kappa=0.47; sensitivity=0.82; specificity=0.67; PPV=0.64; NPV=0.83).

O objetivo deste artigo é desenvolver uma proposta metodológica para avaliar a insegurança alimentar e nutricional (INSAN) em adultos e idosos. A proposta metodológica Vigi-INSAN foi elaborada com dados do Brazuca Natal, um estudo transversal com 411 residentes de Natal-RN. O modelo preditivo foi desenvolvido por regressão múltipla de Poisson, analisando-se as variáveis sociodemográficas, de saúde e nutrição, e a insegurança alimentar (IA). A prevalência de IA foi 42,1% (37,4%-46,9%), sendo maior em mulheres (47,5%), adultos (48,2%) e pessoas de cor/raça preta (52,7%). O Vigi-INSAN foi composto por: presença de <18 anos no domicílio (A) (RPaj=1,3; 1,1-1,6), renda familiar (B) (em quintis) (Q1: RPaj=5,4; 2,5-11,7; Q2: RPaj=4,8; 2,2-10,5; Q3: RPaj=3,8; 1,8-8,5; Q4 RPaj=2,2; 1,0-5,1), tratamento inadequado da água de beber (C) (RPaj=1,3; 1,1-1,5), presença de DCNT (D) (RPaj=1,3; 1,1-1,7), não comer frutas no café da manhã (E) (RPaj=1,7; 1,3-2,5), realizar refeições no sofá da sala ou na cama (F) (RPaj=1,3; 1,1-1,6) e pular pelo menos o almoço ou o jantar (G) (RPaj=1,4; 1,2-1,7). Foi adotado o ponto de corte 2,3 (Kappa=0,47; Sensibilidade=0,82; Especificidade=0,67; VPP=0,64; VPN=0,83).

Social determinants of health associated with the experience of hunger among Brazilian adolescents. / Determinantes sociais em saúde associados à vivência da fome entre adolescentes do Brasil.

The aim of this study was to identify social determinants of health associated with the experience of hunger among school-age adolescents in Brazil. We conducted a cross-sectional study with a sample of 16,526 adolescents using data from the 2015 National School-based Student Health Survey. Experience of hunger was determined based on the answer to the question "In the last 30 days, how often have you been hungry because there wasn't enough food at home?" The social determinants of health were analyzed using Poisson regression with robust variance. The prevalence of the experience of hunger was 22.8% (95%CI: 21.9-23.7). The experience of hunger was directly associated with being male (PR = 1.12; 95%CI: 1.07-1.16); not being overweight (PR = 1.08; 95%CI: 1.04-1.13 ); irregular consumption of beans (PR = 1.20; 95%CI: 1.13-1.26), vegetables (PR=1.16; 95%CI: 1.09-1.22) and fruit (PR = 1.19; 95%CI: 1.13-1.24); body dissatisfaction (PR = 1.26; 95%CI: 1.18-1.35); and not regularly eating lunch or dinner with parents or guardians (PR = 1.41; 95%CI: 1.32-1.52). An inverse association was found between the experience of hunger and maternal education level and living in the Mid-West, Southeast and South. The findings show that the experience of hunger among Brazilian adolescents coexists with risky eating behaviors, body dissatisfaction, and social inequality.

Objetivou-se identificar determinantes sociais em saúde associados à vivência da fome entre adolescentes escolares brasileiros. Foi realizado um estudo transversal com microdados de 16.526 adolescentes da Pesquisa Nacional de Saúde do Escolar 2015. A vivência da fome foi estimada considerando a frequência com que o adolescente havia ficado com fome por não ter comida suficiente em casa no mês anterior à pesquisa. Para a análise dos determinantes sociais em saúde foi realizada Regressão de Poisson com variância robusta. Verificou-se, no Brasil, que a vivência da fome foi de 22,8% (IC95%: 21,9-23,7) entre adolescentes. Essa associou-se diretamente ao sexo masculino (RP=1,12; IC95%: 1,07-1,16), a não ter excesso de peso (RP=1,08; IC95%: 1,04-1,13), ao consumo irregular de feijão (RP=1,20; IC95%: 1,13-1,26), de legumes e verduras (RP=1,16; IC95%: 1,09-1,22) e de frutas (RP=1,19; IC95%: 1,13-1,24), à insatisfação corporal (RP=1,26; IC95%: 1,18-1,35) e ao consumo irregular de almoço ou jantar com os responsáveis (RP=1,41; IC95%: 1,32-1,52); e inversamente ao gradiente de escolaridade materna, e às macrorregiões do complexo Centro-Sul. Os resultados indicam a coexistência da fome, comportamentos alimentares de risco nutricional, insatisfação corporal e condições de iniquidade social entre adolescentes brasileiros.

The impact of essential and toxic elements on cardiometabolic risk factors in adults and older people.

BACKGROUND AND AIM: Evidence suggests an association between essential and toxic elements and the worsening of cardiometabolic risk factors. This study aimed to investigate the concentrations of zinc, copper, selenium, arsenic, cadmium, and mercury and their relationship with cardiometabolic risk factors in adults and older people. METHODS: This cross-sectional study was carried out with 112 adults with a mean age of 59 (sd 14) years old and a BMI of 29.30 (sd 5.11) Kg/m2. The subject's weight and height were measured for body mass index (BMI) calculation, classified according to the cut-off points recommended by the World Health Organization (WHO). We evaluated sociodemographic, clinical, lifestyle, waist circumference - WC, visceral adiposity index - VAI, glycemic lipid profile, blood pressure, and high-sensitive C-reactive protein (hs-CRP). Cardiovascular risk was defined by The Global Risk Score (GRS) score. Plasma zinc, selenium, copper levels, urinary arsenic, cadmium, and mercury levels were measured using the inductively coupled plasma mass spectrometry technique (ICP-MS). RESULTS: There was a negative association between urinary arsenic and VAI (ß - 0.03, p < 0.01), triglycerides (ß - 1.10, p < 0.01), and VLDL cholesterol (ß - 0.14, p = 0.02). Plasma copper and copper/zinc ratio were positively associated with fasting glucose and hs-CRP (ß 0.38, p < 0.01; ß 36.02, p = 0.01, ß 0.004, p < 0.01, ß 0.68, p < 0.001, respectively). Urinary arsenic (ß - 0.14, p = 0.04) and cadmium (ß - 36.42, p = 0.04) were negatively associated with systolic blood pressure. Also, urinary cadmium was negatively associated with diastolic blood pressure (ß - 21.55, p = 0.03), and urinary mercury showed an opposite behavior (ß 1.45, p = 0.03). CONCLUSION: Essential and toxic elements in urine and plasma could be potential biomarkers for cardiovascular risk factors. A healthy lifestyle should be adopted; in addition, government policies should be developed to guarantee sustainable production and a safe environment.

A Systematic Review on Processed/Ultra-Processed Foods and Arterial Hypertension in Adults and Older People.

The increase in the availability of processed and ultra-processed foods has altered the eating patterns of populations, and these foods constitute an exposure factor for the development of arterial hypertension. This systematic review analyzed evidence of the association between consumption of processed/ultra-processed foods and arterial hypertension in adults and older people. Electronic searches for relevant articles were performed in the PUBMED, EMBASE and LILACS databases. The review was conducted following the PRISMA guidelines and the Newcastle-Ottawa Scale. The search of the databases led to the retrieval of 2323 articles, eight of which were included in the review. A positive association was found between the consumption of ultra-processed foods and blood pressure/arterial hypertension, whereas insufficient evidence was found for the association between the consumption of processed foods and arterial hypertension. The results reveal the high consumption of ultra-processed foods in developed and middle-income countries, warning of the health risks of such foods, which have a high energy density and are rich in salt, sugar and fat. The findings underscore the urgent need for the adoption of measures that exert a positive impact on the quality of life of populations, especially those at greater risk, such as adults and older people.

Food Insecurity and Associated Factors in Brazilian Undergraduates during the COVID-19 Pandemic.

Undergraduates may face challenges to assure food security, related to economic and mental distress, especially during the COVID-19 pandemic. This study aimed to assess food insecurity and its associated factors in undergraduates during the COVID-19 pandemic. An online cross-sectional study was conducted from August 2020 to February 2021 with 4775 undergraduates from all Brazilian regions. The questionnaire contained socio-economic variables, the validated Brazilian food insecurity scale, and the ESQUADA scale to assess diet quality. The median age of the students was 22.0 years, and 48.0% reported income decreasing with the pandemic. Food insecurity was present in 38.6% of the students, 4.5% with severe food insecurity and 7.7% moderate. Logistic regressions showed students with brown and black skin color/race presented the highest OR for food insecurity; both income and weight increase or reduction during the pandemic was also associated with a higher OR for food insecurity, and better diet quality was associated with decreased OR for food insecurity. Our study showed a considerable presence of food insecurity in undergraduates. Policy for this population must be directed to the most vulnerable: those with brown and black skin color/race, who changed income during the pandemic, and those presented with difficulties maintaining weight and with poor diet quality.

Redução do déficit de estatura e a compra de alimentos da agricultura familiar para alimentação escolar no Brasil / Reduction of stature deficit and purchase of family agriculture produce for school meals in Brazil / Reducción del déficit de estatura y de la agricultura familiar en la alimentación escolar en Brasil

O objetivo do artigo é analisar o efeito da compra direta de alimentos da agricultura familiar para alimentação escolar sobre o déficit de estatura em crianças menores de cinco anos, entre 2013 e 2017, no Brasil. O método utilizado é o estudo ecológico e longitudinal, em que a coleta de dados ocorreu em diferentes bancos de dados. A análise foi realizada por meio do teste t para amostras independentes, a fim de comparar as médias entre as variáveis déficit de estatura e compras da agricultura familiar. Além disso, uma análise multivariável foi feita por meio da regressão linear múltipla. Verificou-se uma diferença de médias na prevalência do déficit de estatura significativa entre os municípios que compraram menos de 30% e aqueles que adquiriram 30% ou mais de alimentos da agricultura familiar para alimentação escolar, com 1,47 pontos de diferença. O modelo de regressão linear mostrou que a cada ponto percentual de aumento na compra de alimentos da agricultura familiar para a alimentação escolar pelo município, haverá, em média, uma diminuição 0,55 pontos na prevalência do déficit de estatura, independentemente das demais variáveis. Assim, conclui-se que a compra de alimentos da agricultura familiar para alimentação escolar no Brasil pode contribuir para a redução da prevalência do déficit de estatura em crianças menores de cinco anos.

The objective of this work is to analyze the effect of direct purchase of food from family farms for school meals on the deficit of stature in children under 5 years of age between 2013 and 2017 in Brazil. Method: Ecological and longitudinal study in which data collection occurred in different databases. The analysis was performed using the t-test for independent samples in order to compare the means between the variables stature deficit and purchases from family agriculture. In addition, a multivariable analysis was conducted through multiple linear regression. Results: There was a difference in means in the prevalence of significant stature deficit between the municipalities that bought < 30% and ≥30% of food from family farms for school feeding, with 1.47 points of difference. The linear regression model showed that for each percentage point of increase in the purchase of food from family farms for school feeding by the municipality, there will be on average a decrease of 0.55 points in the prevalence of stature deficit, independent of the other variables. Conclusion: the purchase of food from family agriculture for school feeding in Brazil may contribute to the reduction of the prevalence of stature deficit in children under five years old.

Objetivo: Analizar el efecto de la compra directa de alimentos de las granjas familiares para la alimentación escolar en el déficit de estatura de los niños menores de cinco años entre 2013 y 2017 en Brasil. Método: Estudio ecológico y longitudinal en el que se recogieron datos en diferentes bases de datos. El análisis se llevó a cabo mediante la prueba t para muestras independientes con el fin de comparar las medias entre las variables déficit de estatura y compras de la agricultura familiar. Además, se hizo un análisis multivariable a través de una regresión lineal múltiple. Resultados: Se produjo una diferencia de medias en la prevalencia del déficit de estatura significativo entre los municipios que compraron < 30% y ≥ 30% de los alimentos de las granjas familiares para la alimentación escolar, con 1,47 puntos de diferencia. El modelo de regresión lineal mostró que por cada punto porcentual de aumento en la compra de alimentos de las granjas familiares para la alimentación escolar por parte del municipio, habrá, en promedio, una disminución de 0,55 puntos en la prevalencia del déficit de estatura, independientemente de las demás variables. Conclusión: la compra de alimentos de las granjas familiares para la alimentación escolar en el Brasil puede contribuir a reducir la prevalencia del déficit de estatura en los niños menores de cinco años.

Proposta metodológica para avaliação da insegurança alimentar sob a ótica de suas múltiplas dimensões / A methodological proposal for assessing food insecurity from a multidimensional perspective

Resumo O objetivo deste artigo é desenvolver uma proposta metodológica para avaliar a insegurança alimentar e nutricional (INSAN) em adultos e idosos. A proposta metodológica Vigi-INSAN foi elaborada com dados do Brazuca Natal, um estudo transversal com 411 residentes de Natal-RN. O modelo preditivo foi desenvolvido por regressão múltipla de Poisson, analisando-se as variáveis sociodemográficas, de saúde e nutrição, e a insegurança alimentar (IA). A prevalência de IA foi 42,1% (37,4%-46,9%), sendo maior em mulheres (47,5%), adultos (48,2%) e pessoas de cor/raça preta (52,7%). O Vigi-INSAN foi composto por: presença de <18 anos no domicílio (A) (RPaj=1,3; 1,1-1,6), renda familiar (B) (em quintis) (Q1: RPaj=5,4; 2,5-11,7; Q2: RPaj=4,8; 2,2-10,5; Q3: RPaj=3,8; 1,8-8,5; Q4 RPaj=2,2; 1,0-5,1), tratamento inadequado da água de beber (C) (RPaj=1,3; 1,1-1,5), presença de DCNT (D) (RPaj=1,3; 1,1-1,7), não comer frutas no café da manhã (E) (RPaj=1,7; 1,3-2,5), realizar refeições no sofá da sala ou na cama (F) (RPaj=1,3; 1,1-1,6) e pular pelo menos o almoço ou o jantar (G) (RPaj=1,4; 1,2-1,7). Foi adotado o ponto de corte 2,3 (Kappa=0,47; Sensibilidade=0,82; Especificidade=0,67; VPP=0,64; VPN=0,83).

Abstract The aim of this study was to develop a methodological proposal for the assessment of food and nutritional insecurity (FNiS) in adults and older adults (Vigi-FNiS). The proposal was developed using data from the BRAZUCA Natal survey, a cross-sectional study with 411 people living in Natal in the state of Rio Grande do Norte, Brazil. The association between sociodemographic, health and nutrition variables and food insecurity (FI) was tested using Poisson multiple regression. Overall prevalence of FI was 42.1% (37.4%-46.9%) and was higher in women (47.5%), adults (48.2%) and black people (52.7%). The following variables were included in the Vigi-FNiS: people aged <18 years living in the household (A) (AdjPR=1.3; 1.1-1.6); family income (B) in quintiles (Q1: AdjPR=5, 4; 2.5-11.7; Q2: AdjPR=4.8; 2.2-10.5; Q3: AdjPR=3.8; 1.8-8.5; Q4 AdjPR=2.2; 1.0-5.1); inadequate treatment of drinking water (C) (AdjPR=1.3; 1.1-1.5); presence of chronic non-communicable diseases (D) (AdjPR=1.3; 1.1-1.7); not eating fruit for breakfast (E) (AdjPR=1.7; 1.3-2.5);eating meals on the couch or in bed (F) (AdjPR=1.3; 1.1-1.6); and skipping either lunch or dinner or dinner (G) (AdjPR=1.4; 1.2-1.7). A cutoff point for FNiS of 2.3 was adopted (Kappa=0.47; sensitivity=0.82; specificity=0.67; PPV=0.64; NPV=0.83).

Determinantes sociais em saúde associados à vivência da fome entre adolescentes do Brasil / Social determinants of health associated with the experience of hunger among Brazilian adolescents

Resumo Objetivou-se identificar determinantes sociais em saúde associados à vivência da fome entre adolescentes escolares brasileiros. Foi realizado um estudo transversal com microdados de 16.526 adolescentes da Pesquisa Nacional de Saúde do Escolar 2015. A vivência da fome foi estimada considerando a frequência com que o adolescente havia ficado com fome por não ter comida suficiente em casa no mês anterior à pesquisa. Para a análise dos determinantes sociais em saúde foi realizada Regressão de Poisson com variância robusta. Verificou-se, no Brasil, que a vivência da fome foi de 22,8% (IC95%: 21,9-23,7) entre adolescentes. Essa associou-se diretamente ao sexo masculino (RP=1,12; IC95%: 1,07-1,16), a não ter excesso de peso (RP=1,08; IC95%: 1,04-1,13), ao consumo irregular de feijão (RP=1,20; IC95%: 1,13-1,26), de legumes e verduras (RP=1,16; IC95%: 1,09-1,22) e de frutas (RP=1,19; IC95%: 1,13-1,24), à insatisfação corporal (RP=1,26; IC95%: 1,18-1,35) e ao consumo irregular de almoço ou jantar com os responsáveis (RP=1,41; IC95%: 1,32-1,52); e inversamente ao gradiente de escolaridade materna, e às macrorregiões do complexo Centro-Sul. Os resultados indicam a coexistência da fome, comportamentos alimentares de risco nutricional, insatisfação corporal e condições de iniquidade social entre adolescentes brasileiros.

Abstract The aim of this study was to identify social determinants of health associated with the experience of hunger among school-age adolescents in Brazil. We conducted a cross-sectional study with a sample of 16,526 adolescents using data from the 2015 National School-based Student Health Survey. Experience of hunger was determined based on the answer to the question "In the last 30 days, how often have you been hungry because there wasn't enough food at home?" The social determinants of health were analyzed using Poisson regression with robust variance. The prevalence of the experience of hunger was 22.8% (95%CI: 21.9-23.7). The experience of hunger was directly associated with being male (PR = 1.12; 95%CI: 1.07-1.16); not being overweight (PR = 1.08; 95%CI: 1.04-1.13 ); irregular consumption of beans (PR = 1.20; 95%CI: 1.13-1.26), vegetables (PR=1.16; 95%CI: 1.09-1.22) and fruit (PR = 1.19; 95%CI: 1.13-1.24); body dissatisfaction (PR = 1.26; 95%CI: 1.18-1.35); and not regularly eating lunch or dinner with parents or guardians (PR = 1.41; 95%CI: 1.32-1.52). An inverse association was found between the experience of hunger and maternal education level and living in the Mid-West, Southeast and South. The findings show that the experience of hunger among Brazilian adolescents coexists with risky eating behaviors, body dissatisfaction, and social inequality.

Influence of federal feeding programs on the anthropometric indicators of nutritional status of adolescents / Influência de programas federais de alimentação sobre os indicadores antropométricos do estado nutricional de adolescentes

ABSTRACT Objective To assess the influence of federal feeding programs on the anthropometric indicators of nutritional status of adolescents from Federal Institutes. Methods Temporal analysis of the anthropometric data of students from the capital of Rio Grande do Norte, Brazil (n=250), on admission in 2017 (baseline) and after one year, in 2018 (follow-up). Participation in student assistance programs, sociodemographic, anthropometric, dietary, and physical activity aspects were evaluated. The Split Plot ANOVA test was used to analyze height-for-age and body mass index-for-age as continuous variables (mean of z-score; variation in the mean of z-score between baseline and follow-up). Prevalence Ratio was used to analyze categorical variables: improvement in height-for-age (increase in z-score value between baseline and follow-up); improvement in body mass index-for-age (change in z-score towards zero between baseline and follow-up). Results There was a reduction in the height-for-age z-score (-0.173 to -0.350; p<0.001; eta=0.195), but this decline was smaller in the participants of both programs (from -0.249 to -0.357) compared to those not assisted by both simultaneously (from -0.149 to -0.345) (p=0.041). The improvement in height-for-age was positively associated with longer daily time spent at school and participation in the food program under the National Student Assistance Program. The improvement in body mass index-for-age was negatively associated with sex and positively with the number of people in the household. Conclusion The concomitant participation in the National School Feeding Program and in the National Student Assistance Program had a positive influence on the linear growth of students in situations of socioeconomic vulnerability.

RESUMO Objetivo Avaliar a influência de programas federais de alimentação sobre os índices antropométricos do estado nutricional de adolescentes matriculados em institutos federais. Métodos Análise temporal dos dados antropométricos de estudantes da capital do Rio Grande do Norte, Brasil (n=250) na admissão, em 2017 (baseline), e após um ano, em 2018 (follow-up). Foram avaliados a participação nos programas de assistência estudantil, aspectos sociodemográficos, antropométricos, práticas alimentares e de atividade física. O teste Split Plot ANOVA foi utilizado para analisar estatura-para-idade e índice de massa corporal-para-idade como variáveis contínuas (média de escore-z; variação da média de escore-z entre baseline e follow-up). A Razão de Prevalência foi utilizada para analisar as variáveis categóricas: melhora na estatura-para-idade (aumento no valor de escore-z entre baseline e follow-up) e melhora no índice de massa corporal-para-idade (mudança no escore-z em direção ao zero entre baseline e follow-up). Resultados Houve redução no escore-z de estatura-para-idade (de -0,173 para -0,350; p<0,001; eta=0,195), porém esse declínio foi menor nos participantes de ambos os programas (de -0,240 para -0,357) comparados àqueles que não foram assistidos simultaneamente por eles (de -0,149 para -0,345) (p=0,041). A melhora na estatura-para-idade associou-se positivamente a um maior tempo diário na escola e à participação no programa de alimentação do Programa Nacional de Assistência Estudantil. A melhora no índice de massa corporal-para-idade associou-se negativamente ao sexo e positivamente ao número de pessoas no domicílio. Conclusão A participação concomitante no Programa Nacional de Alimentação Escolar e no Programa Nacional de Assistência Estudantil teve uma influência positiva no crescimento linear dos escolares em situação de vulnerabilidade socioeconômica.

Compra de alimentos da agricultura familiar para a alimentação escolar: a situação do Rio Grande do Norte / Purchase of food from family farming for school feeding: the situation in Rio Grande do Norte

RESUMO Objetivou-se caracterizar o cenário da aquisição dos alimentos provenientes da Agricultura Familiar (AF) para o Programa Nacional de Alimentação Escolar (PNAE) nos municípios do Rio Grande do Norte. Pesquisa avaliativa com delineamento ecológico, utilizando dados do Centro Colaborador em Alimentação e Nutrição Escolar da Universidade Federal do Rio Grande do Norte em 2017 e 2018. Avaliaram-se 31 municípios, analisando o percentual de aquisição de alimentos da AF para a alimentação escolar, além das possíveis dificuldades nesse processo, utilizando variáveis relacionadas com governança e gestão, estabilidade e disponibilidade de alimentos. Dos municípios avaliados, mais de 50% adquiriram alimentos da AF no ano anterior e afirmaram a compra no ano atual. Todos relataram empregar o modelo de gestão centralizada, 29% declararam aquisição menor que 30%, 9,7%, aquisição acima de 30%, e 61,3% não souberam informar. Quanto às principais dificuldades relacionadas com governança e gestão, a articulação intersetorial e o edital de chamada pública ganharam destaque. Sobre a estabilidade de alimentos, destacaram-se as condições higienicossanitárias necessárias, e em relação à disponibilidade de alimentos, a aquisição de alimentos orgânicos mostrou-se como uma dificuldade elencada por 80,6% dos municípios.

ABSTRACT The objective was to characterize the scenario of acquisition of food from Family Farming (AF) for the National School Feeding Program (PNAE) in the municipalities of Rio Grande do Norte. An evaluative research with an ecological design, using data from the Collaborating Center for School Food and Nutrition of the Federal University of Rio Grande do Norte in 2017 and 2018. 31 municipalities were evaluated, analyzing the percentage of food purchases from AF for school meals, in addition to of the possible difficulties in this process, using variables related to governance and management, stability and availability of food. Of the evaluated municipalities, more than 50% purchased food from the AF in the previous year and confirmed the purchase in the current year. All reported using the centralized management model, 29% declared acquisition less than 30%, 9.7%, acquisition above 30%, and 61.3% were unable to inform. As for the main difficulties related to governance and management, intersectorial articulation and the public call notice were highlighted. Regarding food stability, the necessary hygienic-sanitary conditions were highlighted, and in relation to food availability, the purchase of organic food was shown to be a difficulty listed by 80.6% of the municipalities.