Effect of a personalized nutritional intervention program on nutritional status, quality of life and mortality in hemodialysis patients / Efecto de un programa de intervención nutricional personalizado en el estado nutricional, calidad de vida y mortalidad en pacientes en hemodiálisis

Objective: dietary advice provided through a nutritional intervention program (NIP) is recommended by renal clinic guidelines to prevent or treat malnutrition, that could improve quality of life (QoL) and survival in hemodialysis (HD) patients. This study set out to evaluate the effect of a personalized NIP on the nutritional status and its impact on QoL and mortality in dialyzed patients. Material and methods: this was a 12-month intervention study with regular follow-up in which nutritional parameters were measured at baseline and after 6 and 12 months. QoL was assessed by the Kidney Disease Quality of Life version 1.2 (KDQOL-SF) at baseline and at the end of the study. All dialyzed patients received individualized consultations with a trained dietitian. The content of the nutritional education program included a personalized meal plan and educational materials addressing nutrition to manage fluids, electrolytes, and vitamin D. Results: a total of 75 patients were included. After the NIP, visceral proteins, phosphorous, potassium and vitamin D levels had improved significantly (p < 0.001). The percentage of well-nourished patients increased by 30 % (p < 0.001). At the end of the study, the well-nourished patients had significantly improved scores on the general summary areas of the KDQOL-SF, reduced worry concerning fluid and dietary restrictions (p < 0.001), and the survival rate was 12 months longer (p < 0.01). Conclusion: the results of this study suggest that personalized NIP contributed to improved nutritional status, QoL and survival in HD patients. (AU)

Objetivo: el asesoramiento dietético proporcionado a través de un programa de intervención nutricional (PIN) es recomendado por las guías clínicas renales para prevenir o tratar la desnutrición, puediendo mejorar la calidad de vida (CV) y la supervivencia en pacientes en hemodiálisis (HD). El objetivo de este estudio fue evaluar el efecto de un PNI personalizado sobre el estado nutricional y su impacto en la calidad de vida y la mortalidad en pacientes dializados. Material y métodos: estudio de intervención de 12 meses de duración, con seguimiento periódico de los pacientes en el que se midieron los parámetros nutricionales al inicio, a los 6 y 12 meses. La CV fue evaluada por el cuestionario Kidney Disease Quality of Life versión 1.2 (KDQOL-SF) al inicio y al final del estudio. Todos los pacientes dializados recibieron consultas individualizadas con un dietista. El contenido del programa de educación nutricional incluyó un plan de alimentación personalizado y materiales educativos sobre nutrición para el manejo de fluidos, electrolitos y vitamina D. Resultados: se incluyeron un total de 75 pacientes. Después del PIN, los niveles de proteínas viscerales, fósforo, potasio y vitamina D habían mejorado significativamente (p < 0,001). El porcentaje de pacientes bien nutridos aumentó un 30 % (p < 0,001). Al final del estudio, los pacientes bien nutridos mejoraron significativamente las puntuaciones en las áreas de resumen general del KDQOL-SF, redujeron la preocupación por las restricciones dietéticas y de líquidos (p < 0,001) y la tasa de supervivencia fue de 12 meses superior (p < 0,01). Conclusión: los resultados de este estudio sugieren que el PIN personalizado contribuyó a mejorar el estado nutricional, la calidad de vida y la supervivencia en pacientes en HD. (AU)

Análisis de un programa de atención nutricional respecto a la seguridad alimentaria y nutricional de la comunidad Sikuani del municipio de Puerto Gaitán, Meta: Un reporte de caso comunitario / Analysis of the nutritional care program regarding the food and nutritional security of the Sikuani community: case report

Fundamentos: La seguridad alimentaria y nutricional supone que las personas tienen una disponibilidad de alimentos que garanticen su aprovechamiento biológico suficiente para satisfacer las necesidades energéticas y nutricionales. Las intervenciones mediadas a través de programas comunitarios para promover una alimentación adecuada y contribuir a la mejoría de la situación nutricional en poblaciones étnicas, conlleva a interrogantes respecto a la pertinencia. El objetivo del presente estudio fue analizar las limitaciones del programa para garantizar la disponibilidad de alimentos, acceso, consumo y aprovechamiento biológico de la población Sikuani. Métodos: Se realizó una reflexión crítica de un caso comunitario de un programa en el marco de la seguridad alimentaria, desde la observación y experiencia. El análisis parte de organizar una serie de preguntas para reportar la experiencia en el programa considerando la definición de seguridad alimentaria y nutricional y la perspectiva de factores que influyen en propender o no una adecuada alimentación y nutrición en la comunidad Sikuani. Resultados: se rescataron cambios positivos como el empoderamiento de cuidadores respecto a protección y cuidados que requieren los niños y en la mejoría del estado de desnutrición, evidenciados a través de la toma de medidas antropométricas y la observación. Se identificaron situaciones de cambios comportamentales que alteraron no solo el estado nutricional de la población beneficiaria y su familia, sino también su sistema alimentario tradicional. Conclusiones: se considera que el programa es pertinente como parte de una estrategia de prevención de la desnutrición, ya que considera el mejoramiento del estado nutricional, el fortalecimiento familiar y el entorno protector mediante acciones pedagógicas que respondan a las características del contexto cultural. (AU)

Background: Food and nutritional security assumes that people have food availability that guarantees its sufficient biological use to satisfy energy and nutritional needs. Interventions mediated through community programs to promote adequate nutrition and contribute to the improvement of the nutritional situation in ethnic populations raise questions regarding relevance. The objective of this study was to analyze the limitations of the program to guarantee the availability of food, access, consumption and biological use of the Sikuani population. Methods: A critical reflection was carried out on a community case of a program within the framework of food security, from observation and experience. The analysis starts from organizing a series of questions to report the experience in the program, considering the definition of food and nutritional security and the perspective of factors that influence whether or not to promote adequate food and nutrition in the Sikuani community. Results: Positive changes were recovered such as the empowerment of caregivers regarding the protection and care that children require and the improvement in the state of malnutrition, evidenced through the taking of anthropometric measurements and observation. Situations of behavioral changes were identified that altered not only the nutritional status of the beneficiary population and their family, but also their traditional food system. Conclusions: The program is considered relevant as part of a malnutrition prevention strategy, since it considers the improvement of nutritional status, family strengthening and the protective environment through pedagogical actions that respond to the characteristics of the cultural context. (AU)

Técnicas de Intervención educativa nutricional en el consumo de alimentos fuentes de hierro en preescolares / Nutritional intervention techniques in the consumption of foods that are sources of iron in preschoolers

Introducción: La ingesta deficiente de alimentos fuentesde hierro, es un factor de riesgo para el desarrollo de anemiaferropénica infantil, es necesario identificar la estrategia deintervención educativa nutricional más efectiva en un entornocomunitario urbano y dinámico. Objetivo: Comparar el efecto de la intervención educativanutricional a través de dos técnicas, en el consumo de alimentos fuentes de hierro en preescolares residentes en unazona urbana.Materiales y Métodos: Se realizó un estudio de enfoquecuantitativo, aplicada, diseño experimental de tipo ensayo nocontrolado, realizado en 80 preescolares de 3 a 5 años edad.Se seleccionaron dos grupos de 40 (madre e hijo) para unaintervención educativa nutricional sincrónica y presencial respectivamente: antes y después de la intervención educativanutricional; se evaluó a ambos grupos el consumo de hierrode los preescolares, a través de un cuestionario de frecuenciade consumo de alimentos fuentes de hierro. Para el análisisestadístico, se aplicó la prueba estadística T de Student.Resultados: El consumo de hierro promedio de la dietafue de1,25 ± 0,29 mg/día y después de la intervención nutrición sincrónica fue de 1,35 + 0,19 mg/día. En el grupo deintervención presencial, antes fue de 1,17 ± 0,27 mg/día ydespués de la intervención fue de 2,63 ± 0,35 mg/día. Existediferencia del consumo de hierro antes y después de la intervención educativa nutricional en ambas técnicas de intervención nutricional, sincrónica y presencial (p<0,001).Conclusión: La técnica de intervención nutricional, bajo lamodalidad presencial fue la más efectiva en aumentar el consumo de alimentos fuentes de hierro en preescolares residentes en una zona urbana.(AU)

Introduction: Deficient intake of food sources of iron is arisk factor for the development of iron deficiency anemia inchildren, it is necessary to identify the most effective nutritional educational intervention strategy in an urban and dynamic community environment. Objective: To compare the effect of the nutritional educational intervention through two techniques, on the consumption of foods that are sources of iron in preschoolers residingin an urban area.Materials and Methods: A study with a quantitative approach, applied, experimental design of the uncontrolled trialtype, carried out in 80 preschoolers from 3 to 5 years of age, was carried out. Two groups of 40 (mother and son) were selected for a synchronous and face-to-face nutritional educational intervention respectively. Before and after the nutritional educational intervention, the iron consumption of thepreschoolers was evaluated in both groups, through a questionnaire on the frequency of consumption of foods that aresources of iron. For the statistical analysis, the Student’s Tstatistical test was applied.Results: Before the intervention, the average dietary ironintake was 1,25 ± 0,29 mg (synchronous nutritional intervention) and 1,17 ± 0,27 mg (face-to-face nutritional intervention). After the intervention it was 1,35 ± 0,19 mg (synchronous nutritional intervention) and 2,63 ± 0,35 mg(synchronous nutritional intervention). There is a differencein iron consumption before and after the nutritional educational intervention of the synchronous and face-to-facetechnique (p<0,001).Conclusion: The nutritional intervention technique, underthe face-to-face modality, was the most effective in increasing the consumption of foods that are sources of iron inpreschoolers residing in an urban área.(AU)

Adequacy of school menus and national school food program requirements: a systematic review / Adequação dos cardápios escolares e exigências do programa nacional de alimentação escolar: uma revisão sistemática

Abstract Objectives: this review aimed to evaluate the adequacy of school menus regarding the nutritional requirements of the Programa Nacional de Alimentação Escolar (PNAE) in Brazilian public schools regarding the presence of macronutrients and micronutrients and allocation of resources to purchase products from family farming. Methods: a systematic literature review was carried out using the SciELO, Bireme and Lilacs databases to select the articles. The inclusion criteria were articles that presented data on the adequacy of energy, macronutrients, micronutrients, and purchases of products from family farming during the PNAE regiment, as well as quantitative, cross-sectional, and descriptive studies carried out in the Brazilian territory. Review, editorials, letters, case studies, duplicates and those that did not assess the requirements of the PNAE were excluded. Results: at the end, 12 studies were included that showed overestimation and underestimation of nutritional adequacy in the school environment. In relation to purchases of inputs from family farming, it was observed that most of the Brazilian municipalities evaluated fulfilled the requirements for the allocation of resources. Conclusion: school menus need more supervision so that they meet the adjustments proposed by the PNAE. In addition, it is essential to promote a healthy diet that contains all the nutrients necessary to provide nutritional support for child growth and development.

Resumo Objetivo: avaliar a adequação dos cardápios escolares quanto às exigências nutricionais do Programa Nacional de Alimentação Escolar (PNAE) em escolas públicas brasileiras considerando quanto a adequação de macronutrientes e micronutrientes e destinação de recursos para compras de produtos advindos da agricultura familiar. Métodos: foi realizada uma revisão sistemática da literatura utilizando as bases de dados SciELO, Bireme e Lilacs para seleção dos artigos. Os critérios de inclusão foram: Artigos que apresentaram dados sobre a adequação de energia, macronutrientes, micronutrientes e compras de produtos oriundos da agricultura familiar durante o regimento do PNAE, assim como estudos quantitativos, transversais e descritivos realizados no território brasileiro. Foram excluídos artigos de revisão, editoriais, cartas ao editor, estudos de caso, artigos em duplicatas e que não avaliaram as exigências do PNAE. Resultados: ao final, foram incluídos12 estudos que apontaram superestimação e subestimação nas adequações nutricionais no ambiente escolar. Em relação às compras de insumo provenientes da agricultura familiar, observou-se que a maioria dos municípios brasileiros avaliados cumpriam as exigências de destinação dos recursos. Conclusões: os cardápios escolares necessitam de maior fiscalização para que atendam as adequações propostas pelo PNAE. Além disso, é primordial promover uma alimentação saudável que contenha todos os nutrientes necessários para fornecer um aporte nutricional para o crescimento e desenvolvimento infantil.

Revisión sistemática de programas de intervención para promover hábitos saludables de actividad física y nutrición en escolares españoles / Systematic review of intervention programmes to promote healthy physical activity and nutrition habits in Spanish school children

Introducción. La obesidad infantil es uno de los problemas de salud pública más graves del siglo XXI, originado porque los niños crecen en un entorno en el que no se fomenta la práctica deportiva. Esto es debido al cambio en el tipo de alimentación y al aumento del sedentarismo. Objetivo. Describir y analizar los principales programas de intervención, basados en la promoción de hábitos saludables (Nutrición y Actividad Física) en la población infantil y las principales estrategias utilizadas para su implantación en los centros educativos españoles. Materiales y métodos. Se ha realizado un estudio transversal descriptivo mediante el empleo de una revisión sistemática de la literatura realizada en el mes de octubre de 2022. La población de estudio fue el alumnado de entre 6 y 12 años escolarizados en centros de Educación Primaria de España. Resultados. Se ha identificado que las intervenciones educativas sobre nutrición y/o actividad física realizadas en los centros educativos, resultan positivas en la mejora de los hábitos de alimentación y la práctica físico-deportiva entre los escolares. Discusión. Además, combinando las temáticas de nutrición y actividad física, se fomenta la consecución de hábitos saludables, con el objetivo de prevenir la obesidad y el sedentarismo. A su vez, fomentando la participación de las familias en los programas de intervención se obtiene un resultado positivo en la efectividad de las intervenciones. Conclusiones. La mayor parte de los programas de intervención analizados demuestran su eficacia a la hora de modificar los hábitos alimentarios, además, se produce un aumento del nivel de actividad física, evitando el sedentarismo entre los escolares, y, por ende, disminuir el riesgo de obesidad(AU)

Introduction: Childhood obesity is one of the most serious public health problems of the 21st century, because children are growing up in an environment where sport is not encouraged. This is due to changes in dietary patterns and an increase in sedentary lifestyles. Objective. Describe and analyze the main intervention programs, based on the promotion of healthy habits (Nutrition and Physical Activity) in the child population and the main strategies used for their implementation in Spanish schools. Material and methods. A descriptive cross-sectional study based on a systematic review of the literature carried out in October 2022. The study population was pupils aged between 6 and 12 years old attending primary schools in Spain. Results. It has been identified that educational interventions on nutrition and/or physical activity carried out in schools are positive in improving eating habits and physical activity among schoolchildren. Discussion. In addition, by combining the topics of nutrition and physical activity, healthy habits are encouraged, with the aim of preventing obesity and sedentary lifestyles. In turn, by encouraging the participation of families in the intervention programmes, a positive result is obtained in the effectiveness of the interventions. Conclusions. Most of the intervention programmes analysed demonstrate their effectiveness in modifying eating habits, as well as increasing the level of physical activity, avoiding sedentary lifestyles among schoolchildren and, therefore, reducing the risk of obesity(AU)

Consumption of energy drinks on cardiovascular and metabolic response and performance. Is there an effect? / Consumo de bebidas energéticas sobre la respuesta cardiovascular, metabólica y rendimiento. ¿Hay efecto?

Over the years, the search for nutritional strategies that promote improved sports performance has increased. Among the available options, energy drinks appear as potential nutritional resources for this purpose, because they offer, in addition to caffeine, substances that act synergistically to improve performance, such as taurine, carbohydrates, amino acids, vitamins and minerals, promoting improved performance for both amateur and professional athletes. The aim of the study was to verify the effects of ingesting energy drinks with (ED1) and without carbohydrates (ED0) containing 2 mg·kg-1 of caffeine, and a decaffeinated placebo (PL) on cardiovascular, metabolic and performance parameters during cycling. Twelve male cyclists (age = 24.4 ± 6.6 years old) volunteered to participate in this study. The protocol consisted of three experimental sessions of 60 min of continuous cycling (65-75% of VO2maxE) followed by time-trial 6 km. The subjects ingested ED1, ED0 or a placebo drink (PL) 40 min before beginning the exercise. The heart rate (HR), blood pressure (BP), plasma glucose and lactate concentrations, and the time taken to complete the 6 km time-trial were evaluated. The time taken to complete the time-trial was significantly higher (p < 0.05) in the PL group than in the groups ED1 and ED0. This time significantly decreased after the ED1 consumption relative to that for the ED0 consumption. Heart rate, systolic and diastolic arterial pressure and in the plasma glucose and lactate concentrations were similar in all the considered groups. These results demonstrate that ED1 consumption appears to be more effective at maximizing performance during the last 6 km.(AU)

Con el paso de los años, se ha incrementado la búsqueda de estrategias nutricionales que promuevan un mejor rendimiento deportivo. Entre las opciones disponibles, las bebidas energéticas aparecen como potenciales recursos nutricionales para este fin, pues ofrecen, además de la cafeína, sustancias que actúan sinérgicamente para mejorar el rendimiento, como taurina, carbohidratos, aminoácidos, vitaminas y minerales, promoviendo un mejor rendimiento para atletas tanto aficionados como profesionales. El objetivo del estudio fue verificar los efectos de la ingestión de bebidas energéticas con (ED1) y sin carbohidratos (ED0) que contienen 2 mg · kg-1 de cafeína y un placebo descafeinado (PL) sobre los parámetros cardiovasculares, metabólicos y de rendimiento durante el ciclismo. Doce ciclistas varones (edad = 24,4 ± 6,6 años) participaron voluntariamente en este estudio. El protocolo consistió en tres sesiones experimentales de 60 min de ciclismo continuo (65-75% del VO2max) seguidas de una prueba contrarreloj de 6 km. Los sujetos ingirieron ED1, ED0 o una bebida placebo (PL) 40 minutos antes de comenzar el ejercicio. Se registró la frecuencia cardíaca (FC), la presión arterial (PA), las concentraciones plasmáticas de glucosa y lactato y el tiempo necesario para completar la prueba contrarreloj de 6 km. El tiempo necesario para completar la contrarreloj en el grupo PL fue significativamente mayor (p <0,05) que en los grupos ED1 y ED0. Este tiempo disminuyó significativamente después del consumo de ED1 en relación con el consumo de ED0. La frecuencia cardíaca, la presión arterial sistólica y diastólica y las concentraciones plasmáticas de glucosa y lactato fueron similares en todos los grupos. Estos resultados demuestran que el consumo de ED1 parece ser más eficaz para maximizar el rendimiento durante los últimos 6 km.(AU)

Prevención y manejo de los conflictos de intereses en los programas de nutrición nacionales. Hoja de ruta para aplicar el proyecto de enfoque de la Organización Mundial de la Salud en la Región de las Américas

La Organización Panamericana de la Salud (OPS) espera que esta publicación ayude a sus Estados Miembros a que detecten, prevengan y manejen posibles conflictos de intereses en caso de que se incluya una interacción con agentes no estatales en sus políticas y programas de nutrición. En esta publicación se presenta una hoja de ruta para introducir y aplicar en la Región de las Américas el Proyecto de enfoque para la prevención y el manejo de los conflictos de intereses en la formulación de políticas y la ejecución de programas de nutrición a escala de país, publicado por la Organización Mundial de la Salud (OMS) en diciembre del 2017. Esta hoja de ruta describe cómo se puede presentar este enfoque a los equipos pertinentes dentro de los Ministerios de Salud de los Estados Miembros y familiarizarlos con el enfoque de la OMS y el uso de las herramientas conexas de la OMS y de triaje, con el apoyo y la orientación de funcionarios de la OPS. La hoja de ruta tiene por objeto presentar los principios subyacentes del enfoque de la OMS a los encargados de adoptar decisiones en los organismos gubernamentales pertinentes; adaptar y elaborar formatos complementarios del enfoque de la OMS para que se ajuste a los procesos de toma de decisiones existentes a nivel nacional, y complementar la herramienta de la OMS con una herramienta más breve de triaje para aumentar la accesibilidad y facilitar que el involucramiento y el uso sean más eficaces en la toma de decisiones de la vida real respecto a posibles interacciones con agentes no estatales. La publicación explica cómo pueden abordarse estos objetivos mediante un enfoque en tres etapas. También proporciona algunos anexos en los que se presentan estudios de casos, programas de los talleres y una herramienta de triaje para evaluar la posible interacción con agentes no estatales.

Caderno dos programas nacionais de suplementação de micronutrientes - versão preliminar / Guideline: National Micronutrient Supplementation Programs - preliminary version

Este documento apresenta as recomendações referentes aos atuais Programas Nacionais de Suplementação de Micronutrientes, que são formulados a partir das necessidades de saúde do território brasileiro, considerando os agravos nutricionais de maior frequência e relevância e observando os critérios de risco e vulnerabilidade da população.

Talla baja y sobrepeso en menores de 5 años que habitan la Sierra Tarahumara, México / Stunting and overweight in children under 5y who inhabit the Sierra Tarahumara in northern Mexico

La doble carga de la desnutrición y el exceso de peso (o mala nutrición) es uno de los indicadores que mejor ilustra las inequidades en salud que existen en zonas indígenas de México. Por otro lado, existe escasa evidencia del estado de nutrición en población Tarahumara. Objetivo: Estimar indicadores del estado de nutrición y su asociación con factores sociodemográficos en población indígena Tarahumara menor de 5 años. Métodos: Estudio transversal en 21 localidades indígenas de la Sierra Tarahumara en Chihuahua, México, que analizó información sociodemográfica, de salud y antropométrica en población infantil de 6 a 59 meses de edad (n=323). Se estimaron índices antropométricos y su asociación con variables de interés mediante regresión logística múltiple. Un valor de p ≤0,05 fue considerado como estadísticamente significativo. Todos los análisis se realizaron en el paquete estadístico Stata v14.2. Resultados: Se encontraron altas prevalencias de talla baja (44,4%), emaciación (5,3%), bajo peso (11,9%) y sobrepeso (15,2%). El sexo masculino se asoció significativamente con talla baja (Razón de Momios (RM)=2,5; 1,45-4,34), mientras que, ninguna escolaridad de la madre (RM=0,39; 0,15-0,99) y ser beneficiario de un programa local de nutrición por más de 2 años se asoció con sobrepeso (RM=2,97; 1,26 -6,97). Conclusión: Se encontraron indicadores de mala nutrición en la muestra estudiada; éstos hallazgos podrían sugerir la existencia de inequidad y rezago en salud y nutrición de población infantil indígena Tarahumara. Se requieren más estudios que puedan orientar programas y acciones de salud y nutrición para atender a esta población de forma prioritaria(AU)

The double burden of malnutrition and excess weight (or poor nutrition) is one of the indicators that best illustrates the health inequities that exist in indigenous areas of Mexico. On the other hand, there is scarce evidence of the nutritional status of the Tarahumara population. Objective: To estimate indicators of the nutritional status and its association with sociodemographic factors in the Tarahumara indigenous population under 5 years of age. Methods: A cross-sectional study in 21 indigenous localities of the Sierra Tarahumara in Chihuahua, Mexico, which analyzed sociodemographic, health and anthropometric information in children from 6 to 59 months of age (n=323). Anthropometric indices and their association with variables of interest was estimated by multiple logistic regression. A value of p ≤0.05 was considered statistically significant. All analyzes were performed using the Stata v14.2 statistical package. Results: It were founded high prevalences of short stature (44.4%), emaciation (5.3%), underweight (11.9%) and overweight (15.2%). Male sex was significantly associated with short stature (Odds Ratio (OR) = 2.5; 1.45-4.34), while no education of the mother (OR = 0.39; 0.15-0.99) and being a beneficiary of a local nutrition program for more than 2 years it was associated with being overweight (OR = 2.97; 1.26-6.97). Conclusion: Indicators of malnutrition and overweight were founded in the sample studied; these findings suggest inequity and delays in health and nutrition of the indigenous Tarahumara child population. More research is required that can guide health and nutrition programs and actions to serve this indigenous population as a priority(AU)

Latin America and the Caribbean Regional Overview of Food Security and Nutrition 2021: Statistics and Trends

Food is central to people's development throughout their lives. Hunger and poverty impede the enjoyment of this fundamental right. In recent years, various factors have diverted the world off the path to eradicating hunger, food insecurity and all forms of malnutrition by 2030 and the COVID-19 pandemic has exacerbated this trend. Our region is no exception. This edition of the Regional Overview of Food Security and Nutrition 2021: Statistics and Trends reveals a bleak scenario for the future. In 2020, 59.7 million people in our region suffered from hunger, and between 2019 and 2020 the prevalence of hunger in Latin America and the Caribbean increased by 2 percentage points. The increases in moderate or severe food insecurity from 2019 to 2020 were even steeper than the increase in hunger at 9 percentage points. Forty-one percent of the regional population is moderately or severely food insecure: that is 267 million people whose human right to food is not being met. In the Region, one in four adults suffer from obesity. Childhood overweight has been increasing over the last 20 years and is above the world average: it affected 7.5 percent of children under five in 2020. Overweight and obesity have a significant economic, social and health impact on countries because of reduced productivity and increased disability, premature mortality, and medical care and treatment costs. If we do not make rapid and thorough changes, the countries of the region will fail to meet Sustainable Development Goal (SDG) 2: “End hunger, achieve food security and improved nutrition and promote sustainable agriculture” and SDG 3: “Ensure healthy lives and promote well-being for all at all ages.” These trends will not be reversed if we do not transform our agri-food systems to make them efficient, resilient, inclusive and sustainable enough to provide a healthy diet for everyone, leaving no one behind. That was the aim of the Food Systems Summit, convened by United Nations Secretary-General António Guterres, which brought together 23 Member States from Latin America and the Caribbean to discuss how they could bring about a transformation that would benefit the most vulnerable communities. The five United Nations agencies behind this publication want to contribute to this transformation by measuring and monitoring food and nutrition security indicators to promote the formulation and implementation of evidence-based policies. This publication contributes to the policy dialogue for post-pandemic recovery, which is fundamental to closing gaps in equality and to meeting the goals of the 2030 Agenda for Sustainable Development.

Mapping dietary salt/sodium reduction policies and initiatives in the Region of the Americas

The aim of this study was to map existing country policies and initiatives addressing population dietary sodium reduction in the Region of the Americas; to identify policy gaps following what is outlined in the World Health Organization (WHO) “Best Buys” most cost-effective recommendations for the prevention and control of diet-related noncommunicable diseases (NCDs); and to discuss priorities for future work to reduce population salt/sodium intake. We analyzed data from 34 countries in the Region. A review of different databases informed the mapping. Databases included (1) responses from the online Survey on National Initiatives for Salt/Sodium Reduction in the Americas carried out by PAHO in 2016; (2) the databases from the 2017 and 2019 PAHO Country Capacity Surveys for NCDs and Risk Factors; and (3) the repositories of legislation of the PAHO REGULA initiative as of 2018. Research in these databases was complemented by electronic searches on official websites from the ministries of health, education, and agriculture and the library of the national congress in each country. Additionally, when available, government regulatory gazettes were reviewed. National policies that have adopted the most cost-effective interventions for preventing and controlling diet-related NCDs of WHO “Best Buys” included reformulating food products with both voluntary (n=11/34) and mandatory (n=2/34) targets; establishing a supportive environment in public institutions (n=13/34); consumer awareness programs (n=26/34) and behavior-change communication and mass media campaigns (n=(0/34); and implementing front-of-pack labeling (n=5/34). We also found that some countries have implemented regulations that restrict marketing of foods high in salt/sodium to children (n=5/34), or are using nutritional labeling that includes sodium content, either voluntary (n=9/34) or mandatory (n=10/34). However, no country in the Region has implemented taxes on high salt/sodium foods. Based on our review, we concluded that there has been a significant advance in policies to reduce sodium intake in the Region of the Americas in recent years. However, we identified that the level of implementation is quite varied and is challenging to assess. Despite the progress, there remains much work to do on this issue, especially in countries where there is limited or no action yet. Reducing sodium consumption is a cost-effective intervention that can save many lives by preventing and reducing the burden of diet-related NCDs. Therefore, a further call to action is needed for governments to accelerate efforts to meet the 2025 global target of a 30% relative reduction in mean population intake of sodium.

Preventing and Managing Conflicts of Interest in Country-level Nutrition Programs: A Roadmap for Implementing the World Health Organization’s Draft Approach in the Americas

The Pan American Health Organization (PAHO) expects this publication to help its Member States identify, prevent, and manage potential conflicts of interest in potential engagement with non-State actors in their nutrition programs. The publication sets out a roadmap for introducing and implementing in the Region of the Americas the Draft Approach for the Prevention and Management of Conflicts of Interest in the Policy Development and Implementation of Nutrition Programmes at Country Level, published by the World Health Organization (WHO) in December 2017. This roadmap describes how relevant teams within Member States’ Ministries of Health can be introduced to and gain familiarity with the WHO approach and the use of associated WHO and triage tools, with support and guidance from staff of PAHO. This roadmap aims to: introduce decisionmakers in relevant government agencies to the principles underlying the WHO approach; adapt and develop complementary formats of the WHO approach to fit with existing decision-making processes at a national level; and supplement the full WHO tool with a shorter triage tool to increase accessibility and to enable more effective engagement and use in real-life decision-making regarding potential engagements with non-State actors. The publication explains how these aims can be addressed through a three-stage approach. It also contains annexes that cover case studies, workshop agendas, and a triage tool for evaluating potential engagement with non-state actors.

Updated PAHO Regional Sodium Reduction Targets

This publication presents the set of new and revised Pan American Health Organization (PAHO) Regional Sodium Reduction Targets 2021–2025 adopted by the PAHO Technical Advisory Group on Cardiovascular Disease Prevention through Population-wide Dietary Salt Reduction. It also provides an overview of the methodological approaches taken to expand the number of food categories and to generate the revised targets. PAHO and the World Health Organization have called on countries to strive for a 30% relative reduction in mean population intake of salt/sodium by 2025. Although there have been significant advances in policies or interventions in the Region of the Americas, more accelerated action is needed to reduce cardiovascular disease and other diet-related noncommunicable diseases (NCDs) by reducing sodium intake. Member States have demonstrated that it is feasible to reduce sodium levels in food products by setting national or regional sodium targets. These updated harmonized sodium reduction targets are a tool for governments to boost progress towards achieving a reduction in the NCD burden. They are designed to complement existing and ongoing national efforts and initiatives, and are intended to serve as a regional reference, and for the monitoring of sodium content in food products.

Looked-after children and young people

This guideline covers how organisations, practitioners and carers should work together to deliver high-quality care, stable placements and nurturing relationships for looked-after children and young people. It aims to help these children and young people reach their full potential and have the same opportunities as their peers.

Comedores preescolares y escolares. Guías, recomendaciones y normativa en España / School lunch menus in Spain. A review on recommendations and policy

Introducción: Una dieta apropiada en la infancia es fundamental para un crecimiento y desarrollo adecuados, pero también para la prevención del desarrollo de enfermedades no transmisibles. La etapa escolar es transcendental. Una proporción importante de alumnos hacen uso del comedor escolar. Se revisa la situación actual de los comedores escolares, así como la normativa y las guías para los comedores en España y en sus diferentes Comunidades Autónomas.Material y métodos: Se recoge en esta revisión la normativa estatal así como la de cada Comunidad Autónoma referidas a las características de los menús escolares, dejando de lado las relativas a los aspectos que tienen que ver con las instalaciones o las garantías higiénico-sanitarias.Resultados: Existe una normativa estatal sobre los comedores escolares relativamente reciente, aunque al ser una competencia transferida es desarrollada por cada Comunidad Autónoma. Dentro de una cierta heterogeneidad, hacen referencia a la distribución de la dieta y a los alimentos a restringir. Suelen dar pautas, ejemplos de menús diarios y representaciones gráficas. En general, se constata una tendencia hacia la mejoría en la adecuación nutricional, pero todavía con bastante por acordar: modelo de gestión, tipo de supervisión, sostenibilidad y consumo de proximidad, así como los horarios.Conclusiones: Los aportes nutricionales realizados en el comedor escolar son importantes cualitativa y cuantitativamente. Además, el comedor debe cumplir funciones educativas y de equidad social. Aunque en todas las Comunidades Autónomas estas preocupaciones guían el desarrollo de la normativa espcífica, existe gran heterogeneidad en su concreción práctica. (AU)

Introduction: An appropriate diet in childhood is essential for suitable growth and development, but it is also essential for preventing the development of non-communicable diseases in later stages. The School stage is fundamental. A significant proportion of students in Spain make use of the school lunch. We review the current situation in Spain, as well as public policy on school lunch and a nationwide review of specific legislation on each Autonomous Community.Material and methods: National public policy and specific considerations in every Autonomous Community were reviewed. Only considerations on the composition of the school menu were considered.Results: There are relatively recent state regulations but on school lunch menus also specific to each Autonomous Community. In general, and within a certain heterogeneity, they refer to the distribution of the diet and foods to be restricted. They usually provide guidelines, examples of daily menus, and graphic representations. Regarding school menus, there is a trend towards improvement in nutritional adequacy, but there is still room to improve. There are certain aspects related to the best solutions yet to be elucidated: management model, type of supervision, sustainability and local consumption, as well as school lunch schedules.Conclusions: The nutritional contributions made in the school canteens are qualitatively and quantitatively important. In addition, it must fulfill educational and social equity functions. Although these concerns address specific recommendation in every Autonomous Community, there is huge heterogeneity on practical implementations. (AU)

Curso de contenido propio Alimentación Saludable: su implementación en la carrera de Medicina en Cuba / Course on Healthy Food: its implementation in the Medicine degree in Cuba

RESUMEN Fundamento: el Plan de Estudio D para la carrera de Medicina incluyó un curso de contenido propio o curso propio sobre nutrición, cuyo programa original fue sustituido por una versión confeccionada por docentes de la Universidad de Ciencias Médicas de Villa Clara. Objetivo: valorar los resultados del curso propio Alimentación Saludable elaborado por docentes de la Universidad de Ciencias Médicas de Villa Clara, e implementado desde 2018-2019 en la carrera de Medicina en Cuba. Métodos: se realizó una investigación descriptiva en la Universidad de Ciencias Médicas de Villa Clara, curso 2019-2020. Se utilizaron métodos teóricos para la fundamentación de la investigación y recogida de información, y empíricos: análisis documental, cuestionario a docentes y la técnica de grupo focal. Resultados: los criterios de profesores y estudiantes de la carrera en Villa Clara y de algunos docentes de 20 facultades de Medicina en Cuba fueron favorables en cuanto al diseño del curso, su pertinencia y posibilidades de su implementación; consideraron sus contenidos en correspondencia con el perfil declarado en el modelo del profesional; la mayoría de los docentes logró motivar a los estudiantes y los resultados de promoción fueron satisfactorios; aunque se advierten aspectos a mejorar, entre los que se destaca que docentes de diez facultades consideraron que se requiere preparación previa para lograr un proceso enseñanza aprendizaje con mayor calidad. Conclusiones: el curso Alimentación Saludable es un proyecto válido en el empeño de elevar la calidad de la enseñanza de la nutrición en la carrera de Medicina.

ABSTRACT Background: Study Plan D for the Medicine degree included a course on nutrition; the original program was replaced by a version prepared by teachers from Villa Clara University of Medical Sciences. Objective: to assess the results of the Healthy food course prepared by teachers from Villa Clara University of Medical Sciences, and implemented from 2018 to 2019 in the Medicine degree in Cuba. Methods: a descriptive research was carried out at Villa Clara University of Medical Sciences, 2019-2020 academic year. Theoretical methods were used to base the research and information gathering, and empirical ones: documentary analysis, questionnaire for teachers and the focal group technique. Results: the criteria of professors and students of the degree in Villa Clara and some teachers of 20 medical schools in Cuba were favorable regarding the design of the course, its relevance and possibilities of its implementation; they considered its contents in correspondence with the profile declared in the professional model; most of the teachers managed to motivate the students and the course grade results were satisfactory; although there are aspects to be improved, among which it stands out that teachers from ten faculties considered that prior preparation is required to achieve a higher quality teaching-learning process. Conclusions: the Healthy food course is a valid project in the effort to raise the quality of nutrition teaching in Medicine.

Avaliação do estado nutricional em relação à presença de cárie dentária em crianças de 4 a 6 anos do município de Cajamar - São Paulo / Evaluation of the nutritional status in relation to the presence of dental caries in children aged 4 to 6 years in the city of Cajamar - São Paulo

Este artigo tem como objetivo avaliar o estado nutricional em relação à presença de cáries dentárias em crianças de 4 a 6 anos de idade, do município de Cajamar, São Paulo. Trata-se de estudo transversal com crianças entre 4 a 6 anos (n=1642), acompanhadas pelo Programa Saúde na Escola (PSE) do Município de Cajamar, São Paulo. A classificação do estado nutricional foi baseada no Índice de Massa Corporal (IMC) e a avaliação das condições bucais, por meio do índice ceo-d e critério para Risco de Cárie. A análise do estado nutricional, faixa etária e sexo conforme o número de cáries, foi feita por meio dos testes Mann-Whitney U e Kruskal-Wallis (p<0,05). Observou-se maior prevalência de meninos entre 4 a 6 anos. Em todas as faixas etárias a prevalência de excesso de peso foi de aproximadamente 30% e eutrofia em torno de 70%. 65% (n=1068) das crianças não apresentavam risco de cárie (A) e 28,8% (n=475), alto risco (D, E e F). Das 1162 crianças sem cáries, 0,2% eram magras (n=2), 67,2% (n=781) eutróficas e 32,7% (n=380) possuíam excesso de peso. A frequência de 1 a 5 cáries maior entre meninas e de 6 ou mais cáries, entre meninos. Segundo estado nutricional, o número médio do número de cáries foi de 2,17 para magreza, 0,93 para eutrofia e 0,65 para excesso de peso (p<0,010). Conclui-se que houve diferença entre número cáries e estado nutricional, na qual crianças com déficit nutricional apresentavam maior número de cáries dentárias comparadas às eutróficas ou com excesso de peso, sugerindo-se a inclusão do estado nutricional na avaliação odontológica.

This article aims at evaluating the nutritional status in relation to the presence of dental caries in children aged 4 to 6 years in the city of Cajamar, in the state of São Paulo. It is a cross-sectional study with children aged 4 to 6 years (n=1642) accompanied by the School Health Program of the City of Cajamar, São Paulo. The nutritional status classification was based on the Body Mass Index (BMI) and the evaluation of oral conditions, through the ceo-d index, and criteria for risk for caries. The analysis of the nutritional status, age, and sex according to the number of caries was made through the Mann-Whitney U and Kruskal-Wallis tests (p<0.05). A higher prevalence was observed among boys aged 4 to 6 years. In all age groups, there was a prevalence of 30% of overweight children, and eutrophy of approximately 70%. A total of 65% (n=1068) of the children presented no risk of caries (A), whereas 28.8% (n=475) showed high risk (D, E, and F). Among the 1162 children with no caries, 0.2% were thin (n=2); 67.2% (n=781) eutrophic; and 32.7% (n=380) were overweight. Girls presented a higher frequency of 1 to 5 caries while boys presented frequency of having 6 or more caries. According to the nutritional status, the average number of caries was 2.17 for thin individuals; 0.93 for eutrophic individuals; and 0.65 for overweight individuals (p<0.010). It could be concluded that there was a difference between the number of caries and the nutritional status, in which children with nutritional deficit presented a higher number of dental caries when compared to eutrophic or overweight ones, suggesting the inclusion of the nutritional status in the dental evaluation.

Programa Nutricional: Informe de la situación nutricional de población atendida en centros de salud nivel 1: año 2021 / Status report nutritional population attended in Level 1 Health Centres: Year 2021

En este informe se presenta la situación nutricional de la población menor de 19 años, adultos/as y embarazadas atendidas en los Centros de Salud Nivel 1 (CESACs) durante el período 2021. Esta sistematización ha sido elaborada a partir de los datos brindados por la Gerencia Operativa de Gestión de Información y Estadísticas de Salud (Dirección General de Sistemas de Información Sanitaria) de la Sub-Secretaría de Planificación Sanitaria del Ministerio de Salud del GCBA. El propósito de este Informe es facilitar el acceso a datos consolidados sobre la situación nutricional de la población atendida en el primer nivel de atención, de manera que los equipos de salud puedan disponer y compartir información correspondiente a sus áreas de trabajo y al conjunto de la Ciudad, y planificar acciones acordes al perfil epidemiológico-nutricional. (AU)

Efecto del Programa de Estabilización Nutricional "ESNUT" en el consumo alimenticio, IMC, composición corporal y actividad física en estudiantes universitarios mexicanos / Effect of the "ESNUT" Nutritional Stabilization Program on food consumption, BMI, body composition and physical activity in Mexican university students

INTRODUCCIÓN: La encuesta Nacional de Salud y Nutrición en México (ENSANUT-2018) señala que existe un 38.4% de sobrepeso/obesidad en la población entre 10-24 años, lo que favorece las enfermedades crónicas no transmisibles (ECNT). En jóvenes universitarios los factores que mayormente contribuyen son la alimentación y la actividad física inadecuadas. OBJETIVO: Evaluar el efecto de una intervención (Programa de Estabilización Nutricional "ESNUT") en la composición corporal, índice de masa corporal, nivel de actividad física, consumo de energía y macronutrientes en estudiantes universitarios de nuevo ingreso. MÉTODOS: Diseño. Cuasiexperimental con seguimiento, de agosto de 2017 a mayo de 2018 en un Centro de Salud Universitario (CSU). Población. Estudiantes de 17 a 21 años (ambos sexos), sin condiciones de salud, gestación, lactancia, deporte de alto rendimiento o patología que impactaran en el estado nutricional, que firmaron el consentimiento informado. Los grupos experimental (GE, n=23) y control (GC, n=35) se conformaron por asignación aleatoria y ciego sencillo. Variables. Independiente: Programa ESNUT. Dependientes: Kilocalorías (Kcal), macronutrientes, masa grasa (%MG), masa músculo-esquelética (%MME), índice de masa corporal (lMC) y nivel de actividad física (NAF). Instrumentos: Bioimpedanciómetro Inbody 230; estadímetro digital SECA 274; Encuesta de nivel de actividad física (NAF); Recordatorio de 24 horas (R24), réplicas plásticas de alimentos. Análisis. Estadística descriptiva, U de Mann-Whitney-Wilcoxon, ANOVA, t de student y r de Pearson, con significancia p≤0.05. RESULTADOS: El 50% del GE padecía SP/OB. Mejoró la adecuación de ingesta energética y de macronutrientes, se redujo %MG, se incrementó %MME y NAF. DISCUSIÓN: El SP/OB y bajo peso decrementaron, asociados a mejoras dietética y de NAF, similarmente a intervenciones educativo-nutricionales efectivas en la prevención de malnutrición y por consiguiente de ECNT en universitarios latinoamericanos. CONCLUSIONES: El programa "ESNUT" tuvo efecto de mejora en la ingesta, composición corporal y NAF. Deben fomentarse estilos de vida saludables en el ámbito universitario

INTRODUCTION: According to the 2018 National Health and Nutrition Survey (ENSANUT), overweight/obesity was 38.4% in the population between 10-24 years of age in Mexico, which bolsters chronic non-communicable diseases (CNCD). In university students, inadequate diet and physical activity contribute to this. OBJECTIVE: To evaluate the effect of the Nutritional Stabilization Program "ESNUT" on body composition, BodyMass Index, energy and macronutrient intakes and on the level of physical activity in new university students. METHODS: Design. Quasi-experimental with follow-up carried out from August 2017 to May 2018 in a University Health Center (CSU). Population. Students of both sexes, from 17 to 21 years old, non-pregnant, lactation, high-performance sports, pathology or health condition impacting their nutritional status, who signed the informed consent. The experimental (EG, n=23) and control (CG, n=35) groups were made up of randomized and single-blind allocation. Variables Independent: ESNUT Program. Dependent: Kilocalories (Kcal) and macronutrients, fat mass (%FM), musculoskeletal mass(% MM), body mass index (BMI) and physical activity level (PAL). Instruments: Inbody 230 Bioimpedance Meter; SECA274 digital stadiometer; PAL survey; 24-hour reminder (R24) and plastic food replicas. Analysis. Descriptive statistics and tests: Mann-Whitney-Wilcoxon U ranges, ANOVA, student's tand Pearson's r, with significance p≤0.05. RESULTS: 50% GE suffered from OW/OB. The adequacy of energy and micronutrients, intake improved,% FM was reduced, % MM and PAL increased. DISCUSSION: OW/OB and low weight were reduced associated with improvements in diet and PAL, similarly to effective educational-nutritional interventions in the prevention of malnutrition and, consequently, of CNCD in Latin American university students. CONCLUSIONS: The "ESNUT" program had an improvement effect on intake, body composition and PAL. Healthy lifestyles should be promoted in the university setting