Food and Nutrition Surveillance System markers predict diet quality.

OBJECTIVE: To investigate the performance of food consumption markers of the Food and Nutrition Surveillance System (Sisvan) in assessing the overall dietary quality. METHODS: The study was carried out based on the reproduction of responses to markers in 24-hour recall data from 46,164 individuals aged ≥ 10 years, from the 2017-2018 Household Budget Survey (POF). Seven Sisvan markers were evaluated, and two scores were calculated for each participant, based on the sum of the number of healthy food markers (beans, fruits, and vegetables, ranging from 0 to 3) and unhealthy (hamburgers/sausages, sweetened beverages, instant noodles/salt snacks/crackers, stuffed cookies/sweets/candies, ranging from 0 to 4) consumed. Linear regression analyses were used to assess the association between scores and diet quality indicators (ultra-processed foods, dietary diversity, and levels of saturated and trans fat, added sugar, sodium, potassium, and fiber in the diet). RESULTS: The score of healthy eating markers increased significantly with increasing dietary diversity and potassium and fiber contents in the diet, while the opposite trend was observed for the densities of added sugar, sodium, saturated and trans fat (p < 0.001). The score of unhealthy eating markers increased significantly with the increase in the consumption of ultra-processed foods and densities of added sugar, saturated and trans fat levels in the diet, while an inverse trend was observed for potassium and fiber (p < 0.001). The joint analysis of the combination of the two marker scores showed that individuals with better performance (3 in the healthy food score, and 0 in the unhealthy food score) have a lower number of inadequacies in nutrient consumption. CONCLUSION: Sisvan food consumption markers, quickly and easily applied and already incorporated into the Brazilian public health system, have good potential to reflect the overall dietary quality.

A synthesis of pathways linking diet, metabolic risk and cardiovascular disease: a framework to guide further research and approaches to evidence-based practice.

Cardiovascular disease (CVD) is the most common non-communicable disease occurring globally. Although previous literature has provided useful insights into the important role that diet plays in CVD prevention and treatment, understanding the causal role of diets is a difficult task considering inherent and introduced weaknesses of observational (e.g. not properly addressing confounders and mediators) and experimental research designs (e.g. not appropriate or well designed). In this narrative review, we organised current evidence linking diet, as well as conventional and emerging physiological risk factors, with CVD risk, incidence and mortality in a series of diagrams. The diagrams presented can aid causal inference studies as they provide a visual representation of the types of studies underlying the associations between potential risk markers/factors for CVD. This may facilitate the selection of variables to be considered and the creation of analytical models. Evidence depicted in the diagrams was systematically collected from studies included in the British Nutrition Task Force report on diet and CVD and database searches, including Medline and Embase. Although several markers and disorders linked to conventional and emerging risk factors for CVD were identified, the causal link between many remains unknown. There is a need to address the multifactorial nature of CVD and the complex interplay between conventional and emerging risk factors with natural and built environments, while bringing the life course into the spotlight.

Do markers of adiposity and glycaemia mediate the association between low carbohydrate diet and cardiovascular risk factors: findings from the UK National Diet and Nutrition Survey (NDNS) 2008-2016.

Objectives: To examine the associations between low carbohydrate diet (LCD) and conventional cardiovascular risk factors and investigate whether these associations are mediated by body mass index (BMI), waist circumference (WC) and haemoglobin A1c (HbA1c) applying causal mediation analyses. Methods: We included 3640 adults aged 45-80 years from the UK National Diet and Nutrition Survey programme (2008-2016) with data on dietary intake, anthropometric and biochemical parameters. Four hypothetical interventions were examined: (1) LCD, (2) Low carbohydrate (LC) and high fibre diet (LCHF), (3) LC and high saturated fat diet (LCHS) and (4) LC and high unsaturated fat diet (LCHU). BMI and WC were used as markers of obesity. Biochemical markers included HbA1c, total cholesterol, high-density lipoprotein and low-density lipoprotein (LDL) cholesterol, triglycerides, systolic and diastolic blood pressure and C reactive protein (CRP). BMI, WC and HbA1c were used as a mediator of the effects. The analysis was adjusted for sociodemographic characteristic, smoking, estimated total energy intake, alcohol consumption and antihypertensive medication. To identify a potential causal effect of LCD on cardiovascular disease (CVD) risk, we estimated the average treatment effect, and corresponding p values and CI for the total, indirect and direct effect of the treatment on the outcome. Results: BMI, WC and HbA1c fully mediated the association between LCD and triglycerides and fully mediated the effects of LCHF on LDL, although BMI and WC were not sufficient to fully mediate the effects of LCHF on triglycerides and CRP. BMI alone fully mediated the effects of LCHS on HbA1c, triglycerides, LDL and CRP. None of these mediators explained the effect of LCHU on CVD risk markers. Conclusion: The causal hypotheses tested in this study demonstrate that individuals on LCD with high fibre intakes improved their CVD markers as expected, but those on LCD who increase fat intake had no effects on CVD markers mediated by obesity and diabetes.

Food and Nutrition Surveillance System markers predict diet quality / Marcadores do Sistema de Vigilância Alimentar e Nutricional predizem qualidade da dieta

ABSTRACT OBJECTIVE To investigate the performance of food consumption markers of the Food and Nutrition Surveillance System (Sisvan) in assessing the overall dietary quality. METHODS The study was carried out based on the reproduction of responses to markers in 24-hour recall data from 46,164 individuals aged ≥ 10 years, from the 2017-2018 Household Budget Survey (POF). Seven Sisvan markers were evaluated, and two scores were calculated for each participant, based on the sum of the number of healthy food markers (beans, fruits, and vegetables, ranging from 0 to 3) and unhealthy (hamburgers/sausages, sweetened beverages, instant noodles/salt snacks/crackers, stuffed cookies/sweets/candies, ranging from 0 to 4) consumed. Linear regression analyses were used to assess the association between scores and diet quality indicators (ultra-processed foods, dietary diversity, and levels of saturated and trans fat, added sugar, sodium, potassium, and fiber in the diet). RESULTS The score of healthy eating markers increased significantly with increasing dietary diversity and potassium and fiber contents in the diet, while the opposite trend was observed for the densities of added sugar, sodium, saturated and trans fat (p < 0.001). The score of unhealthy eating markers increased significantly with the increase in the consumption of ultra-processed foods and densities of added sugar, saturated and trans fat levels in the diet, while an inverse trend was observed for potassium and fiber (p < 0.001). The joint analysis of the combination of the two marker scores showed that individuals with better performance (3 in the healthy food score, and 0 in the unhealthy food score) have a lower number of inadequacies in nutrient consumption. CONCLUSION Sisvan food consumption markers, quickly and easily applied and already incorporated into the Brazilian public health system, have good potential to reflect the overall dietary quality.

RESUMO OBJETIVO Investigar o desempenho dos marcadores do consumo alimentar do Sistema de Vigilância Alimentar e Nutricional (Sisvan) na avaliação da qualidade global da alimentação. MÉTODOS O estudo foi realizado a partir da reprodução de respostas aos marcadores em dados de recordatórios de 24 horas, de 46.164 indivíduos com idade menor ou igual a 10 anos, da Pesquisa de Orçamentos Familiares 2017-2018. Foram avaliados sete marcadores do Sisvan e calculados dois escores para cada participante, a partir do somatório do número de marcadores de alimentação saudável (feijão, frutas, verduras/legumes, variando de 0 a 3) e não saudável (hambúrguer/embutidos, bebidas adoçadas, macarrão instantâneo/salgadinhos/biscoitos salgados, biscoito recheado/doces/guloseimas, variando de 0 a 4) consumidos. Análises de regressão linear foram usadas para avaliar a associação entre os escores e indicadores de qualidade da alimentação (participação de alimentos ultraprocessados, diversidade e teores de gordura saturada, trans, açúcar de adição, sódio, potássio e fibra da dieta). RESULTADOS o escore de marcadores de alimentação saudável aumentou de forma significativa com o aumento da diversidade e dos teores de potássio e fibra da dieta, enquanto tendência oposta foi observada para as densidades de açúcar de adição, sódio, gordura saturada e trans (p < 0,001). Observou-se que o escore de marcadores de alimentação não saudável aumentou de forma significativa com o aumento da participação de alimentos ultraprocessados e dos teores de açúcar de adição, gordura saturada e trans da dieta, enquanto tendência inversa é observada para potássio e fibra (p < 0,001). A análise conjunta da combinação dos dois escores de marcadores mostrou que indivíduos com melhor desempenho (3 no escore de alimentos saudáveis, e 0 no de alimentos não saudáveis) possuem menor número de inadequações no consumo de nutrientes. CONCLUSÃO Os marcadores do consumo alimentar do Sisvan, aplicados de forma rápida e prática e já incorporados no sistema público de saúde brasileiro, possuem bom potencial para refletir a qualidade global da alimentação.

Conhecimento, autoeficácia e práticas profissionais relacionadas ao Guia Alimentar para a população brasileira na atenção primária à saúde / Knowledge, self-efficacy and professional practices related to the Dietary Guidelines for the Brazilian population in primary health care

Resumo Introdução fatores individuais parecem estar relacionados à utilização de novas recomendações e mudanças de prática profissional para ações de promoção à saúde. Objetivo avaliar a relação entre conhecimento, autoeficácia (AE) e utilização das recomendações do Guia Alimentar Brasileiro (GAB) nas práticas de equipes de Núcleos de Apoio à Saúde da Família (NASF-AB). Método recorte transversal de pós-intervenção de um ensaio comunitário controlado envolvendo 26 profissionais de saúde. Conhecimento e AE em utilizar as recomendações do GAB foram coletados por escalas validadas autoaplicáveis. A utilização do GAB na prática profissional foi mensurada mediante observação da rotina de trabalho dos NASF-AB e preenchimento de escala validada sobre as recomendações do GAB. Todos os escores variaram de 0 a 100. Resultados as pontuações médias nos escores de conhecimento, AE e utilização do GAB foram de 83,07 (DP = 18,29), 63,36 (DP = 19,07) e 4,33 (DP = 8,03), respectivamente. Houve correlação positiva e moderada entre AE e escore de utilização do GAB (r = 0,45; p = 0,03). Conhecimento sobre o GAB obteve fraca correlação com o escore de utilização (r = 0,34; p = 0,11). Diferença significativa foi obtida entre as médias do escore de utilização do GAB no grupo de elevada AE (5,13; p = 0,004; DP =1,55), em relação ao de baixa AE (3,40; p = 0,059; DP = 1,69), independentemente da categoria profissional. Conclusão neste estudo, a AE demonstrou estar moderadamente correlacionada com a adoção de novas práticas profissionais.

Abstract Background Individual factors appear related to the adoption of new recommendations and changes to professional practice for health promotion initiatives. Objective to evaluate the relationship between knowledge, self-efficacy (SE) and adoption of the Brazilian Dietary Guideline (BDG) recommendations in the practices of Family Health Support Center (NASF-AB) teams. Method a post-intervention cross-sectional sample from a controlled community trial involving 26 health professionals. Knowledge and SE in adopting the BDG recommendations were determined using a validated self- applicable scale. BDG adoption in professional practice was measured by observing the NASF-AB work routine and the scoring on the validated scale investigating GAB recommendation uptake. Scores ranged from 0 to 100 points. Results Average scores for knowledge, SE and BDG use were 83.07 (SD = 18.29), 63.36 (SD = 19.07) and 4.33 (SD = 8.03), respectively. There was a positive moderate correlation between SE and BDG utilization scores (r = 0.45; p = 0.03). Knowledge about BDG presented a weak correlation with the utilization score (r = 0.34; p = 0.11). Significant difference was observed between the averages of the BDG utilization score in the high SE group (5.13; p = 0.004; SD = 1.55), in relation to the low SE group (3.40; p = 0.059; SD = 1.69), regardless of professional category. Conclusion in this study, SE was moderately correlated with the adoption of new professional practices.

Development and Validation of a Protocol for Pregnant Women Based on the Brazilian Dietary Guidelines.

OBJECTIVE: To develop and validate a protocol for the use of the Dietary Guidelines for the Brazilian Population (DGBP) in the individual dietary advice for pregnant women assisted in primary healthcare (PHC). METHODS: Methodological study that involved the elaboration of a protocol in six steps: definition of the format, definition of the instrument to evaluate food consumption, systematization of evidence on food and nutrition needs of pregnant women, extraction of DGBP recommendations, development of messages of dietary guidelines and content, and face validity. The analyses of the validation steps were carried out by calculating the Content Validity Index (CVI) and thematic content analysis. RESULTS: As products of the steps, the protocol structure was defined and the dietary advice for pregnant women were elaborated, considering physiological changes, food consumption, nutritional and health needs, and socioeconomic conditions of this population. The protocol was well evaluated by experts and health professionals in terms of clarity, relevance (CVI > 0.8), and applicability. In addition, the participants made some suggestions to improve the clarity of the messages and to expand the applicability of the instrument with Brazilian pregnant women. CONCLUSION: The instrument developed fills a gap in clinical protocols on dietary advice for pregnant women focused on promoting a healthy diet, contributing to a healthy pregnancy. In addition, it demonstrates potential to contribute to the qualification of PHC professionals and to the implementation of the DGBP recommendations.

OBJETIVO: Desenvolver e validar um protocolo para uso do Guia Alimentar para a População Brasileira (GAPB) na orientação alimentar individual de gestantes atendidas na atenção primária à saúde (APS). MéTODOS: Estudo metodológico que envolveu a elaboração de um protocolo em seis etapas: definição do formato do documento, definição do instrumento de avaliação do consumo alimentar, sistematização de evidências sobre necessidades de alimentação e nutrição de gestantes, extração das recomendações do GAPB, desenvolvimento de mensagens de orientação alimentar e validação de conteúdo e validação aparente. As análises das etapas de validação foram realizadas através do cálculo do índice de validade de conteúdo e análise temática de conteúdo. RESULTADOS: Como produtos das etapas, a estrutura do protocolo foi definida e as orientações alimentares de gestantes foram elaboradas, considerando as alterações fisiológicas, consumo alimentar, necessidades nutricionais e de saúde e condições socioeconômicas desta população. O protocolo foi bem avaliado por especialistas e profissionais de saúde nos critérios de clareza, pertinência (índice de validade de conteúdo > 0,8) e aplicabilidade. Além disso, os participantes deram sugestões para melhoria da clareza das mensagens e para ampliar a aplicabilidade do instrumento em gestantes brasileiras. CONCLUSãO: O instrumento desenvolvido preenche uma lacuna sobre protocolos clínicos de orientação alimentar para gestantes focado na promoção da alimentação saudável, contribuindo para uma gestação saudável. Além disso, o instrumento demonstra potencial para contribuir na qualificação de profissionais da APS e implementação das recomendações do GAPB.

Development and Validation of a Protocol for Pregnant Women Based on the Brazilian Dietary Guidelines / Desenvolvimento e validação de um protocolo para orientação de gestantes baseado no guia alimentar para a população brasileira

Abstract Objective To develop and validate a protocol for the use of the Dietary Guidelines for the Brazilian Population (DGBP) in the individual dietary advice for pregnant women assisted in primary healthcare (PHC). Methods Methodological study that involved the elaboration of a protocol in six steps: definition of the format, definition of the instrument to evaluate food consumption, systematization of evidence on food and nutrition needs of pregnant women, extraction of DGBP recommendations, development of messages of dietary guidelines and content, and face validity. The analyses of the validation steps were carried out by calculating the Content Validity Index (CVI) and thematic content analysis. Results As products of the steps, the protocol structure was defined and the dietary advice for pregnant women were elaborated, considering physiological changes, food consumption, nutritional and health needs, and socioeconomic conditions of this population. The protocol was well evaluated by experts and health professionals in terms of clarity, relevance (CVI > 0.8), and applicability. In addition, the participants made some suggestions to improve the clarity of the messages and to expand the applicability of the instrument with Brazilian pregnant women. Conclusion The instrument developed fills a gap in clinical protocols on dietary advice for pregnant women focused on promoting a healthy diet, contributing to a healthy pregnancy. In addition, it demonstrates potential to contribute to the qualification of PHC professionals and to the implementation of the DGBP recommendations.

Resumo Objetivo Desenvolver e validar um protocolo para uso do Guia Alimentar para a População Brasileira (GAPB) na orientação alimentar individual de gestantes atendidas na atenção primária à saúde (APS). Métodos Estudo metodológico que envolveu a elaboração de um protocolo em seis etapas: definição do formato do documento, definição do instrumento de avaliação do consumo alimentar, sistematização de evidências sobre necessidades de alimentação e nutrição de gestantes, extração das recomendações do GAPB, desenvolvimento de mensagens de orientação alimentar e validação de conteúdo e validação aparente. As análises das etapas de validação foram realizadas através do cálculo do índice de validade de conteúdo e análise temática de conteúdo. Resultados Como produtos das etapas, a estrutura do protocolo foi definida e as orientações alimentares de gestantes foram elaboradas, considerando as alterações fisiológicas, consumo alimentar, necessidades nutricionais e de saúde e condições socioeconômicas desta população. O protocolo foi bem avaliado por especialistas e profissionais de saúde nos critérios de clareza, pertinência (índice de validade de conteúdo > 0,8) e aplicabilidade. Além disso, os participantes deram sugestões para melhoria da clareza das mensagens e para ampliar a aplicabilidade do instrumento em gestantes brasileiras. Conclusão O instrumento desenvolvido preenche uma lacuna sobre protocolos clínicos de orientação alimentar para gestantes focado na promoção da alimentação saudável, contribuindo para uma gestação saudável. Além disso, o instrumento demonstra potencial para contribuir na qualificação de profissionais da APS e implementação das recomendações do GAPB.

Developing a protocol based on the Brazilian Dietary Guidelines for individual dietary advice in the primary healthcare: theoretical and methodological bases.

To describe the methodology of development of a protocol for application of the Brazilian Dietary Guidelines by primary healthcare professionals in individual dietary advice. A five-step approach was followed: (1) format definition; (2) definition of the instrument for assessment of individuals' food consumption; (3) Dietary Guidelines' content extraction; (4) protocol content development; (5) content and face validity. An example from Brazil was displayed with the development of a protocol to guide healthcare professional decision-making when providing nutrition advice based on the Brazilian Dietary Guidelines. The instrument of the Brazilian Nutrition Surveillance System (SISVAN) was chosen to the food consumption assessment, which contains questions about the consumption of seven healthy or unhealthy food groups and one question about eating modes. The Guidelines' content extraction process led to the identification of recommendations related to the food consumption markers assessed by the SISVAN questionnaire. Then, a protocol was developed in a flowchart format, in which the professional's conduct is guided by the answer given to each question of the SISVAN instrument. For each 'non-compliant' answer (unhealthy eating practice), the professional is instructed how to provide recommendations and identify obstacles. Lastly, experts and healthcare professionals highlighted pertinence, clarity and usability of the protocol. This study provides the blueprint for the phase-wise development of protocols of application of the Dietary Guidelines and may contribute to promote healthier eating and ending malnutrition in all its forms.

Implementation of food-based dietary guidelines: conceptual framework and analysis of the Brazilian case.

OBJECTIVE: This study aimed to develop a conceptual framework of the process of food-based dietary guidelines (FBDG) implementation and analyse Brazil's employed measures to implement dietary guidelines for the Brazilian population (2014). DESIGN: Qualitative research. SETTING: Aiming to develop the conceptual framework, a literature review on FBDG implementation was carried out. Both documents scoped within the macropolitical sphere and scientific articles were reviewed. In the case study, measures took in Brazil were identified through a search on institutional websites and technical management reports of government sectors were responsible for FBDG implementation in the country. PARTICIPANTS: This study does not involve humans. RESULTS: The new conceptual framework frames FBDG implementation as a part of a larger set of intersectoral public policies to promote healthy eating and highlights two main implementation ways: educational materials and public policies. Brazil has a range of policies to promote healthy eating guided by the perspective of food as a right. Most of the implemented measures focussed on the concept of 'FBDG as educational materials,' although the recommendations have also been implemented in public policies. CONCLUSION: The FBDG implementation should be carried out in an integrated manner with multi-sector involvement. The Brazilian's case analysis can be helpful to decision makers in food policy across the globe be inspired by the Brazilian efforts, considering that the Brazilian FBDG was one of the firsts to have adopted a multidimensional paradigm of healthy eating, including diet sustainability.

Factors associated with diet changes during the COVID-19 pandemic period in Brazilian adults: Time, skills, habits, feelings and beliefs.

This study aimed to identify individual, household and sociodemographic factors associated with changes in food consumption that lead to changes in the diet quality, in the context of the COVID-19 pandemic concerning Brazilian adults. Improvements or worsening in diet quality (IDQ or WDQ) were verified using an exploratory online survey which investigated whether participants (n = 4780) increased or decreased their consumption of food subgroups that mark positive or negative food patterns. Respondents also agreed or disagreed with their beliefs about food safety, cooking skills, family support, home characterization, feelings and behaviors. All factors of influence on the IDQ or WDQ groups were always compared against the general participants (who did not change their diet sufficiently to be classified into these groups). Individuals from the IDQ group spent more time on food (81.4% versus 62.0%), started to cook more often (91.4%), were more confident with their cooking skills (p < 0.01) and positive feelings were at least 2.5 times more prevalent. Adjusted analysis showed the chance to improve diet was 1.39 higher among those who did not feel overworked and increased 1.07 in each additional cooking chore shared between household members. For each additional positive feeling, the odds were 1.41 to IDQ and 0.67 to WDQ. Moreover, for each additional negative feeling the chances for WDQ were 1.21 and 0.90 for IDQ. Those in the WDQ group were more unaware of issues related to contagion during meals, they were not afraid of eating food prepared outside their home and agreed that industrialized food is safer (OR = 1.85). These results highlight the associated factors in improving or worsening diet patterns as a consequence of the COVID-19 pandemic, supporting messages presented in Dietary Guidelines.

Dietary guidelines training may improve health promotion practice: Results of a controlled trial in Brazil.

BACKGROUND: The double burden of malnutrition points to an urgent need to develop strategies to promote healthy diets. Health professionals are key elements for health promotion and must be prepared to deal with these issues in health services. AIM: This study aimed to evaluate the impact of an educational intervention based on Brazilian Dietary Guidelines in the practice of multidisciplinary teams working in primary health care. METHODS: A controlled trial comprising pre- and post-tests was conducted with four multidisciplinary healthcare teams. The intervention group received 16 hours of training on the Brazilian Dietary Guidelines. The professionals' practices were evaluated by direct observation, before and after the intervention, for two months at each timepoint. Data on dietary counselling were collected using a previously validated scale. The Kruskal-Wallis test was used for intragroup comparison at T0 versus T1, and the intergroup effects of the intervention were estimated by generalized linear regression analysis with a 95% confidence interval. RESULTS: The regression with the interaction term between the intervention group and time showed a positive effect of the educational intervention on professionals' practices in the intervention group in the crude and adjusted models (coefficient = 1.36 and p = 0.020). Brazilian Dietary Guidelines application significantly increased in non-nutritionist professionals' practices (p = 0.007) and in activities not related to nutrition (p = 0.028) in the intervention group over time (T1-T0). No significant differences were found in the control group. CONCLUSION: The intervention proved to be effective in promoting changes in health professionals' practices, demonstrating the strength of the strategy for dissemination of nutrition guidelines in primary health care.

Orientação alimentar da pessoa idosa na Atenção Primária à Saúde: desenvolvimento e validação de um protocolo baseado no Guia Alimentar para a População Brasileira / Dietary guidelines for the elderly in Primary Health Care: development and validation of a protocol based on the Food Guide for the Brazilian Population

Resumo Objetivo Desenvolver e validar um protocolo de uso do Guia Alimentar para a População Brasileira na orientação alimentar da pessoa idosa durante as consultas clínicas individuais na Atenção Primária à Saúde (APS). Métodos Esta construção seguiu seis etapas metodológicas, sendo elas: (1) definição do formato do protocolo; (2) definição do instrumento de avaliação do consumo alimentar dos indivíduos; (3) extração das recomendações do Guia Alimentar aplicáveis para orientação alimentar individual; (4) sistematização de evidências sobre necessidades de alimentação e nutrição da pessoa idosa; (5) desenvolvimento de mensagens de orientação alimentar para a pessoa idosa; (6) validação de conteúdo e aparente e análise dos dados. Resultados Como produtos das etapas, foi definida a estrutura do protocolo e construída as orientações alimentares baseadas nas necessidades nutricionais e de saúde da população idosa, considerando a capacidade funcional e alterações fisiológicas e sociais desse ciclo de vida. O protocolo foi bem avaliado por especialistas e profissionais de saúde nos critérios de clareza, pertinência (Índice de validade de conteúdo >0,8) e aplicabilidade. Além disso, os participantes deram sugestões para melhoria da clareza das mensagens e para ampliar a aplicabilidade do instrumento com pessoas idosas brasileiras. Conclusão O protocolo pode contribuir para qualificação da orientação alimentar na APS, disseminação das informações do Guia Alimentar e promoção do cuidado integral e envelhecimento saudável da população.

Abstract Objective Develop and validate a protocol for the use of the Food Guide for the Brazilian Population (FGBP) in the dietary guidelines for elderly people during individual clinic appointments in Primary Health Care (PHC). Methods The elaboration followed six methodological steps, namely: (1) protocol format definition; (2) definition of the instrument for assessing food consumption; (3) extracting applicable Food Guide recommendations for individual dietary guidelines; (4) evidence systematization on dietary and nutrition needs of the elderly; (5) development of nutritional guidelines messages for the elderly; (6) content and apparent validation and data analysis. Results As products of the steps, the protocol structure was defined and dietary guidelines were elaborated based on the nutritional and health needs of the elderly population, considering the functional capacity and physiological and social changes of this life cycle. The protocol was well assessed by experts and health professionals as to clarity, relevance (content validity index > 0.8) and applicability. In addition, the participants made some suggestions to improve the clarity of the messages and to expand the applicability of the instrument with elderly Brazilians. Conclusion The protocol can contribute to the qualification of dietary guidelines in PHC, dissemination of information from the Food Guide and promotion of comprehensive care and healthy aging of the population.

Impacto de uma intervenção educativa para implementação do guia alimentar para a população brasileira na atenção básica em saúde / Impact of an educational intervention to implement the dietary guidelines for the Brazilian population in primary health care

Introdução: A implementação do Guia Alimentar para a população brasileira (GAB) é uma estratégia para qualificação do trabalho em saúde pública para ampliação do escopo de ações de promoção da alimentação adequada e saudável. Objetivo: Avaliar o impacto de uma intervenção educativa baseada no GAB no conhecimento, auto-eficácia (AE), eficáciacoletiva (EC) e orientação alimentar de equipes multiprofissionais atuantes na Atenção Primária em Saúde (APS). Métodos: Ensaio comunitário controlado, envolvendo 24 profissionais de saúde de diferentes áreas, divididos em grupo controle (GC) e intervenção (GI). O GI recebeu uma oficina educativa de 16 horas sobre o GAB, guiada por protocolo validado. Foram produzidos três manuscritos sobre a avaliação do impacto da intervenção educativa. Artigo 1: Conhecimento, AE e EC para utilização do GAB foram avaliados via escala autoadministrada, variando de 0 a 16 pontos, previamente validada, preenchida antes e após dois meses da intervenção educativa. Teste t pareado foi utilizado para comparação intragrupo no T0 versus T1, e os efeitos da intervenção intergrupos foram estimados por análises de regressão linear. Artigo 2: A orientação alimentar desempenhada pelos participantes baseada no GAB foi aferida mediante observação direta das práticas dos profissionais, durante dois meses antes e depois da intervenção, coletada por instrumento previamente validado. Utilizou-se teste de Kruskal-Wallis para comparação intragrupo no T0 versus T1, e os efeitos da intervenção intergrupos foram estimados por análises de regressão linear generalizada, com 95% de IC. Artigo 3: Recorte transversal do momento pós intervenção para avaliação da correlação entre conhecimento, AE e utilização das recomendações do GAB na prática dos profissionais de saúde. Resultados: Artigo 1: os participantes do GI obtiveram 59 e 52,8% pontos a mais no conhecimento e na AE, respectivamente, em relação ao GC, no entanto, esse aumento não foi significativo para garantir o impacto da intervenção na análise de regressão linear intergrupos no conhecimento, AE e EC (ß= 1,18; IC -1.80 a 4.17; ß=3,57; IC= -4.15 a 11.29 e ß= -2.11, IC= -5.92 to 10.12, respectivamente). Artigo 2: A regressão com interação tempo e grupo, mostrou efeito positivo da intervenção educativa no escore de orientação alimentar baseadas no GAB no GI no modelo bruto (ß = 1,36 e p = 0,017) e ajustado por categoria profissional (ß = 1,36 e p = 0,020). A abordagem sobre o GAB aumentou significativamente nos profissionais não nutricionistas (p= 0,007) e em atividades não relacionadas diretamente à temática da alimentação/nutrição (p=0,028), no GI na variação de tempo (T1-T0). Não foram encontradas diferenças significativas no GC. Artigo 3: Correlação positiva e moderada entre AE orientação alimentar baseadas no GAB dos profissionais (r=0,45; p=0,03) foi encontrada. Conhecimento obteve fraca correlação com orientações alimentares baseadas no GAB (r= 0,34; p=0,11). Diferença significativa foi obtida entre as médias do escore de orientação alimentar no grupo de baixa AE (AE<63,36) comparada ao de alta AE (p=0,02). Conclusões: Embora a intervenção educativa não tenha demonstrado impacto significativo no conhecimento, AE e EC dos profissionais de saúde, ela foi capaz de impactar as práticas e o desenvolvimento da autonomia dos profissionais de saúde, que pareceram reconhecer a interdisciplinaridade da nutrição e passaram a disseminar recomendações baseadas no GAB em vários cenários e situações da APS.

Introduction: The implementation of the Dietary Guidelines for the Brazilian population (GAB) is a strategy for qualifying public health work to expand the scope of actions to promote adequate and healthy food. Objective: To evaluate the impact of an educational intervention based on GAB on knowledge, self-efficacy (EC), collective efficacy (EC) and dietary counseling of multiprofessional teams working in Primary Health Care. Methods: Controlled community trial, involving 24 health professionals from different areas, divided into a control group (CG) and intervention (IG). The GI received a 16-hour educational workshop on the GAB, guided by a validated protocol. Three manuscripts were produced on the evaluation of the impact of educational intervention. Article 1: Knowledge, AE and EC for using the GAB were assessed via a self-administered scale, ranging from 0 to 16 points, previously validated, completed before and after two months of the educational intervention. Paired t-test was used for intragroup comparison at T0 versus T1, and the effects of intergroup intervention were estimated by linear regression analysis. Article 2: The dietary counseling performed by the participants based on the GAB was assessed through direct observation of the professionals' practices, for two months before and after the intervention, collected by a previously validated instrument. Kruskal-Wallis test was used for intragroup comparison at T0 versus T1, and the effects of intergroup intervention were estimated by generalized linear regression analysis, with 95% CI. Article 3: Cross-section of the postintervention moment to assess the correlation between knowledge, AE and use of GAB recommendations in the practice of health professionals. Results: Article 1: IG participants obtained 59 and 52.8% more points in knowledge and in AE, respectively, in relation to CG, however, this increase was not significant to guarantee the impact of the intervention in the linear regression analysis intergroups in knowledge, AE and EC (ß = 1.18; CI -1.80 to 4.17; ß = 3.57; CI = -4.15 to 11.29 and ß = -2.11, CI = -5.92 to 10.12, respectively). Article 2: The regression with time and group interaction, showed a positive effect of the educational intervention on the GAB food-based GI score in the crude model (ß = 1.36 and p = 0.017) and adjusted by professional category (ß = 1, 36 and p = 0.020). The GAB approach increased significantly in non-nutritionist professionals (p = 0.007) and in activities not directly related to the theme of food / nutrition (p = 0.028), in the GI in time variation (T1-T0). No significant differences were found in the CG. Article 3: Positive and moderate correlation between AE dietary guidance based on the professionals' GAB (r = 0.45; p = 0.03) was found. Knowledge obtained a weak correlation with dietary guidelines based on GAB (r = 0.34; p = 0.11). Significant difference was obtained between the means of the food orientation score in the low LA group (LA <63.36) compared to the high LA group (p = 0.02). Conclusions: Although the educational intervention demonstrated no significant impact on the knowledge, AE and EC of health professionals, it was able to impact the practice and autonomy development of health professionals, who seemed to recognize the interdisciplinarity of nutrition and began to disseminate recommendations based on the Guidelines in various scenarios and situations of primary care.

Content validity of an educational workshop based on the Dietary Guidelines for the Brazilian Population / Validade de conteúdo de uma ofi cina educativa baseada no Guia Alimentar para a População Brasileira

ABSTRACT Objective To describe the development and validation of a workshop protocol for the implementation of the Dietary Guidelines for the Brazilian Population in primary healthcare units. Methods This descriptive study was developed in the state of São Paulo, Brazil, and it involved 20-25 professionals in the experimentation phase and 12 experts in the content validity phase. The workshop protocol was developed according to three theoretical references: Dietary Guidelines, Interprofessional Collaborative Practice and Critical Reflexive Methodology. The protocol consisted of four 4-hour modules, 16 activities in 16 hours. The activities matrix was composed of three axes: (a) organizational strategies, (b) dietary guideline comprehension and (c) dietary guideline implementation. For the validity analysis, the expert panel assessed clarity, relevance and theoretical representativeness. Content validity index was calculated, and adequate activities scored >0.80. The proportion of experts who recognized the presence of the theoretical framework in the activities was calculated. Results All 16 proposed activities obtained a score greater than the established cut-off point, both for clarity and relevance. For theoretical representativeness analysis, the dietary guidelines reached higher scores on the (b) and (c) axes of the protocol and was less recognized on the (a) axis, whose highest score was for the Critical Reflexive Methodology. Interprofessional Collaborative Practice presented a higher score on the (c) axis and a lower one on the (b) axis. Conclusion The protocol was considered appropriate for its purpose and with potential application in the different scenarios of primary health care in Brazil.

RESUMO Objetivo Descrever o desenvolvimento e validação de um protocolo de oficina de educação permanente para implementação do Guia Alimentar para a População Brasileira no âmbito da atenção primária à saúde. Métodos Este estudo descritivo foi desenvolvido no estado de São Paulo. Participaram do estudo 20-25 profissionais de saúde na fase de experimentação e 12 doze especialistas na fase de validação de conteúdo. O protocolo da oficina foi desenvolvido de acordo com três referenciais teóricos: o Guia Alimentar, a Prática Colaborativa Interprofissional e a Metodologia Crítico Reflexiva. O protocolo da oficina foi definido em 4 módulos com 16 atividades, em 16 horas. A matriz de atividades compreendeu três eixos: (a) estratégias organizacionais, (b) compreensão do Guia Alimentar e (c) implementação do Guia Alimentar. Para validação de conteúdo o painel de especialistas avaliou a clareza, relevância e representatividade teórica do protocolo. Índice de validade de conteúdo foi calculado e atividades adequadas pontuaram >0,80. A proporção de especialistas que reconheceu a presença do referencial teórico nas atividades foi calculada. Resultados Todas as 16 atividades propostas obtiveram escores maiores do que o ponto de corte estabelecido, tanto para clareza como para relevância. Na análise da representatividade teórica, o Guia Alimentar alcançou escores mais altos nos eixos (b) e (c), e foi menos reconhecido no eixo (a), cuja maior pontuação ocorreu para a Metodologia Crítico Reflexiva. A Prática Colaborativa Interprofissional apresentou maior pontuação no eixo (c) e menor no eixo (b). Conclusão O protocolo foi considerado adequado à sua finalidade e com potencial de aplicação nos diversos cenários da atenção primária à saúde no Brasil.

Compulsão alimentar e bulimia nervosa em praticantes de exercício físico / Compulsión alimentaria y bulimia nerviosa en practicantes de ejercicio físico

INTRODUÇÃO: Estudos nacionais mostram variações na prevalência de compulsão alimentar entre 14,9 a 18,1%, enquanto a bulimia nervosa (BN) apresenta-se em torno de 1 a 3,6%. Indivíduos que apresentam transtornos alimentares procuram espaços onde o exercício físico é estimulado e assim mascaram características da doença, exercitando-se compulsivamente após um episódio de compulsão alimentar. OBJETIVO: Identificar a prevalência de transtorno da compulsão alimentar periódica (TCAP) e bulimia nervosa em praticantes de exercício físico associando ao estado nutricional, modalidade, frequência, duração e objetivo da prática do exercício físico. MÉTODOS: Estudo transversal composto por 103 indivíduos maiores de 18 anos com idade média de 37,7 (DP±15,6) anos, de ambos os sexos, praticantes de exercício físico há pelo menos três meses ininterruptos antes do início da pesquisa. Para análise da prevalência de TCAP e BN foi utilizado o Questionário sobre Alimentação e Peso (QEWP-R) e um questionário específico sobre exercício físico. O estado nutricional foi classificado conforme o IMC. RESULTADOS: A prevalência de TCAP entre os indivíduos praticantes de exercício físico foi de 0,97%. Houve associação entre valores de IMC mais alto (p=0,026), idade menor (para TCAP p=0,036, BN p=0,01) e objetivo da prática de exercício físico declarado "estética" (para TCAP p=0,011 e BN p=0,043) com maiores pontuações nos escores de TCAP e BN. CONCLUSÃO: A prevalência de TCAP e BN encontrada neste estudo está de acordo com o referido na literatura internacional. Não foram encontradas associações entre compulsão alimentar e maior frequência ...

INTRODUCTION: National studies have shown variations on the prevalence of binge eating ranging from 14.9 to 18.1%, while Bulimia Nervosa rates (BN) have been reported from 1 a 3.6%. Individuals with eating disorders may look for environments where physical exercise is stimulated, and therefore mask their disease's characteristics, doing exercises compulsively after a binge eating episode. OBJECTIVE: To identify the prevalence of Binge Eating Disorder (BED) and BN in physical exercise practitioners, and verify its associations with nutritional status, modality, frequency, duration and the goals of the physical exercise practice. METHODS: Cross-sectional study composed with 103 individuals, over 18 years old, mean age 37.7 (SD±15.6) years old, of both genders, physical exercise practitioners for a period of at least three months uninterruptedly before the beginning of the study. In order to analyze the prevalence of BED and BN, the Questionnaire on Eating and Weight Patterns - Revised (QEWP-R) was used, as well as a specific questionnaire approaching physical exercise. The nutritional status was classified based on BMI. RESULTS: The BED prevalence in physical exercise practitioners was 0.97%. There were associations between higher BMI values (p= 0.026), lower age (TCAP p= 0.036; BN p= 0.01) and "aesthetics" goals as a reason for practicing physical exercise (TCAP p= 0.011; BN p= 0.043) with higher scores in BED and BN. CONCLUSION: The prevalence of BED and BN found in this study was in accordance to what has been reported in the international literature. No association was found between binge eating and higher frequency of physical exercise. .

INTRODUCCIÓN: Estudios nacionales muestran variaciones en la prevalencia de compulsión alimentaria entre 14,9 a 18,1%, mientras que la bulimia nerviosa (BN) se presenta en torno de 1 a 3,6%. Los individuos que presentan trastornos alimentarios buscan espacios en donde el ejercicio físico es estimulado y así enmascaran características de la enfermedad, ejercitándose compulsivamente después de un episodio de compulsión alimentaria. OBJETIVO: Identificar la prevalencia de trastorno de la compulsión alimentaria periódica (TCAP) y bulimia nerviosa en practicantes de ejercicio físico, asociando con el estado nutricional, modalidad, frecuencia, duración y objetivo de la práctica del ejercicio físico. MÉTODOS: Estudio transversal compuesto por 103 individuos, mayores de 18 años con edad promedio de 37,7 (DP±15,6) años, de ambos sexos, practicantes de ejercicio físico desde hace por lo menos tres meses ininterrumpidos antes del inicio de la encuesta. Para análisis de la prevalencia de TCAP y BN fue utilizado el Cuestionario sobre Alimentación y Peso (QEWP-R) y un cuestionario específico sobre ejercicio físico. El estado nutricional fue clasificado de acuerdo al IMC. RESULTADOS: La prevalencia de TCAP entre los individuos practicantes de ejercicio físico fue de 0,97%. Hubo asociación entre valores de IMC más altos (p=0,026), edad menor (para TCAP p=0,036, BN p=0,01) y objetivo de la práctica de ejercicio físico "estética" (para TCAP p=0,011 y BN p=0,043) con mayores puntuaciones en los escores de TCAP y BN. CONCLUSIÓN: La prevalencia de TCAP y BN encontrada en este estudio se encuentra de acuerdo con lo referido en la literatura internacional. No fueron encontradas asociaciones entre compulsión alimentaria y mayor frecuencia de ejercicio físico. .