It is time: free meals at schools for all.

The link between school feeding programmes (SFP) and the promotion of healthy eating and health is being explored in studies performed in different countries. The coronavirus disease-19 pandemic has revealed flaws and weaknesses in contemporary food systems, with many school-age children experiencing food insecurity and hunger. There is intense debate among policymakers regarding whether government SFP should be universal or targeted. Countries such as Brazil and India, which have two of the most comprehensive universal free-of-charge programmes, have shown the benefits of SFP, including improved nutritional status, support for more sustainable food systems, attendance and academic performance. Evidence shows and supports actions advocating that it is time to offer healthy and free school meals for all students.

Evaluation of food purchasing in the Brazilian School Feeding Programme: feasibility of the requirements and recommendations.

OBJECTIVE: To analyse the purchase of food for school feeding, according to the extent and purpose of industrial processing and variety, exploring the feasibility of achieving the requirements and recommendations of the Brazilian School Feeding Programme, and the variety of unprocessed or minimally processed foods according to the purchase of ultra-processed foods. DESIGN: Secondary data from 2016 from the Accountability Management System of the National Fund for Educational Development, concerning the food items purchased, were used to explore the feasibility of the requirements and recommendations. The foods were grouped according to the NOVA classification system. Variety was assessed by counting different types of unprocessed or minimally processed foods. SETTING: Brazil. PARTICIPANTS: 3698 Brazilian municipalities. RESULTS: Energy share from unprocessed or minimally processed foods was 44·1 % while that of ultra-processed foods was 29·9 %. The average of unprocessed or minimally processed food types purchased annually was 33·8 items. Of the municipalities, 35·8 % were within the limit established for the expenditure of funds for the purchase of processed and ultra-processed foods, while 8·7 % followed the recommendation for variety. The proportion of ultra-processed foods did not influence the variety of food items purchased. CONCLUSIONS: The results showed the feasibility of achieving the requirements and recommendations and underscored the importance of continued efforts to promote the inclusion of unprocessed or minimally processed foods in the school feeding programme while addressing the challenges associated with expenditure limits of processed and ultra-processed foods and enhancing variety, which is strategic to promote adequate and healthy meals.

Carbohydrate restriction during lactation: A systematic review.

The quality of a mother's diet is important to ensure child growth and development and keep women healthy. This systematic review aimed to identify the outcomes of a carbohydrate-restricted diet during lactation. PubMed, EMBASE, Scopus, Web of Science, and LILACS were searched for studies published between 2012 and 2023; 16 studies were selected, all of them case reports or care series. The carbohydrate restriction described in the papers mainly was ketogenic, low-carb, low-carbohydrate and high-fat, and modified ketogenic diets. The main goal of women undertaking these diets was weight loss, with therapeutic purposes (monitored and supervised by health professionals) in only 2 cases: (1) ketogenic diet therapy for treatment of seizures in the infant and (2) to reduce symptoms of mother's gastroesophageal reflux. Most articles reported that lactating women were hospitalized, experiencing symptoms such as vomiting, muscle weakness, nausea, abdominal pain, general malaise, and fatigue. However, articles did not mention poor outcomes for the infants. Most of the studies in this review were published in the past 3 years, indicating a possible increase in cases of women practicing carbohydrate restriction during lactation for weight loss caused by body dissatisfaction. In conclusion, carbohydrate restriction during lactation may be harmful to the lactating woman and contribute to the state of lactational ketoacidosis, but infant outcomes are mainly a change in feeding patterns. Thus, education on food and nutrition is necessary for this population.

Association between Consumption of Ultra-Processed Foods and Sociodemographic Characteristics in Brazilian Adolescents.

BACKGROUND: The consumption of ultra-processed foods is associated with several negative health outcomes. Studies on adolescents have shown that this population has a high consumption of these foods, especially in high-income countries. However, there are no studies on the types of ultra-processed foods consumed. The present study evaluated secondary data from a representative sample of the National School Health Survey, the consumption of ultra-processed foods by 159,245 Brazilian adolescents. METHODS: Data were collected via a self-administered questionnaire using a mobile device. A Poisson regression model was used to assess the prevalence of ultra-processed food consumption and its correlation with sociodemographic characteristics. RESULTS: The consumption of ultra-processed foods was significant among Brazilian adolescents, and almost half of the participants reported consumption the day before. We observed that sociodemographic characteristics such as school type, race/skin color, region, municipality type, age, living with mother, living with father, and maternal education level were associated with greater or lesser consumption of ultra-processed foods. Adolescents who study in private schools, are female, white, and live in non-capital cities consume more ultra-processed foods. CONCLUSIONS: Access to in natura and minimally processed foods must be on the agenda of governments and encouraged by food and nutrition education to guarantee the right to adequate and healthy food.

The contribution of school meals to food security among households with children and adolescents in Brazil.

OBJECTIVES: This study aimed to analyze the relationship between food insecurity and school meal consumption, adjusted for sociodemographic variables. METHODS: This cross-sectional study investigated households with children and adolescents living in Brazilian municipalities. A semistructured survey was administered to parents/guardians at a parent-teacher meeting to assess their socioeconomic conditions and access to food, using the Brazilian Food Insecurity Scale to classify households as having food security or mild, moderate, or severe food insecurity. Parents and students were asked about the frequency of their consumption of school meals offered by the Brazilian School Food Program, which is one of the largest public policies in Brazil and offers free meals to all students in all public schools. Multinomial regression was performed to assess the relationship between food security and frequency of school meal consumption. RESULTS: A total of 1705 students participated in the study, most of whom displayed some degree of food insecurity (56.5%) per the Brazilian Food Insecurity Scale. Regular consumption of school meals (>3 times/wk) was reported by 78.5% of students. Regarding the frequency of school meal consumption adjusted by sociodemographic variables, students from households with food insecurity (moderate or severe) were more likely to regularly consume school meals. The prevalence of households with moderate or severe food insecurity was twice as high as for those who lived in households with food security after adjusting for sociodemographic variables (odds ratio: 2.35; 95% confidence interval 1.53-3.61). CONCLUSIONS: The Brazilian School Food Program has contributed greatly to food security. Although the guarantee of universality is essential for the program to reach all school children who are experiencing food insecurity, the program should also aim for greater equity.

Use Database to Evaluate the Prevalence of Hunger Among Adolescents in Brazil.

Food insecurity and malnutrition have become serious problems in many countries. In recent years, Brazil has experienced an increase in the prevalence of food insecurity and hunger. However, there is limited information on the status of these issues, and food security assessments are only performed as household measures. Therefore, the use of available databases is essential to expand information and support decision-making in the fight against food insecurity. This study aimed to evaluate the relationship between reports of hunger among adolescents and their sociodemographic characteristics. We used data from the 2015 National School Health Survey. The main variable of interest was obtained from responses to the following question: "Over the past 30 days, how often have you gone hungry because you did not have enough food at home?". The responses were separately gathered from those who reported going hungry and those who did not. Socioeconomic characteristics were evaluated simultaneously. For statistical analysis, a Pearson chi-square test and multiple analyses were performed using Poisson regression models. A total of 101,888 adolescents were evaluated. The variable used to measure hunger was associated with maternal education, internet access, and fruit intake. The results showed a positive association between adolescents who reported going hungry and women, black and indigenous adolescent students living in households with more than five people, adolescents not living with their father, and adolescents planning to work or not knowing what they will do after completing the ninth grade. The results demonstrate that it is possible to use secondary data with a single question to assess, monitor, and provide insights into how food security impacts the sociodemographic groups differently.

Programa Nacional de Alimentação Escolar: estratégias para enfrentar a insegurança alimentar durante e após a COVID-19 / Programa Nacional de Alimentación Escolar: estrategias para enfrentar la inseguridad alimentaria durante y después de la COVID-19 / National school feeding program: strategies to overcome food insecurities during and after the COVID-19 pandemic

Resumo Este artigo tem como objetivo analisar a contribuição do Programa Nacional de Alimentação Escolar (PNAE) para o enfrentamento da fome e da insegurança alimentar (IA), ao propor um conjunto de estratégias para que o PNAE possa garantir a alimentação dos escolares neste momento de crise. Realizamos um diagnóstico da IA e da fome no Brasil, analisamos o processo de enfraquecimento das políticas de segurança alimentar e nutricional, consideramos a evolução histórica do PNAE e sua situação atual e, com base nessas reflexões, apresentamos um conjunto de propostas, avaliando seus impactos no orçamento destinado ao PNAE. Apresentamos as seguintes estratégias para o período em que as aulas estiverem suspensas: distribuição de kits ou refeições para escolares, se possível mantendo o caráter universal da política ou beneficiando estudantes das famílias elegíveis para receber o Auxílio Emergencial; ampliar o valor repassado pelo PNAE para os municípios com Índice de Desenvolvimento Humano (IDH) baixo e muito baixo; manter e incentivar a aquisição de alimentos da agricultura familiar. Após o retorno das aulas, sugerimos as seguintes estratégias: levantamento da IA entre os estudantes, manutenção da equidade da política por meio da ampliação do valor do repasse para municípios com IDH baixo e muito baixo, além de atendimento dos escolares de famílias em IA durante as férias e o recesso escolar.

Resumen Este artículo tiene como objetivo analizar la contribución del Programa Nacional de Alimentación Escolar (PNAE) en la lucha contra el hambre y la inseguridad alimentaria (IA) y proponer un conjunto de estrategias para que el PNAE pueda garantizar la alimentación de los estudiantes en este momento de crisis. Para tanto, realizamos un diagnóstico de la IA y el hambre en Brasil, analizamos el debilitamiento de las políticas de seguridad alimentaria y nutricional, consideramos la evolución histórica del PNAE y su situación actual. Con base en estas reflexiones, presentamos un conjunto de propuestas evaluando sus impactos en el presupuesto asignado al PNAE. Presentamos las siguientes estrategias para el período en que las clases estén suspendidas: distribución de kits de alimentos o comidas a los alumnos, manteniendo, si fuera posible, el carácter universal de la política o beneficiando a los estudiantes de familias elegibles para recibir la Ayuda de Emergencia debido a la COVID-19; aumentar el monto transferido por el PNAE a los municipios con un índice de desarrollo humano (IDH) bajo y muy bajo y; mantener e incentivar la compra de alimentos a la agricultura familiar. Después del regreso de las clases, sugerimos las siguientes estrategias: encuesta de IA entre los estudiantes; mantenimiento de la equidad de la política mediante el aumento del monto de la transferencia a municipios con IDH bajo y muy bajo; y asistencia a los estudiantes de familias en situación de IA durante las vacaciones y el receso escolar.

Abstract This article aims to analyze the contribution of the National School Feeding Program (PNAE), in the fight against hunger and food insecurity (FI) and to propose a set of strategies to guarantee that students will continue to receive food during the COVID-19 pandemic. Diagnosis of FI and hunger in Brazil was carried out, analyzing the weakening of Food and Nutritional Security Policies, considering the historical evolution of PNAE and its current situation, and from this analysis, a set of proposals were drawn up, assessing their impacts on the PNAE's budget. We present the following strategies for the period of school closures: distribution of meals for students, maintaining, if possible, the universal character of the policy or benefiting students from families eligible to receive Emergency Aid due to COVID-19; expand the amount transferred by the PNAE to municipalities with a low and very low Human Development Index (HDI) and; maintenance and incentive to purchase food from family farming. When schools re-open, we suggest the following strategies: FI survey among students; maintenance of the equity of the policy by expanding the transfer amount to municipalities with low and very low HDI, and; attendance of students from families in FI during the vacations.

Dimensioning of the physical area and required number of food handlers for school food services / Dimensionamento da área física e do número de manipuladores de alimentos de serviços de alimentação escolar

ABSTRACT Objective We aimed to establish equations for dimensioning of the physical area and determining the required number of food handlers in food services of schools and to compare them with reference equations. Methods It was visited 44 municipalities located in the states of São Paulo (n=36) and Rio de Janeiro (n=8) between 2013 and 2014. The physical area for school food services was evaluated using a measuring tape. For all food services, we calculated the Maximum Attendance Capacity, which is the sum of small and large meals served during the busiest shift. A validated checklist was used to evaluate food safety practices. Linear regression models were developed to establish the proposed equations. Results In total, we evaluated 205 school units. Based on the data, the following equations were established: Equation A: area of production=15.22+(maximum attendance capacity×0.02), which estimates the minimum area needed for a school food service; and Equation B: the number of food handlers=2.17+(maximum attendance capacity×0.002), to determine the minimum number of food handlers needed. These equations were established based on school food services that presented adequate food safety practices (i.e., low health risk). Conclusion It was established new equations for calculating the size of the physical area for school food services and the required number of food handlers. These new equations can be used as a starting point in management planning of a school food service.

RESUMO Objective Estabelecer equações para o dimensionamento da área física e do número de manipuladores em serviços de alimentação escolar comparando-as com equações de referência. Métodos Foram visitados, entre 2013 e 2014, 44 municípios localizados nos estados de São Paulo (n=36) e Rio de Janeiro (n=8). A área útil dos serviços de alimentação escolar foi avaliada por meio de uma trena. Para todas as unidades foi calculada a Capacidade Máxima de Atendimento que é a soma das pequenas e grandes refeições servidas no turno de maior movimento. Para a avaliação das boas práticas de manipulação de alimentos foi utilizada uma lista de verificação validada. As equações foram estabelecidas por meio de regressão linear com base em serviços de alimentação escolar que apresentaram boa adequação das boas práticas (i.e. baixo risco sanitário). Resultados Foram avaliados 205 serviços de alimentação escolar. Com base nos dados foi determinada a Equação A: m2 da área de produção=15,22+(Capacidade máxima de atendimento×0,02) que estima a área mínima para um serviço de alimentação escolar e a Equação B: número de manipuladores=2,17+(Capacidade máxima de atendimento×0,002) para o número mínimo de manipuladores de alimentos. Conclusão Novas equações para cálculo do dimensionamento da área física de serviços de alimentação escolar e para o número de manipuladores de alimentos necessários foram estabelecidas. Essas novas equações podem ser utilizadas como ponto de partida para o planejamento gerencial de um serviço de alimentação escolar.