Avaliação de programa de prevenção de obesidade em adolescentes de escolas públicas

Effects of computer-based interventions on food consumption and anthropometric parameters of adolescents: A systematic review and metanalysis

This review aimed to systematically assess the effects of computer-based interventions for the promotion of healthy eating on anthropometric indicators and food consumption of adolescents at school. Relevant scientific articles were searched in MEDLINE/PubMed, Embase, Scopus, Lilacs, PsycINFO and Cochrane Library/CENTRAL following the recommendations by PRISMA guide in August 2021. The quality and risk of bias in the studies were assessed by two reviewers independently. The search strategy retained 13 studies for qualitative analysis. In total 9.603 adolescents of both sexes, were recruited in a school environment. According to studies with information for the meta-analysis, a reduction in the average consumption of fats in favor of computer-based intervention was identified (SMD: -0.14; 95% CI -0.24;-0.05). Considering the changes in the consumption of fruits and vegetables (SMD: 0.09; 95% CI -0.08; 0.26) and in the BMI (WMD: -0.02; 95% CI -0.18; 0.14), the analyses did not identify the effect of computer-based interventions on these parameters after follow-up. The results of this review demonstrate that there is evidence of the positive effect of using digital technology (website and CD-ROM) in educational programs with a focus on promoting a healthy lifestyle, with evidence on reducing fat consumption.

Effectiveness of education intervention to reduce sugar-sweetened beverages and 100% fruit juice in children and adolescents: a scoping review

OBJECTIVE

To determine the impact of educational intervention in reducing the consumption of sugar-sweetened beverages (SSBs) and 100% fruit juice in children and adolescents.

DESIGN

We conducted a comprehensive Ovid Medline and Scopus search. Articles had to be peer-reviewed, full-text and published in English. Studies had to be controlled intervention, published between 1 January 2010 to 7 February 2021, and in children and adolescents. Study quality was measured using the Quality Assessment Tool for Controlled Intervention Studies.

RESULTS

Forty intervention articles were included in this review involving 25,069 children and adolescents. All studies employed a quantitative research method using the Randomized Controlled Trial designs. Twenty-eight out of forty interventions used psychosocial theories. Study quality ranged from 'fair' to 'good.' Results showed that education intervention effectively reduced SSBs, and reduced 100% fruit juice in children.

EXPERT OPINION

Reducing the SSBs consumption in children should be initiated by conducting school-based programs consisting of interactive learning process, psychosocial theories and the involvement of parents or caregivers. Theories that focus on personal, behavior and environment factors improve the effectiveness of the intervention. More research is warranted to investigate the impacts of 100% fruit juice on obesity, dental caries and risk of co-morbidities in children.

The Psychological Effects of Exergames for Children and Adolescents with Obesity: A Systematic Review and Meta-Analysis

The systematic review and meta-analysis were conducted to analyze the psychological effects of exergames for children and adolescents with overweight or obesity. In August 2018, the electronic databases searched were PubMed, Scopus, Web of Science, SPORTDiscus, Science Direct, CINAHL, and PsycINFO. The eligibility criteria were defined according to the population, intervention, comparison, outcome, and study design. In relation to the population, only studies with children or adolescents with overweight or obesity and without any other comorbidities were analyzed. Only publications in English were considered. Nine studies were selected. The comparisons identified were in relation to weight, type of activity, and play style versus control and preintervention. The magnitude of effect size suggests that the practice of exergaming has a small effect on psychological outcomes. Furthermore, cooperative games produced greater attraction to the game (g = 4.71, 95% confidence interval [CI] = 3.23-6.19) and greater intrinsic motivation (g = 5.29; 95% CI = 3.68-6.90). It was verified that self-esteem (standard mean difference [SMD] = 0.37; 95% CI = 0.09-0.66), and self-efficacy (SMD = 0.42; 95% CI = 0.06-0.79) improved after playing an exergame. This systematic review and meta-analysis suggest that exergames may be effective in improving psychological aspects of children and adolescents with overweight or obesity. Given the limited number of studies, it is essential to increase scientific research in this area.

Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health

BACKGROUND

Frequent consumption of excess amounts of sugar-sweetened beverages (SSB) is a risk factor for obesity, type 2 diabetes, cardiovascular disease and dental caries. Environmental interventions, i.e. interventions that alter the physical or social environment in which individuals make beverage choices, have been advocated as a means to reduce the consumption of SSB.

OBJECTIVES

To assess the effects of environmental interventions (excluding taxation) on the consumption of sugar-sweetened beverages and sugar-sweetened milk, diet-related anthropometric measures and health outcomes, and on any reported unintended consequences or adverse outcomes.

SEARCH METHODS

We searched 11 general, specialist and regional databases from inception to 24 January 2018. We also searched trial registers, reference lists and citations, scanned websites of relevant organisations, and contacted study authors.

SELECTION CRITERIA

We included studies on interventions implemented at an environmental level, reporting effects on direct or indirect measures of SSB intake, diet-related anthropometric measures and health outcomes, or any reported adverse outcome. We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) and interrupted-time-series (ITS) studies, implemented in real-world settings with a combined length of intervention and follow-up of at least 12 weeks and at least 20 individuals in each of the intervention and control groups. We excluded studies in which participants were administered SSB as part of clinical trials, and multicomponent interventions which did not report SSB-specific outcome data. We excluded studies on the taxation of SSB, as these are the subject of a separate Cochrane Review.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened studies for inclusion, extracted data and assessed the risks of bias of included studies. We classified interventions according to the NOURISHING framework, and synthesised results narratively and conducted meta-analyses for two outcomes relating to two intervention types. We assessed our confidence in the certainty of effect estimates with the GRADE framework as very low, low, moderate or high, and presented 'Summary of findings' tables.

MAIN RESULTS

We identified 14,488 unique records, and assessed 1030 in full text for eligibility. We found 58 studies meeting our inclusion criteria, including 22 RCTs, 3 NRCTs, 14 CBA studies, and 19 ITS studies, with a total of 1,180,096 participants. The median length of follow-up was 10 months. The studies included children, teenagers and adults, and were implemented in a variety of settings, including schools, retailing and food service establishments. We judged most studies to be at high or unclear risk of bias in at least one domain, and most studies used non-randomised designs. The studies examine a broad range of interventions, and we present results for these separately.Labelling interventions (8 studies): We found moderate-certainty evidence that traffic-light labelling is associated with decreasing sales of SSBs, and low-certainty evidence that nutritional rating score labelling is associated with decreasing sales of SSBs. For menu-board calorie labelling reported effects on SSB sales varied.Nutrition standards in public institutions (16 studies): We found low-certainty evidence that reduced availability of SSBs in schools is associated with decreased SSB consumption. We found very low-certainty evidence that improved availability of drinking water in schools and school fruit programmes are associated with decreased SSB consumption. Reported associations between improved availability of drinking water in schools and student body weight varied.Economic tools (7 studies): We found moderate-certainty evidence that price increases on SSBs are associated with decreasing SSB sales. For price discounts on low-calorie beverages reported effects on SSB sales varied.Whole food supply interventions (3 studies): Reported associations between voluntary industry initiatives to improve the whole food supply and SSB sales varied.Retail and food service interventions (7 studies): We found low-certainty evidence that healthier default beverages in children's menus in chain restaurants are associated with decreasing SSB sales, and moderate-certainty evidence that in-store promotion of healthier beverages in supermarkets is associated with decreasing SSB sales. We found very low-certainty evidence that urban planning restrictions on new fast-food restaurants and restrictions on the number of stores selling SSBs in remote communities are associated with decreasing SSB sales. Reported associations between promotion of healthier beverages in vending machines and SSB intake or sales varied.Intersectoral approaches (8 studies): We found moderate-certainty evidence that government food benefit programmes with restrictions on purchasing SSBs are associated with decreased SSB intake. For unrestricted food benefit programmes reported effects varied. We found moderate-certainty evidence that multicomponent community campaigns focused on SSBs are associated with decreasing SSB sales. Reported associations between trade and investment liberalisation and SSB sales varied.Home-based interventions (7 studies): We found moderate-certainty evidence that improved availability of low-calorie beverages in the home environment is associated with decreased SSB intake, and high-certainty evidence that it is associated with decreased body weight among adolescents with overweight or obesity and a high baseline consumption of SSBs.Adverse outcomes reported by studies, which may occur in some circumstances, included negative effects on revenue, compensatory SSB consumption outside school when the availability of SSBs in schools is reduced, reduced milk intake, stakeholder discontent, and increased total energy content of grocery purchases with price discounts on low-calorie beverages, among others. The certainty of evidence on adverse outcomes was low to very low for most outcomes.We analysed interventions targeting sugar-sweetened milk separately, and found low- to moderate-certainty evidence that emoticon labelling and small prizes for the selection of healthier beverages in elementary school cafeterias are associated with decreased consumption of sugar-sweetened milk. We found low-certainty evidence that improved placement of plain milk in school cafeterias is not associated with decreasing sugar-sweetened milk consumption.

AUTHORS' CONCLUSIONS

The evidence included in this review indicates that effective, scalable interventions addressing SSB consumption at a population level exist. Implementation should be accompanied by high-quality evaluations using appropriate study designs, with a particular focus on the long-term effects of approaches suitable for large-scale implementation.

Alimentação escolar e constituição de identidades dos escolares: da merenda para pobres ao direito à alimentação

Resumo: Este ensaio busca problematizar a alimentação escolar enquanto prática que contribui para a constituição de identidades escolares. Parte-se de uma revisão bibliográfica, não sistemática, de publicações sobre alimentação escolar e identidades no contexto das escolas públicas brasileiras. Discute-se, inicialmente, a persistência de discursos e práticas de caráter assistencialista que reduziam a alimentação escolar a uma comida para pobres, questão observada nos estudos. Os significados desse caráter assistencialista concorrem para o entendimento de que ele parece funcionar como um mecanismo de poder capaz de inscrever, nos escolares, uma identidade de pobreza e inferioridade. Esse entendimento é situado nas relações de poder existentes na escola, no exercício do poder disciplinar e seu potencial de produzir identidades, assim como nas práticas de resistência decorrentes desses poderes no contexto da alimentação escolar. Considera-se ainda que os escolares sejam agentes de seus próprios processos identitários, haja vista que, em sua relação com a alimentação escolar, evidenciam-se, além de processos de sujeição, também processos de resistência e de construção ativa de identidade alimentar, nos quais agregam o tradicional e o moderno, o local e o global, dentre outros aspectos. Mesmo que ambiguidades sejam percebidas nesse cenário, entende-se que são indícios de mudanças no paradigma do pensar e fazer a alimentação escolar, trazendo elementos para problematizá-la: de um lado, ainda como um dispositivo de manutenção das desigualdades sociais e, de outro, esforços e ações para propiciá-la como um direito e promotora de identidades emancipatórias.

Prevenção de transtornos alimentares e obesidade: relato de experiência da implementação do programa New Moves

RESUMO O objetivo deste relato foi refletir sobre a adaptação, sobre as dificuldades e sobre as potencialidades de implementação do programa de prevenção conjunta de obesidade e transtornos alimentares New Moves para meninas de escolas públicas de São Paulo (SP). A versão brasileira do programa tem como potencialidades utilizar técnicas comportamentais efetivas, como a teoria sociocognitiva e a entrevista motivacional, e apresentar um conteúdo que aborda fatores comuns à obesidade e aos transtornos alimentares, o qual pode ser aplicado considerando-se as dificuldades quanto à adaptação e implementação apresentadas no estudo.

A free lunch or a walk back home? The school food environment and dietary behaviours among children and adolescents in Ghana

Food environments can play an important roles in shaping nutrition and health outcomes. One such environment that has potential to affect youth is the school food environment. In contrast to higher-income countries, however, there is a critical evidence gap on the role of school food environments on children and adolescents in low- and middle-income countries. This mixed-methods study contributes to filling this gap by investigating the role of school food environments on dietary behaviours of children and adolescents in Ghana. It draws on data from household and school questionnaires as well as focus group discussions collected as part of the baseline for an impact evaluation of the Ghana School Feeding Programme (GSFP). Multi-level regression models were fitted with random intercepts at the individual, household and community levels. Excerpts from the focus group discussions provided a deeper understanding of quantitative findings. Children and adolescents who received free school meals provided by the GSFP or who lived further away from school were less likely to go home for lunch. More than half of sampled schools reported offering foods for sale by independent vendors, the most common being meals followed by confectionery, fruit and sugar-sweetened beverages. Predictors of bringing money to school to buy food included non-receipt of free school meals, adolescence, greater commuting distance from home, household asset score, and urban location. Policy efforts focusing on the school food environment may contribute to healthy dietary behaviours for children and adolescents with positive impacts over the lifecourse.

Healthy School, Happy School: Design and Protocol for a Randomized Clinical Trial Designed to Prevent Weight Gain in Children

BACKGROUND:

Schools have become a key figure for the promotion of health and obesity interventions, bringing the development of critical awareness to the construction and promotion of a healthy diet, physical activity, and the monitoring of the nutritional status in childhood and adolescence.

OBJECTIVES:

To describe a study protocol to evaluate the effectiveness of an intervention designed to improve knowledge of food choices in the school environment.

METHODS:

This is a cluster-randomized, parallel, two-arm study conducted in public elementary and middle schools in Brazil. Participants will be children and adolescents between the ages of 5 and 15 years, from both genders. The interventions will be focusing on changes in lifestyle, physical activities and nutritional education. Intervention activities will occur monthly in the school's multimedia room or sports court. The control group arm will receive usual recommendations by the school. The primary outcome variable will be anthropometric measures, such as body mass index percentiles and levels of physical activity by the International Physical Activity Questionnaire.

RESULTS:

We expect that after the study children will increase the ingestion of fresh food, reduce excessive consumption of sugary and processed foods, and reduce the hours of sedentary activities.

CONCLUSION:

The purpose of starting the dietary intervention at this stage of life is to develop a knowledge that will enable for healthy choices, providing opportunities for a better future for this population.

FUNDAMENTO:

As escolas tornaram-se essenciais para a promoção de saúde e de intervenções para obesidade, propiciando o desenvolvimento de consciência crítica para a construção e promoção de dieta saudável, atividade física e monitoramento do status nutricional na infância e adolescência.

OBJETIVOS:

Descrever um protocolo de estudo para avaliar a eficiência de uma intervenção projetada para aprimorar o conhecimento sobre escolhas alimentares no ambiente escolar.

MÉTODOS:

Estudo clínico randomizado em cluster, paralelo, de dois braços, conduzido em escolas públicas de ensino fundamental e médio no Brasil. Os participantes serão crianças e adolescentes entre 5 e 15 anos de idade, dos dois sexos. As intervenções se concentrarão em mudanças de estilo de vida, atividade física e educação nutricional. As atividades de intervenção ocorrerão mensalmente na sala de multimídia ou quadra de esportes das escolas. O grupo controle receberá as recomendações usuais através da escola. O desfecho primário será a mudança nas medidas antropométricas, como índice de massa corporal e os níveis de atividade física conforme o Questionário Internacional de Atividade Física.

RESULTADOS:

Esperamos que, após o estudo, as crianças aumentem o consumo de alimentos frescos, reduzam o consumo excessivo de alimentos açucarados e processados, e reduzam as horas gastas em atividades sedentárias.

CONCLUSÃO:

O propósito de iniciar a intervenção dietética nessa fase da vida é desenvolver o conhecimento que permitirá escolhas saudáveis, propiciando oportunidades para um melhor futuro para essa população.

Evaluation practices in the field of Food and Nutrition

ABSTRACT The objective of this study was to characterize and analyze the different existing methods for the evaluation of food and nutrition programs and services in Brazil, through a systematic review of the literature focused on complete articles published in national indexed journals. We searched the PubMed, MedLine and LILACS databases using the following search terms and Boolean operators: “evaluation and program”; “project”; “intervention”; “servisse”; “actions and nutrition”; “nutritional”. The research was restricted to articles written in Portuguese, English and Spanish and published between 2001 and 2015. Twenty-two studies were selected and the analysis indicates; most were carried out through quantitative approaches and external evaluations based on epidemiological theory; participatory evaluation strategies are still uncommon; Impact assessments and implementation were predominant; there is little diversity in terms of references to the theoretical framework in the field of evaluation of health care programs in the planning and execution of the evaluation processes analyzed. The results of this study indicate the need for a more comprehensive evaluation considering the complexity of the interventions evaluated using the theoretical-methodological apparatus available in the literature to understand the importance of the different perspectives of the agents involved in the evaluation processes.

Dietary counseling adherence during tuberculosis treatment: A longitudinal study

BACKGROUND

The World Health Organization (WHO) recommends the use of dietary counseling to overcome malnutrition for patients with tuberculosis, with or without HIV, however the response to nutritional treatment depends on patient's adherence to nutritional counseling.

OBJECTIVE

Identify the degree of adherence to dietary counseling and predictors of adherence among patients undergoing tuberculosis treatment.

DESIGN

Observational prospective follow-up study conducted in adults treating for tuberculosis with or without HIV. Self-reported adherence and 24-h diet recall were checked. Diet counseling according to WHO strategy was offered at each visit for all patients. The endpoint was the adherence to the recommended dietary allowance (RDA) and total calories consumed during tuberculosis treatment. Data were mainly analyzed with marginal models to estimate adjusted trajectories.

RESULTS

Sixty-eight patients were included in the study. The maximum probability of total calories consumption of at least one RDA was 80%. The adherence to dietary counseling was low regardless of HIV infection. The negative determinants of adherence were the presence of loss of appetite and nausea/vomiting. For patients with loss of appetite and nausea/vomiting, the probability of total calories consumption of at least one RDA is less than 20% at any time.

CONCLUSION

The loss of appetite and nausea/vomiting are highly prevalents and were the main causes of non-adherence to dietary counseling.

Pictorial instrument of food and nutrition education for promoting healthy eating

ABSTRACT To trace the course of building a pictorial instrument that explores semiotic resources about food and nutrition education. The instrument is directed at the treatment and prevention of obesity, considering the food and nutrition problems of the Brazilian population. The criteria for photo production were: images that could cause visual impact and transmit applied nutrition information, insinuating positive and negative eating practices for promoting healthy eating, and preventing and treating obesity. Themes were created to guide photo production, and preparations, food composition tables, and food labels were used for composing the images. Focus groups were conducted with nonobese and obese women, and dietitians to evaluate image comprehension. The pictorial instrument totaled to 20 photos, with 5 photos in each of the following themes: 'Sweet life, being aware of sugar', about sugar content in sweets and drinks; 'Tasty food with little fat', about fat content in foods; 'Eating well by making the best choices', about food replacements; and 'I take care of myself by eating healthy food, about encouraging fruit and vegetable intakes. The photos contain food, meals, and semiotic resources. The pictorial instrument describes four relevant themes to approach food problems in the Brazilian population. It can easily be used for both preventing and treating obesity, and for promoting healthy eating.

A Systematic Review to Assess Sugar-Sweetened Beverage Interventions for Children and Adolescents across the Socioecological Model

Sugar-sweetened beverage (SSB) consumption among children and adolescents is a determinant of childhood obesity. Many programs to reduce consumption across the socioecological model report significant positive results; however, the generalizability of the results, including whether reporting differences exist among socioecological strategy levels, is unknown. This systematic review aimed to examine the extent to which studies reported internal and external validity indicators defined by the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) model and assess reporting differences by socioecological level: Intrapersonal/interpersonal (Level 1), environmental/policy (Level 2), and multilevel (Combined Level). A systematic literature review was conducted in six major databases (PubMed, Web of Science, Cinahl, CAB Abstracts, Education Research Information Center, and Arcola) to identify studies from 2004-2015 meeting inclusion criteria (children aged 3 to 12 years, adolescents aged 13 to 17 years, and young adults aged 18 years, experimental or quasiexperimental, and substantial SSB component). Interventions were categorized by socioecological level, and data were extracted using a validated RE-AIM protocol. One-way analysis of variance assessed differences between levels. There were 55 eligible studies accepted, including 21 Level 1, 18 Level 2, and 16 Combined Level studies. Thirty-six studies (65%) were conducted in the United States, 19 studies (35%) were conducted internationally, and 39 studies (71%) were implemented in schools. Across levels, reporting averages were low for all RE-AIM dimensions (reach=29%, efficacy or effectiveness=45%, adoption=26%, implementation=27%, and maintenance=14%). Level 2 studies had significantly lower reporting on reach and effectiveness (10% and 26%, respectively) compared with Level 1 (44% and 57%, respectively) or Combined Level studies (31% and 52%, respectively) (P<0.001). Adoption, implementation, and maintenance reporting did not vary among levels. Interventions to reduce SSB consumption in children and adolescents across the socioecological spectrum do not provide the necessary information for dissemination and implementation in community nutrition settings. Future interventions should address both internal and external validity to maximize population influence.

Impact of actions of food and nutrition education program in a population of adolescents

ABSTRACT Objective: To evaluate changes in food intake after adolescents attended a food and nutrition education program at a non-profit institution. Methods: Fifty-four adolescents aged 16 to 19 years, of low socioeconomic level, enrolled in an non-governmental organization in São Paulo, underwent a nutritional intervention of six months consisting of six meetings with dieticians, as well as strategic communication and relationship actions. Body weight, height, body mass index, questionnaire on knowledge on nutrition and feeding practices, 24-hour recall, and diet quality assessment using the Diet Quality Index associated with the Digital Food Guide were collected at baseline and after the intervention. Dietary pattern improvement was defined as an increase of at least 5 points in Diet Quality Index associated with the Digital Food Guide. Results: Understanding of food labels increased, and the dietary patterns on weekdays and weekends improved by 33 and 37%, respectively. The intake of legumes, milk, dairy products, fruits, and vegetables increased (adequacy components). However, intakes of nuts and whole grains were low, and intake of moderation components was high. Conclusion: The program improved the dietary patterns of adolescents, making it a viable and inexpensive method to prevent disease and improve health and quality of life. In addition, the Diet Quality Index associated with the Digital Food Guide has proven to be a good nutritional tool for assessing changes in food intake and for guiding future counseling and nutritional intervention actions for this population.

Impact assessment of an intervention on the consumption of fruits and vegetables by students and teachers

OBJECTIVE: To evaluate the impact of an intervention that promoted the consumption of fruits and vegetables on the intake of these products by students and teachers in Rio de Janeiro (RJ), Brazil. METHODS: This is a one-group pretest-posttest study of students and teachers from elementary public schools in Rio de Janeiro. The intervention included a training course for promoting healthy eating; distribution of educational materials; and holding of a one-day health fair. We assessed the activities that had been carried out, teachers' habitual fruits and vegetables intake, students' fruits and vegetables intake at school, and intervention-related issues. RESULTS: Before the intervention, 65.1% of the students consumed the school lunch and most (>79.4%) accepted and consumed the fruits and vegetables served. Most teachers (>75.0%) consumed fruits and other vegetables regularly, but only 36.4% consumed leaf vegetables regularly. The intervention was implemented only moderately (52.7%) but was well accepted by the teachers. The students of schools that implemented the intervention more extensively showed better acceptance of vegetables (p=0.009). Teachers' fruits and vegetables intake did not change. CONCLUSION: Students' fruits and vegetables intake changed modestly. This study contributes to the design of intervention studies for Brazilian schools because it coordinated the National School Food Program with educational activities.

[Food and nutrition education in school: a literature review]

Food and nutrition education is viewed as a key strategy for promoting healthy eating habits, and the school is an appropriate space for developing these activities. The objective of this study was to describe and analyze the scientific literature on intervention studies on food and nutrition education in Brazilian schools. A literature review was conducted, selecting articles published from 2000 to 2011. Despite the topic's current importance, there were few articles, and most were published after 2009. The main results showed improvement in the children's nutritional knowledge and food choices. However, most studies that performed anthropometric measurements failed to show changes in nutritional status. In addition, the studies chose designs based on epidemiological intervention studies, indicating the need for interventions based on innovative health education methodologies and research models that are consistent with the study's objects.

Processed foods aimed at children and adolescents: sodium content, adequacy according to the dietary reference intakes and label compliance

OBJECTIVE: This study determined the sodium content of processed foods aimed at children and adolescents and the adequacy of its content in relation to the dietary reference intakes, and verified label compliance. METHODS: The sodium content of 17 food samples (instant noodles, breaded items, hamburger patties, hot dogs and bologna sausages) was determined by flame photometry and chloride titration, and the results were compared with nutritional data. The labels were checked for compliance with the pertinent laws. RESULTS: According to flame photometry and chloride titration, 13 and 5 products, respectively, had sodium contents that exceeded those reported on the nutrition facts label by more than 20%. All samples had more than 480mg of sodium per serving. The tolerable upper intake level for sodium for children aged 4-8 years was exceeded in 8 instant noodles and 3 breaded items according to flame photometry, and in 9 items according to chloride titration. Regarding the legislation, 5 products used a daily reference intake other than that provided by the legislation to report their percent sodium content per serving. Moreover, the serving sizes of 3 instant noodles, the terminology used in 1 instant noodles and the protein content of 1 breaded item were also not compliant with the legislation. CONCLUSION: The sodium contents in the study samples were high and there was no regard for the legislation.

Knowledge of educators and dieticians on food and nutrition education in the school environment

OBJECTIVE: The purpose of this qualitative study was to reveal the expertise of educators and dieticians on food and nutrition education in the school environment. METHODS: This study used a qualitative approach developed jointly by the Department of Education of the state of Pernambuco, Brazil, and a school in that state. The participants were seven teaching technicians, eight teachers, and thirteen dieticians. The information was collected by interview and submitted to thematic content analysis. RESULTS: Six themes emerged from the participants' statements: food and nutrition education as a guideline for eating correctly; the purpose of food and nutrition education as an instrument for promoting healthy eating habits; the school as a promoter and empowering environment for food and nutrition education; food and nutrition education as a pedagogical practice focused on the reality of students' eating habits; school agents' assignments and partnerships for food and nutrition education; lack of knowledge in the practice of food and nutrition education. CONCLUSION: The participants' knowledge on food and nutrition education is dichotomous, at times permeated by biological aspects, at other times by the social context. Although there are gaps in the knowledge of the subject, educators and dieticians consider themselves partners for the provision of food and nutrition education in school.

Avaliacao de projeto de promocao da saude para adolescentes

OBJETIVO: Avaliar programa de promoção de atividade física e de escolhas alimentares entre adolescentes. MÉTODOS: Estudo transversal realizado com 911 adolescentes de 13 a 18 anos de idade, de escolas públicas de Goiânia, GO, em 2010. Os participantes foram divididos em dois grupos: intervenção (escolas participantes do Projeto Viver Saudável) e controle. Foram considerados como atividade física: deslocamento, aulas de educação física na escola, atividade física fora da escola e no lazer. Foram definidos como ativos aqueles que acumularam 300 ou mais minutos por semana. Quanto às escolhas alimentares, foi classificado como adequado o consumo de alimentos protetores em cinco ou mais dias da semana. Foram realizadas análises estatísticas com teste de Qui-quadrado de Pearson. RESULTADOS: A maioria dos adolescentes foi identificada como inativos ou insuficientemente ativos, com 65,7% no grupo intervenção e 65,2% no grupo controle, sem diferenças significativas entre os grupos e com prevalência maior entre o sexo feminino. Pouco mais da metade dos adolescentes consumiam alimentos protetores da saúde em cinco ou mais dias da semana, sendo 56,6% e 50,4%, respectivamente, nos grupos intervenção e controle (p = 0,373). CONCLUSÕES: A ausência de diferenças quanto a escolhas alimentares e prática de atividade física entre os grupos intervenção e controle indica que o projeto Viver Saudável precisa ser reavaliado visando melhorar a efetividade no cumprimento dos seus objetivos.

O Programa Nacional de Alimentação Escolar sob a ótica dos alunos da rede estadual de ensino de Minas Gerais, Brasil

O objetivo deste artigo é analisar o Programa de Alimentação Escolar sob a ótica dos alunos atendidos na rede estadual de ensino de Minas Gerais. Trata-se de estudo transversal, quali-quantitativo, com amostra de 1500 alunos, representativa do universo da rede estadual de ensino de Minas Gerais, utilizando questionário semiestruturado analisado por meio de frequência simples, média, desvio padrão, teste exato de Fisher, teste qui-quadrado e regressão logística (p < 0,05; IC 95%). Houve efetiva aceitação de 28,8% e efetiva adesão de 45,1% ao Programa. A aceitação foi significativamente maior entre alunos do sexo masculino e entre aqueles que apresentaram menor consumo de alimentos extrainstitucionais. A aceitação e a adesão foram significativamente maiores entre alunos do grupo etário mais velho e entre aqueles que referiram participar de atividades de Educação Alimentar e Nutricional. No total, 73,5% dos alunos sugeriram melhorias para a Alimentação Escolar. Muitos princípios e diretrizes do programa não estão sendo cumpridos. A aceitação da Alimentação Escolar mostrou-se negativamente influenciada pelo consumo de alimentos extrainstitucionais e positivamente influenciada pelas ações de Educação Alimentar e Nutricional.

Effectiveness of a randomized school-based intervention involving families and teachers to prevent excessive weight gain among adolescents in Brazil

Objective

To evaluate the effectiveness of a school-based intervention involving the families and teachers that aimed to promote healthy eating habits in adolescents; the ultimate aim of the intervention was to reduce the increase in body mass index (BMI) of the students.

Design

Paired cluster randomized school-based trial conducted with a sample of fifth graders.

Setting

Twenty classes were randomly assigned into either an intervention group or a control group.

Participants

From a total of 574 eligible students, 559 students participated in the study (intervention: 10 classes with 277 participants; control: 10 classes with 282 participants). The mean age of students was 11 years.

Intervention

Students attended 9 nutritional education sessions during the 2010 academic year. Parents/guardians and teachers received information on the same subjects.

Main Outcome Measurement

Changes in BMI and percentage of body fat.

Results

Intention-to-treat analysis showed that changes in BMI were not significantly different between the 2 groups (β = 0.003; p = 0.75). There was a major reduction in the consumption of sugar-sweetened beverages and cookies in the intervention group; students in this group also consumed more fruits.

Conclusion

Encouraging the adoption of healthy eating habits promoted important changes in the adolescent diet, but this did not lead to a reduction in BMI gain. Strategies based exclusively on the quality of diet may not reduce weight gain among adolescents.

Trial Registration

Clinicaltrials.gov NCT01046474.

Community-based interventions for enhancing access to or consumption of fruit and vegetables among five to 18-year olds: a scoping review

BACKGROUND

Low fruit and vegetable ( FV) consumption is a key risk factor for morbidity and mortality. Consumption of FV is limited by a lack of access to FV. Enhanced understanding of interventions and their impact on both access to and consumption of FV can provide guidance to public health decision-makers. The purpose of this scoping review is to identify and map literature that has evaluated effects of community-based interventions designed to increase FV access or consumption among five to 18-year olds.

METHODS

The search included 21 electronic bibliographic databases, grey literature, targeted organization websites, and 15 key journals for relevant studies published up to May 2011. Retrieved citations were screened in duplicate for relevance. Data extracted from included studies covered: year, country, study design, target audience, intervention setting, intervention strategies, interventionists, and reported outcomes.

RESULTS

The search located 19,607 unique citations. Full text relevance screening was conducted on 1,908 studies. The final 289 unique studies included 30 knowledge syntheses, 27 randomized controlled trials, 55 quasi-experimental studies, 113 cluster controlled studies, 60 before-after studies, one mixed method study, and three controlled time series studies. Of these studies, 46 included access outcomes and 278 included consumption outcomes. In terms of target population, 110 studies focused on five to seven year olds, 175 targeted eight to 10 year olds, 192 targeted 11 to 14 year olds, 73 targeted 15 to 18 year olds, 55 targeted parents, and 30 targeted teachers, other service providers, or the general public. The most common intervention locations included schools, communities or community centres, and homes. Most studies implemented multi-faceted intervention strategies to increase FV access or consumption.

CONCLUSIONS

While consumption measures were commonly reported, this review identified a small yet important subset of literature examining access to FV. This is a critically important issue since consumption is contingent upon access. Future research should examine the impact of interventions on direct outcome measures of FV access and a focused systematic review that examines these interventions is also needed. In addition, research on interventions in low- and middle-income countries is warranted based on a limited existing knowledge base.

Effectiveness of preventive school-based obesity interventions in low- and middle-income countries: a systematic review

BACKGROUND

The prevalence of childhood obesity is increasing rapidly in low- and middle-income countries, and informed policies to tackle the problem must be defined.

OBJECTIVE

We systematically reviewed the evidence on the effectiveness of school-based interventions targeting dietary behavior and/or physical activity for the primary prevention of obesity in children and adolescents aged 6-18 y in low- and middle-income countries.

DESIGN

We searched the MEDLINE, EMBASE, Web of Science, CENTRAL, ERIC, Cochrane Library, and Centre for Reviews and Dissemination databases for peer-reviewed controlled studies published in English, Spanish, French, German, or Dutch between January 1990 and July 2011. The quality of the included studies was appraised independently by 2 authors who used the Effective Public Health Practice Project tool.

RESULTS

From a total of 7218 unique references, we retained 22 studies. Most of the interventions (82%) had a positive effect on dietary behavior and physical activity behavior (effect size ranged from -0.48 to 1.61). BMI decreased in 8 studies (effect size ranged from -0.7 to 0.0). Effective interventions targeted both diet and physical activity, involved multiple stakeholders, and integrated educational activities into the school curriculum.

CONCLUSIONS

School-based interventions have the potential to improve dietary and physical activity behavior and to prevent unhealthy body weights in low- and middle-income countries. To reach their full potential, interventions should conduct process evaluations to document program implementation. The effect and the pathways through which interventions have this effect need to be better documented through rigorous evaluation studies.

Fatores de risco à saúde cardiovascular em escolaresda Tríplice Fronteira

Este estudo identificou os fatores de risco à saúde cardiovascular (FRSC) em escolares da Tríplice Fronteira: Argentina, Brasil e Paraguai. Participaram do estudo 1.183 adolescentes de ambos os sexos, e idades de 15 a 18 anos, que preencheram um questionário para identificação dos FRSC. A proporção de adolescentes com quatro ou mais FRSC foi de 65,2%. Adolescentes brasileiros do sexo masculino apresentaram maior prevalência de insuficientemente ativo (78,3%), enquanto o baixo consumo de verduras (39,4%) e o tempo excessivo em atividades sedentárias (83,1%) foram superiores nos argentinos. As adolescentes paraguaias apresentaram maior proporção de insuficientemente ativo (83,0%), enquanto o tempo excessivo em TV e mídias, o baixo consumo de frutas, o consumo de álcool e o agrupamento de quatro ou mais FRSC foram superiores nas argentinas (38,3%, 92,5%, 59,7% e 69,2%, respectivamente). Estes resultados podem contribuir para as políticas de promoção do estilo de vida saudável na Tríplice Fronteira.