Validation of the illustrated questionnaire on eating and sedentary behaviors (QUICAS) for seven to ten-year-old children.

The Illustrated Questionnaire on Eating and Sedentary Behaviors (QUICAS) was developed and validated for schoolchildren seven to ten years old. It used previous day recall and was illustrated with ten eating behaviors (referring to the act of eating without distractions, with company, on a regular basis, the type of food eaten, and participation in tasks involved in meal preparation) and five sedentary behaviors (related to the use of television, computer, tablet, cell phone, and video game). The instrument was validated in four stages: (1) Its content was developed based on literature review and expert evaluation; (2) Items were validated by comparing the responses of children and their parents, through a questionnaire on Google Forms. At this stage, a convenience sample was adopted, consisting of 145 parent-child dyads. High sensitivity (average of 90.7%); high specificity (mean of 87.9%); low number of false positives (mean of 12.1%); low number of false negatives (mean of 9.3%); almost perfect agreement between the child's and the parent's reports (k = 0.81); and low disagreement (≤22%) were found. In addition, the child's gender and age did not significantly influence the child's report. (3) The illustrations were validated in a focus group with 18 children, who satisfactorily described all the eating and sedentary behaviors of the illustrations. (4) In the pretest of the questionnaire on Google Forms, with the participation of 15 children, the majority (86.7%) judged the questionnaire as excellent or good. Therefore, the QUICAS is valid to assess eating and sedentary behaviors in schoolchildren seven to ten years old.

Effect of a Transtheoretical Model-based intervention on fruit and vegetable intake according to perception of intake adequacy: A randomized controlled community trial.

Interventions based on the Transtheoretical Model (TTM) are usually effective at increasing fruit and vegetable (FV) intake, but it is not known whether individuals with misperceived intake [e.g., in pseudomaintenance (PM)] for FV intake also benefit from these interventions. This study aims to describe the effectiveness of a TTM-based intervention for FV intake according to baseline perception of intake adequacy. A randomized controlled community trial was carried out with 3414 users of a health promotion service in Belo Horizonte, Brazil, aged 20 years or over, in 2013-2014. FV intake was estimated using a validated instrument. PM was identified when participants had insufficient FV intake and thought their intake was adequate. The intervention group (IG) received a TTM-based intervention, and the control group (CG) received usual care. Baseline FV intakes were lower among individuals in PM compared to those with a concordant perception (CP). In both the IG and CG, FV intake increased among those in PM. Fruit intake remained stable, and vegetable intake decreased among those with CP. Generalized estimating equations revealed a significant effect of the intervention on fruit intake at follow-up, which was slightly higher among those in PM. We conclude that participants in PM were partially sensitive to the intervention and improved fruit intake at follow-up. We suggest that future studies emphasize vegetable intake and elucidate how TTM pillars (self-efficacy, decisional balance, processes of change) can be best used to increase FV intake.

Effects of the Rango Cards game intervention on food consumption, nutritional knowledge and self-efficacy in the adoption of healthy eating practices of high school students: a cluster randomised controlled trial.

OBJECTIVE: The study aimed to assess the impact of a game-based nutritional intervention on food consumption, nutritional knowledge and self-efficacy in the adoption of healthy eating practices. DESIGN: This cluster randomised controlled trial included both male and female high school students from private schools in the Federal District, Brazil. Four schools were randomly selected for each group. Investigated variables were age, sex, monthly family income, maternal education level, dietary perceptions and practices, nutritional knowledge and self-efficacy in the adoption of healthy eating practices. SETTING: Intervention group participants were instructed to play Rango Cards, a digital game developed for the study, on their own, for a period of 7-17 d, while the control group was not provided with any game or material during the study. PARTICIPANTS: The study included 319 adolescents (mean age = 15·8 (sd 0·7) years). RESULTS: Significant reductions were observed in the intervention group compared with the control group for the following variables: habit of eating while watching TV or studying and having meals at fast food restaurants. The intervention group showed increased knowledge of the effects of fruit and vegetable consumption as well as improved self-efficacy in the adoption of healthy eating practices such as reducing Na intake and preparing healthy meals. CONCLUSIONS: The design of Rango Cards is potentially capable of effecting positive changes. Therefore, the digital game promotes autonomy and self-care among adolescents with regard to healthy eating.

Transtheoretical model-based nutritional interventions in adolescents: a systematic review.

BACKGROUND: Literature has shown a tendency of inadequate dietary intake among youth, consequently, nutritional interventions are required. The transtheoretical model (TTM) classifies individuals based on their readiness to change. This model is widely used for health education interventions with proven efficacy. PURPOSE: This review aimed to weigh the strength of evidence about the TTM usage in nutritional interventions for adolescents and its effectiveness regarding dietary intake. METHODS: This study followed the PRISMA guidelines. Eligible studies were input into Mendeley software. The Adolec, Google Scholar, LILACS, PsycINFO, PubMed, Science Direct and Web of Science databases were searched. Only full original articles written in English, Spanish or Portuguese on randomized controlled trials and quasi-experimental designs that applied the TTM in the design of nutritional interventions targeting adolescents were included, with no restrictions on publication date. The quality and risk of bias was evaluated with the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. RESULTS: The initial search yielded 3779 results. Three studies were rated as strong, six as moderate and five as weak. The final sample of 14 articles included adolescents that were mostly recruited from schools, with interventions ranging from one month to three years. The TTM was used alone or combined with other behavior-change theories and most of the interventions involved digital technology. The nutritional topics covered included fruit and vegetable consumption, low-fat diet, and cooking skills. Four studies presented improvement in fruit and vegetable consumption and four progressed through stages of change. Participants from two interventions reduced fat intake. At the end of one intervention, all the participants were in action and maintenance stages. CONCLUSION: The TTM seems to be a successful strategy for nutritional intervention aiming at improving dietary intake in adolescents. Its application in different contexts shows that the TTM is flexible and possible to be implemented in many settings. The use of the model is shown to be restricted to the stage of change' construct. Further studies should use all constructs of the TTM in the design and compare the TTM with other behavior-change theories to better understand its effectiveness.

Does misperception of fruit and vegetable intake adequacy affect progression through the stages of behavior change after nutritional intervention?

Pseudomaintenance (PM) is a Transtheoretical Model (TTM) stage of change that refers to individuals who believe they eat enough fruit and vegetables (FV) despite their low FV intake. It is not known how they change behavior after usual TTM-based interventions. Thus, this randomized controlled community trial describes the effect of PM on progression through the stages of change for FV intake among adult and elderly health promotion service users after TTM-based intervention. The stage of change for FV intake was assessed; FV intake was estimated from brief validated questions at baseline (n = 3414) and follow-up (n = 1782). Individuals whose perception of adequacy matched the estimated intake were labeled as "concordant perception," while those with low intake who believed that their intake was adequate were classified as being in PM. The intervention group received the intervention while the control group received usual care. The prevalence of "no stage progression" at follow-up was close to 50% for those in PM at baseline. After adjustment for demographics, randomization, self-efficacy, decisional balance, and baseline intake, users in PM at baseline had higher odds [OR = 1.53 (1.21-1.94)] of progressing to higher stages for fruit and no difference in progression for vegetables. We propose strategies to approach FV intake in future studies and reinforce the need for additional trials aimed at describing changes in FV intake among individuals in PM, in order to continue answering the scientific questions that we began to investigate.

Rango Cards, a digital game designed to promote a healthy diet: a randomized study protocol.

BACKGROUND: Several food and nutrition education actions have been described in the literature, with emphasis on the recommended use of innovative methods when addressing a young audience. Digital games are an attractive, dynamic, and motivating resource for teaching and learning practices, and adolescents form the group that readily accepts and adopts new technologies. Adapting dietary and nutritional guidelines to change dietary behavior is a challenge, and game-based learning has several benefits that can be used in this sense. Thus, this study aims to outline a nutritional intervention for school-aged adolescents from the Federal District, Brazil, whose object is a digital card game aimed at promoting healthy dietary practices. METHODS: In this randomized study with intervention and control groups, we propose a nutritional intervention for adolescents studying in Federal District private schools. The intervention group will be introduced to Rango Cards, a digital game specifically developed for this study. The purpose of the game is to present the concept of an adequate and healthy diet using simple information in a playful context. This game features cards for foods/meals, characters, and healthy habits. The players' choices may lead them to winning or losing. Theme selection and phase order were designed to provide a learning experience. The control group will not receive any material during the study. Both groups will complete questionnaires before and after the intervention. The game is expected to improve food knowledge and self-efficacy in the adoption of healthy practices, thus contributing to appropriate dietary consumption. DISCUSSION: The game was designed as a food and nutrition education tool based on Brazilian dietary guidelines. We believe that Rango Cards will provide a comprehensive experience on the topic, improving the students' autonomy, motivation, and pleasure of learning. TRIAL REGISTRATION: RBR-72zvxv June 29, 2018; Retrospectively registered.

Eating disorders and body image satisfaction among Brazilian undergraduate nutrition students and dietitians.

The objective of this study was to evaluate the prevalence of risk behaviors related to eating disorders and body image satisfaction among Brazilian dietitians and undergraduate Nutrition students. The national representative sample was composed of 427 undergraduate students of Nutrition and 318 dietitians. Data were collected via an online questionnaire. Body image satisfaction was assessed by the Body Shape Questionnaire, and attitudes suggestive of an eating disorder (called positive EAT) were assessed by the Eating Attitudes Test. Adjusted Prevalence Ratios were performed by Poisson's regression. More than 50.0% of women were dissatisfied with their body image, but severe dissatisfaction was more prevalent among students (26.7% versus 16.0%). There was no difference in the prevalence of positive EAT test between both groups. Students with positive EAT had more chance of body dissatisfaction (PRadj 1.31; 95%CI 1.03-1.66). Dietitians with positive EAT had 35% more chance of being dissatisfied with their body image (PRadj 1.35; 95%IC 1.01-1.80). Undergraduate Nutrition students and dietitians are likely to develop attitudes suggestive of an eating disorder and being dissatisfied with'their body image. The susceptibility of developing an eating disorder might have a relation with their professional field.

Consumption of ultra-processed foods and low dietary diversity are associated with sedentary and unhealthy eating behaviors: A nationwide study with Brazilian Schoolchildren.

BACKGROUND: Consumption of ultra-processed foods and low dietary diversity are risk factors for chronic diseases. AIM: To evaluate the association between food consumption and sedentary and unhealthy eating behaviors of Brazilian schoolchildren between 6 and 11 years old. METHODS: Cross-sectional study. A prevalence sample was calculated considering the number of children enrolled in elementary school. This sample was distributed proportionally to Brazil's macro-regions and the type of school (public or private). The questionnaire was developed in Google Forms and disseminated through the snowball technique. The questionnaire was filled in by the children's parents, with information about the child's identification and health. Afterward, the child completed a questionnaire by her/himself. We used the previously validated Illustrated Questionnaire on Food Consumption for Brazilian Schoolchildren and the Illustrated Questionnaire on Eating and Sedentary Behaviors. Food consumption was analyzed using the NOVA score and the dietary diversity score. Poisson's regression with robust variance was performed (p<0.05). RESULTS: The study included 2,021 dyads. Of these, 27.6% of children reported eating five or more ultra-processed foods and 39.0% four or fewer natural or staple foods the previous day. Using screens, proxy of sedentary behavior (Prevalence Ratio-PR = 1.8, Confidence Interval-CI95%1.2-2.8) and eating at irregular hours (PR = 1.6, CI95%1.2-2.2) were risk factors for high consumption of ultra-processed foods and low dietary diversity in schoolchildren. In addition, eating the three main meals on the previous day (PR = 0.6, CI95%0.4-0.8) was identified as protective factors against the consumption of ultra-processed foods and in favor of dietary diversity among schoolchildren. CONCLUSION: Sedentary and unhealthy eating behaviors were associated with the consumption of ultra-processed foods and low dietary diversity in Brazilian schoolchildren.

Validation of the illustrated questionnaire on food consumption for Brazilian schoolchildren (QUACEB) for 6- to 10-year-old children.

Introduction: Evaluating the food consumption of school-aged children is crucial to monitor their dietary habits, promote targeted interventions, and contribute public policies that aimed healthy eating. In this context, our objective was to develop and validate the Illustrated Questionnaire on Food Consumption for Brazilian Schoolchildren (QUACEB) of 6 to 10 years old, which is a self-reported illustrated recall. Methods: Validity was obtained in four stages as follows: selection of foods, validation of items, validation of illustrations, and pretest. Foods were selected by considering the data from the main surveys that have been conducted with the Brazilian population and schoolchildren in recent years, the degree of food processing, and the main foods from each of the country's five macroregions. The content of the items was validated by comparing the children's and their parent's responses. For this, the questionnaire was published in an online format, and 6- to 10-year-old elementary schoolchildren were recruited using the snowball technique. The first part of the questionnaire was answered by the parent after the child's lunch, and the second was completed by the child the following day. Thirty-two parent and child dyads participated. Sensitivity, specificity, area under the curve (AUC), and kappa (k) tests were performed. Results: Of the 30 foods presented on the questionnaire, 15 were reported as consumed. High sensitivity (mean of 88.5%), high specificity (average of 92.0%), substantial agreement (k = 0.78), low disagreement (6.2%), and AUC of 0.90 were found. The illustrations were validated in a focus group with fourth-grade children from a school chosen for convenience. The food illustrations were designed for children, who were asked to name the food. Eighteen children participated and verified that the images were representative of the foods. In the pretest, three schools were chosen for convenience that announced the link to the online questionnaire in WhatsApp groups of parents with students from first to fifth grade. Fifteen children answered the questionnaire and 86.7% (n = 13) judged it excellent or good. Conclusion: Thus, the food consumption questionnaire is valid for elementary schoolchildren of 6 to 10 years old and can be applied in research to assess the dietary patterns of children in Brazil.

Intervention based exclusively on stage-matched printed educational materials regarding healthy eating does not result in changes to adolescents' dietary behavior.

PURPOSE: To assess the impact of a six-month stage-based intervention on fruit and vegetable intake, regarding perceived benefits and barriers, and self-efficacy among adolescents. DESIGN: Randomized treatment-control, pre-post design. SUBJECTS/SETTING: Schools were randomized between control and experimental groups. 860 adolescents from ten public schools in Brasília, Federal District, Brazil were evaluated at baseline; 771 (81%) completed the study. INTERVENTION: Experimental group received monthly magazines and newsletters aimed at promotion of healthy eating. MEASURES: Self-reported fruit and vegetable intake, stages of change, self-efficacy and decisional balance scores were evaluated at baseline and post-intervention in both groups. ANALYSIS: The effectiveness of the intervention was evaluated using the analysis of covariance model (ANCOVA) and repeated measurement analysis by means of weighted least squares. Comparison between the proportions of adolescents who advanced through the stages during the intervention was performed using the Mantel-Haenszel chi-square test. RESULTS: After adjusting for sex and age, study variables showed no modifications through the proposed intervention. There was no statistical difference in participant mobility in the intervention and control groups between the stages of change, throughout the study. CONCLUSION: A nutritional intervention based exclusively on distribution of stage-matched printed educational materials was insufficient to change adolescents' dietary behavior.

Individual and Socioeconomic Contextual Factors Associated with Obesity in Brazilian Adolescents: VigiNUTRI Brasil.

This study investigated the association of socioeconomic contextual factors of the municipality of residence of adolescents, their eating behavior and food consumption with the prevalence of obesity. This was a cross-sectional study, based on individual data regarding anthropometry, eating behavior (eating in front of screens and having at least three main meals a day), and markers of healthy and unhealthy eating of 23,509 adolescents aged 10 to 19 years, participating in the Food and Nutrition Surveillance of the Brazilian Population monitored in Primary Health Care (VigiNUTRI Brasil) assessment in 2018. Based on multilevel Poisson regression, a higher prevalence of obesity was observed among adolescents living in municipalities with per capita income above USD209.68 (PR = 1.22; 95% CI 1.05;1.42) and among those who consumed hamburgers and/or processed meats the previous day (PR = 1.09; 95% CI 1.01;1.17). Adolescents who had the habit of having three main meals a day (PR = 0.81; 95% CI 0.73;0.89 p < 0.05) and who consumed fresh fruit the previous day (PR = 0.91; 95% CI 0.84;0.98 p < 0.001) had lower prevalence of obesity. The results reinforce the influence of the social context and food consumption on obesity rates. The persistence of this situation implies a worsening in the current and future health of adolescents.

Food-based dietary guidelines for children and adolescents.

Objective: This study aimed at reviewing food-based dietary guidelines (FBDGs) with content targeted at children and adolescents to present their main characteristics, thus enabling comparisons among countries. Design: We conducted a search of the FBDGs available on the Food and Agriculture Organization (FAO) website, followed by a scoping review with a gray literature search to find FBDGs for children or adolescents non-listed on the FAO's website. Data extraction included the year of publication, language, and guidelines for the target group. Results: From FAO website searches, 109 documents were found, and 17 of them could not be translated. The Scoping review search conducted in 5,190 articles, and none led to new guidelines, nor from the gray literature. Regarding the 92 FBDGs explored, 41 were specific for infants under 24 months old, children, and/or adolescents, and 51 were for the general population with information for the studied group. Twelve percent of the general FBDG and 35% of the specific ones have food icons. All of the guidelines were published after 2001. Latin America and the Caribbean were the regions that presented more specific FBDGs and the majority of countries with guidelines for fruits and vegetables. The information about fat (15 countries) and sugar (26 countries) consumption reduction is frequent. Reduction of sodium intake appears to be in the majority of guidelines after 2015. Food hygiene guidelines are recurrent in Latin American documents. NOVA classification was adopted in five countries and 21 countries approach recommendations for mealtimes. Both exclusive and continued breastfeeding guidance and healthy complementary feeding orientation are present in over 50% of the specific FBDG for infants and children under 24 months old. Conclusion: Food-based dietary guidelines are diverse due to both the nutritional and political aspects of each region. Latin America stands out for its orientations for the studied group. Further studies should measure the possible impacts and comprehension of FBDGs.

Stages of change and self-efficacy are related to consumption of food markers among Brazilian adolescents and young adults.

Objective: This study aimed at analyzing the association between stages of change, consumption of food markers, and self-efficacy in the adoption of healthy eating practices, adjusted by nutritional knowledge, among Brazilian adolescents and young adults. Methods: A cross-sectional analysis was conducted with 347 individuals from schools in the Federal District, Brazil. They completed a self-administered questionnaire covering: consumption of food markers, stage of change, self-efficacy in the adoption of healthy eating practices, and nutritional knowledge. Adjusted logistic regression was conducted. Results: Participants in pre-contemplation (OR = 0.22), contemplation (OR = 0.19), decision (OR = 0.13) and action (OR = 0.40) stages have less chance to have healthy eating than those in maintenance, including fruits and vegetables [pre-contemplation (OR = 0.23), contemplation (OR = 0.19), and decision (OR = 0.09)]. Adolescents and young adults in pre-contemplation (OR = 0.29) and contemplation (OR = 0.37) had lower chances of having low consumption of sugar-sweetened beverages compared to those in maintenance (p < 0.05). Adolescents and young adults in pre-contemplation (OR = 0.38) and contemplation (OR = 0.36) were less likely to have high self-efficacy scores than those in maintenance (p < 0.05). Higher score of self-efficacy was associated with a lower chance of having a high consumption of sugar-sweetened beverages (OR = 1.02; p = 0.032). Conclusion: Regardless of nutritional knowledge, individuals in the earlier stages of change are less likely to have an adequate consumption of healthy foods markers, including fruits and vegetables, and low sugar-sweetened beverages consumption. They are also less likely to have high self-efficacy scores than those in maintenance. Nutritional interventions to focus on enhancing self-efficacy among adolescents and young adults in earlier stages of change to improve dietary habits.

Performance and perception on front-of-package nutritional labeling models in Brazil.

OBJECTIVE: To evaluate the performance and perception of five models of front-of-package nutrition labeling (FOPNL) among Brazilian consumers. METHODS: Cross-sectional study, which applied an online questionnaire to 2,400 individuals, allocated randomly into six study groups: a control group and five others exposed to FOPNL (octagon, triangle, circle, magnifier and traffic light), applied to nine products. We evaluated the understanding of nutritional content, the perception of healthiness, the purchase intention and the perception of Brazilian consumers on the models. RESULTS: All FOPNL models increased the understanding of the nutritional content and reduced the perception of healthiness and purchase intention, when compared with the control group (41.3%). FOPNL warning models - octagon (62.4%), triangle (61.9%) and circle (61.8%) - performed significantly better than the traffic light (55.0%) regarding the understanding of the nutritional content. The performance of the magnifier (59.5%) was similar to the other four tested models, including the traffic light (55.0%), for understanding nutritional content. The individual analysis of the products suggests a better performance of warnings in relation to the magnifier and the traffic light for the perception of healthiness and purchase intention. Consumers were favorable to the presence of FOPNL, perceiving it as reliable to increase the understanding to nutritional information. CONCLUSION: FOPNL must be implemented on food labels in Brazil, considering that it increases the nutritional understanding, reduces the perception of healthiness and the purchase intention of products with critical nutrients. Warnings showed a better performance when compared with other models.

Family meal frequency and its association with food consumption and nutritional status in adolescents: A systematic review.

This systematic review evaluated the association between frequency of family meals (FFM) and nutritional status (NS) and/or food consumption (FC) in adolescents. The protocol was registered with PROSPERO (CRD42017062180) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. No publication date, language, or meal type restrictions were imposed. Only full-text original articles were included; qualitative studies were excluded. Studies were identified by searching 5 electronic databases (PubMed, Web of Science, Scopus, BVS Brazil, and Adolec) and gray literature (Google Scholar) and by scanning reference lists of included articles. Risk of bias was assessed using the Newcastle-Ottawa scale for cohort and cross-sectional studies. Initial search yielded 2001 results and 47 articles were included. An updated literature search added 3 articles. Of the 50 studies included, 25 studied the association between FFM and NS, 32 investigated the association between FFM and FC, being that seven studies analyzed both outcomes. Thirty-four were cross-sectional studies, 12 were longitudinal studies, and 4 studies analyzed both cross-sectional and longitudinal data. Thirty-five studies were rated as having good quality, whereas 19 were of fair quality. Sample size ranged from 140 to 102 072 participants. Most investigations evaluated the frequency of breakfast, lunch, and/or dinner/supper/evening meals over a 1-week period. Seventeen studies identified a positive relationship between high FFM and better NS, and 26 found a positive association between high FFM and better FC. In conclusion, this review showed an association between FFM and healthy dietary patterns, such as increased consumption of fruits and vegetables. Further research is needed to understand the association between FFM and NS, since some studies showed a protective role of family meals against obesity in this age group, whereas other studies identified no significant association between these variables.

Tailored smartphone intervention to promote healthy eating among Brazilian adolescents: a randomised controlled trial protocol.

INTRODUCTION: Adolescent eating patterns are characterised by high consumption of unhealthy foods, which has resulted in an increasing prevalence of overweight and chronic diseases. It is crucial to promote healthy eating habits, and nutritional interventions based on the transtheoretical model have been found to be especially effective. Mobile health strategies also seem promising for adolescents. This study aims to outline a smartphone intervention via WhatsApp for adolescents to promote healthy eating consumption, better nutritional knowledge, self-efficacy in the adoption of healthy practices and progress through the stages of change. METHODS AND ANALYSIS: There will be three distinct groups in this randomised study: a general intervention group (GG), in which the participants will receive the same healthy eating messages, based on the Brazilian food guide; a tailored intervention group (TG), in which the participants will receive healthy eating messages based on their stage of change; and a control group (CG), in which participants will receive messages on a different theme. Possession of a smartphone, use of WhatsApp and being a senior student (16-19 years) from a public school of the Federal District of Brazil will be the study's inclusion criteria. Rural schools will be excluded. The sample size estimated is 390 individuals: 38 in the GG, 314 in the TG and 38 in the CG. The intervention will last 6 weeks, with a daily message sent to the students. We will investigate nutritional knowledge, self-efficacy in the adoption of healthy eating practices, food consumption and stages of change using preintervention and postintervention questionnaires. Memorisation of the messages will be also assessed. ETHICS AND DISSEMINATION: The study was approved by the University of Brasília, School of Health Sciences and Research Ethics Committee. At the end of the study, the participating schools will receive a printed report with the main results of the intervention. TRIAL REGISTRATION NUMBER: RBR-5b9jk7.

Perception of eating practices and stages of change among Brazilian adolescents.

OBJECTIVE: To evaluate the perception of eating practices and the stages of change among adolescents. METHODS: Cross-sectional study involving a representative sample of 390 adolescents from 11 public schools in the city of Piracicaba, Brazil, in 2004. Food consumption was identified by a food frequency questionnaire and the perception of eating practices evaluation was conducted by comparing food consumption and individual classification of healthy aspects of the diet. The participants were classified within stages of change by means of a specific algorithm. A reclassification within new stages of change was proposed to identify adolescents with similar characteristics regarding food consumption and perception. RESULTS: Low consumption of fruit and vegetables and high consumption of sweets and fats were identified. More than 44% of the adolescents had a mistaken perception of their diet. A significant relationship between the stages of change and food consumption was observed. The reclassification among stages of change, through including the pseudo-maintenance and non-reflective action stages was necessary, considering the high proportion of adolescents who erroneously classified their diets as healthy. CONCLUSION: Classification of the adolescents into stages of change, together with consumption and perception data, enabled identification of groups at risk, in accordance with their inadequate dietary habits and non-recognition of such habits.

Maternal dissatisfaction with their children's body size in private schools in the Federal District, Brazil.

We investigated the prevalence of maternal dissatisfaction with their child's body size and its associated factors among mothers of first- to third-grade elementary school students in private schools in the Federal District, Brazil. This is a cross-sectional study with 548 mother-schoolchildren pairs. We measured children's weight and height, and collected their mother's sociodemographic data and Body Mass Index using an online questionnaire. We also verified maternal body dissatisfaction and maternal dissatisfaction with their child's body size using Shape Scales. Most mothers (50.5%) were dissatisfied with their child's body size. Mothers of boys (Adjusted OR = 2.85) were more likely to want a larger silhouette for their child, while mothers of girls (Adjusted OR = 3.18), overweight (Adjusted OR = 24.83) and obese (Adjusted OR = 189.86) children were more likely to want a thinner silhouette for their child. A positive correlation was observed between maternal dissatisfaction with their own body and maternal dissatisfaction with their children's body size (rs = 0.178). There was a high prevalence of maternal dissatisfaction with their child's body size, particularly among mothers of overweight and obese children. Additional studies should be conducted to better understand the influence of this dissatisfaction on maternal practices and attitudes related to their child's body, food consumption, and lifestyle.

Maternal perception of children's nutritional status in the Federal District, Brazil.

Maternal perception of child's nutritional status has a potential impact on the identification, prevention, and treatment of childhood overweight. Thus, the aim of this study was to evaluate the prevalence of misperception and factors associated with maternal perception of the nutritional status of first- to third-grade elementary school students from private schools in the Federal District, Brazil. This cross-sectional study was conducted with 554 mother-child pairs. Children's nutritional status was assessed by measuring their weight and height. The mothers completed an online questionnaire about sociodemographic data, maternal nutritional status, maternal perception of her own nutritional status (silhouette scale for female adults), and maternal perception of child's nutritional status (silhouette scale for children). Only 30.0% of the mothers were successful in choosing the most appropriate silhouette to represent child's nutritional status. Highly educated mothers (Adjusted OR = 1.51) and mothers of male children (Adjusted OR = 2.53) or of non-overweight children (Adjusted OR = 1.65) were more likely to underestimate child's nutritional status. Conversely, mothers below 35 years of age (Adjusted OR = 1.85) and mothers of female children (Adjusted OR = 2.24) or of overweight children (Adjusted OR = 1.94) were more likely to overestimate child's nutritional status. There was a high prevalence of misperception, which shows the need for interventions for children that take into account the relevance of mother's role and the adequate recognition of child's nutritional status.

Percepções, barreiras e facilitadores da implementação da lei das cantinas escolares por adolescentes do Distrito Federal / Perceptions, barriers, and facilitators of the implementation of the school cafeteria law for adolescents in the Federal District

Este estudo objetivou caracterizar a percepção de estudantes sobre a implementação da Lei 5.146/2013, que visa à promoção da alimentação saudável nas escolas do Distrito Federal, identificando as barreiras e os facilitadores existentes para adotá-la e as perspectivas para a implementação de ações de Educação Alimentar e Nutricional (EAN) no ambiente escolar. Participaram 52 adolescentes do 9º ano de três escolas, públicas e privadas, distribuídos em seis grupos focais. Seguiu-se roteiro semiestruturado com perguntas, validadas pela técnica de Delphi, para conhecer o que era vendido e consumido nas cantinas, segundo os adolescentes, se eles conheciam a lei, e avaliar barreiras e facilitadores para colocar a legislação em funcionamento no ambiente escolar. Por fim, apresentou-se uma situação fictícia aos estudantes em que estes conduziriam ações de EAN para implementar a lei. Os debates foram gravados, transcritos, e agrupadas as falas semelhantes pela análise de conteúdo de Bardin. Os adolescentes consideraram positiva a lei das cantinas, mas pontuaram que estas ainda não haviam se adequado à legislação. Identificaram como barreiras o preço dos alimentos saudáveis e a baixa divulgação da lei e, como facilitadores, a escola e a família. Para EAN, sugeriram meios de divulgação inovadores, como as redes sociais e a utilização de figuras e cores para chamar à atenção do leitor. Apesar de bem recebida pelos adolescentes, a simples promulgação de uma lei não é suficiente para alterar práticas alimentares já adotadas no ambiente escolar se não for associada a estratégia de divulgação e conscientização de toda a comunidade escolar.

This study aimed at characterizing the students' perception of Law 5.146/2013's implementation, whose objective is to promote healthy eating in schools in the Federal District, and to identify the barriers and facilitators that exist in adopting it, as well as the perspectives for the implementation of actions of Food and Nutrition Education (FNE) in the school environment. Fifty-two 9th grade teenagers from three public and private schools participated, distributed in six focus groups. A semi-structured script was followed with questions, validated by the Delphi technique, to find out what was being sold and consumed in the cafeterias according to the adolescents, whether they knew the law, and to assess barriers and facilitators to put the legislation into operation in the school environment. Finally, a fictitious situation was presented to the students in which they would conduct FNE actions to implement the law. The debates were recorded, transcribed, and similar speeches were grouped by Bardin's content analysis. The adolescents considered the cafeteria law to be positive but pointed out that they had not yet adapted to the legislation. They identified the price of healthy foods and the poor disclosure of the law as barriers, and the school and family were facilitators. Concerning FNE, they suggested innovative means of dissemination, such as social networks and the use of figures and colors to draw the reader's attention. Despite being well received by adolescents, the mere passing of a law is not enough to change dietary practices already adopted in the school environment, if it is not associated with a strategy of dissemination and awareness of the entire school community.