Desenvolvimento de guias alimentares em diversos países

Food-Based Dietary Guidelines for Infants in Latin America and the Caribbean: A Systematic Review

Food-based dietary guidelines (FBDGs) are tools for promoting healthy eating habits. For the population of children under two years old in Latin America and the Caribbean (LAC), there is a lack of reviews analyzing the quality of these guidelines. The objective of this systematic review is to evaluate publicly available FBDGs for the population under two years old in LAC until mid-2023. Guidelines aimed at caregivers of children were included, sourced from government websites in LAC countries and the Food and Agriculture Organization (FAO) portal. Documents targeted at healthcare professionals were excluded. For qualitative analysis, the Agree II guidelines assessment tool and the FAO guide principles for developing healthy and sustainable diets were used. The results showed that more recently released and revised FBDGs with a greater number of pages obtained better scores in both assessments. Additionally, out of the 32 LAC countries, only 13 had these FBDGs available on websites for public access. As a limitation, this study faced challenges in standardizing the searches on government websites. The authors emphasize the need to develop FBDGs for the population under two years old that align with current health and sustainability needs and promote health education.

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

OBJECTIVE

This study aimed to develop a conceptual framework of the process of food-based dietary guidelines (FBDG) implementation and analyse Brazil's employed measures to implement dietary guidelines for the Brazilian population (2014).

DESIGN

Qualitative research.

SETTING

Aiming to develop the conceptual framework, a literature review on FBDG implementation was carried out. Both documents scoped within the macropolitical sphere and scientific articles were reviewed. In the case study, measures took in Brazil were identified through a search on institutional websites and technical management reports of government sectors were responsible for FBDG implementation in the country.

PARTICIPANTS

This study does not involve humans.

RESULTS

The new conceptual framework frames FBDG implementation as a part of a larger set of intersectoral public policies to promote healthy eating and highlights two main implementation ways: educational materials and public policies. Brazil has a range of policies to promote healthy eating guided by the perspective of food as a right. Most of the implemented measures focussed on the concept of 'FBDG as educational materials,' although the recommendations have also been implemented in public policies.

CONCLUSION

The FBDG implementation should be carried out in an integrated manner with multi-sector involvement. The Brazilian's case analysis can be helpful to decision makers in food policy across the globe be inspired by the Brazilian efforts, considering that the Brazilian FBDG was one of the firsts to have adopted a multidimensional paradigm of healthy eating, including diet sustainability.

[Standardizing eating habits: a critical analysis of Brazilian and Spanish food norms in the context of the COVID-19 pandemic]

In response to the health, social, economic and political impacts caused by the COVID-19 pandemic, several countries have adopted social isolation as a preventive measure. The concern with "healthy" eating was accentuated in this context and food norms were developed as an orientation strategy related to eating habits. The scope of this article is to carry out a critical and comparative analysis of four food guidelines published in Brazil and Spain in this period, based on three principles: concepts regarding healthy eating; the place attributed to the multidimensionality of the act of eating; and the relevance of intersectionality. Comparison of the documents was conducted using a qualitative approach based on discourse analysis. The documents feature differences in terms of the format and content of the recommendations, but the discursive construction of all the guidelines is normative and reproduces a fundamentally biomedical perspective centered on nutrients and on individual responsibility, without taking into consideration the multidimensionality of the act of eating and the specificities of the micro- and macrosocial contexts. The analysis also reveals the need to include the intersectional dimensions of gender, race, ethnicity and class into the proposed recommendations.

Comparison of government recommendations for healthy eating habits in visual representations of food-based dietary guidelines in Latin America

Visual representations of food-based dietary guidelines (FBDG) express diverse dietary and sociocultural norms, especially as they relate to healthy eating habits. This article investigates government recommendations for healthy eating habits expressed in the visual representation of Latin American FBDGs. Drawing on 15 images published between 1991 and 2017, we conducted an anthropological visual analysis guided by the methodology proposed by James Collier and Malcolm Collier: unstructured analyses, open viewing analyses, structured analyses and microanalyses. Here, we explore government recommendations based on visual representation shapes, food classification systems, lifestyle recommendations and embedded sociocultural elements. Our main findings relate to how dietary and sociocultural norms are used to promote eating practices considered healthy. Dietary norms focus on variety, proportionality, and moderation, as expressed in terms of food classification and food standards considered healthy. Sociocultural norms are referenced by the use of cultural symbols as strategies to promote traditional foods, cooking practices, commensality, water consumption and physical activity. Ultimately, we argue that FBDG visual representations contain embedded messages that counsel individuals to plan, buy, prepare and consume food with family; to consume foods considered healthy; to pay full attention to their meals, without distractions, such as television and cell phones; and to celebrate traditional, local and/or native foods and culinary preparations.

Healthy eating through the eyes of adolescents: A qualitative analysis of messages from the Dietary Guidelines for the Brazilian Population

ABSTRACT Objective To evaluate the interpretation by adolescents of messages contained in the Dietary Guidelines for the Brazilian Population. Methods Qualitative study of adolescents distributed across “conversation circles”. Each group received messages about healthy eating from the Dietary Guidelines and was instructed to develop materials containing their own interpretation thereof, using appealing wording and format. Content analysis was then used to evaluate these materials. Results Presentation of the produced materials revealed a focus on placing the participants at the center of the process and highlighting the dynamic and innovative nature of each strategy. Corpus analysis identified three clusters of meaning: (I) Food classification and selection model: The participants showed comprehension of the different formulations of foods and their impacts on health, but using other terms. A reductionist understanding of the composition of a healthy diet was observed; (II) Environment and eating practices: the environment was characterized as conducive or not to healthy eating, and open-air markets were recognized as spaces for healthy choices. Creating recipes was judged a wise choice to be shared; and (III) Diet-related individual and collective wellness: consequences of unhealthy food intake were linked to physical and emotional well-being. Concerns were raised about the use of natural resources and the impact of pesticides on individuals and the environment. Conclusion To facilitate understanding of the Dietary Guidelines, the wording of its messages must be adapted, and the discussion about healthy eating and proper diet must be broadened to ascribe greater value to the act of cooking in this population.

Evaluation of a mobile application for estimation of food intake

ABSTRACT Objective: Evaluate the use of the Nutrabem (São Paulo, Brasil) mobile application as a tool for measurement of food intake among university students. Methods: Cross-sectional study of a random sample of 40 undergraduate students at the Universidade Federal de São Paulo, Campus Baixada Santista. Food intake data were estimated using the Nutrabem app and the 24-hour dietary recall. Intakes of energy, carbohydrates, proteins, lipids, calcium, iron, and vitamin C were calculated. The intake of food groups and diet quality were evaluated by the Diet Quality Index associated with the Digital Food Guide. The agreement between the methods was assessed using the Pearson's correlation coefficient and the Student' t-test. Results: Strong correlations were observed between energy (0.77), carbohydrates (0.82) and protein (0.83). The groups: poultry, fish, and eggs; beef and pork; refined grains and breads; and fruits and legumes showed strong correlations (between 0.76 and 0.85). There were moderate correlations (0.59 and 0.71) between the groups sugars and sweets; whole grains, tubers and roots, milk and dairy products, animal fats, and the Diet Quality Index associated with the Digital Food Guide scores. Vegetables and leafy greens, nuts, and vegetable oils showed weak correlations (0.31 and 0.43). Homogeneity assessment revealed similarity between the results obtained by both methods (p>0.05) . Conclusion: The Nutrabem app can be used as a tool to assess dietary intake among university students since it produces results similar to those obtained by the 24-hour dietary recall method.

Healthy eating at school: consensus among experts

ABSTRACT Objective: To identify attributes that promote healthy eating in order to support a study for the Quality Index for School Meal Menus content validity. Methods: This study used the Delphi technique to consult school nutrition experts in Brazil. These experts were selected among the authors of articles published between 2010 and 2015 that were identified by searching the Web of Science database, using the keywords 'school feeding', 'school nutrition program', and 'school food program', as well as the authors of official documents on this topic. The Likert method was used to record respondent perceptions in two analytical dimensions: foods that are part of a healthy menu for school feeding, and composition of an indicator of nutritional quality for school feeding menus. Results: Most respondents (n=27) were affiliated with public institutions (92.59%) and had over six years of experience in the area (70.36%). Assertions resulted in consensus according to the analysis criteria. A consensus was established for fresh food, fruits and vegetables, dairy products, beans, meat and eggs, and a schedule compatible with the meal as promoters of healthy eating, and processed foods, sweets, and fat excess as risk attributes. Conclusion: Since a consensus was not reached in the first round, there is a need to broaden the debate on issues related to foods rich in sugar, replacement of meals by sweets, and foods rich in fat.

[Nutritional counseling for children under two years of age: opportunities and obstacles as strategic challenges]

This article sought to conduct a critical analysis of the state of the art of the scientific production in counseling practices in nutrition for infants under two years of age, discussing the opportunities and obstacles in terms of strategic challenges for implementing healthy nutrition practices. It is a bibliographic study, with the core interest being counseling on infant nutrition. The majority (58.1 %) of the articles analyzed was published between 2008 and 2011. The educative actions of counseling on infant feeding were directed at health professionals and caregivers to children under two years of age. As opportunities in the practice of nutritional counseling the following stand out: an improvement in the performance of health professionals, the adoption of healthy eating practices by caregivers, and an improvement in the nutritional status of the children. As obstacles, the following stand out: a lack of training of caregivers and professionals regarding complementary healthy feeding and difficulties regarding the practice of counseling by a health care professional. This evidence reaffirms the importance of incorporating counseling guidance on infant feeding, as permanent practices in policies for child health care.

Functional health literacy and healthy eating: Understanding the brazilian food guide recommendations

Objective: To assess the relationship between the functional health literacy of Unified Heath System users and the understanding of food servings in the pocket version of the Brazilian Food Guide.Methods: Functional health literacy was assessed by the Brief Test of functional health literacy.Two dialogue rounds were conducted with patients with adequate functional health literacy (Group 1) and inadequate functional health literacy (Group 2). The dialogues were recorded and analyzed according to the discourse of the collective subject.Results: Most (58.0%) users had inadequate functional health literacy. Five core areas were identified: understands serving sizes; does not understand serving sizes; serving sizes are confusing; unfamiliar/uncommon foods; small letters. Group 2 had more trouble understanding.Conclusion: Difficulty understanding hinders health promotion. Individuals need to have access to educational materials that are easier to understand and developed taking their functional health literacy into account.

Diet quality index for healthy food choices

OBJECTIVE: To present a Diet Quality Index proper for dietary intake studies of Brazilian adults. METHODS: A diet quality index to analyze the incorporation of healthy food choices was associated with a digital food guide. This index includes moderation components, destined to indicate foods that may represent a risk when in excess, and adequacy components that include sources of nutrients and bioactive compounds in order to help individuals meet their nutritional requirements. The diet quality index-digital food guide performance was measured by determining its psychometric properties, namely content and construct validity, as well as internal consistency. RESULTS: The moderation and adequacy components correlated weakly with dietary energy (-0.16 to 0.09). The strongest correlation (0.52) occurred between the component 'sugars and sweets' and the total score. The Cronbach's coefficient alpha for reliability was 0.36. CONCLUSION: Given that diet quality is a complex and multidimensional construct, the Diet Quality Index-Digital Food Guide, whose validity is comparable to those of other indices, is a useful resource for Brazilian dietary studies. However, new studies can provide additional information to improve its reliability.

[Evaluation of the effectiveness of a change of habits with group nutritional intervention]

Inadequate dietary standards, physical inactivity, smoking and alcohol consumption represent a composite of risk factors for non-communicable diseases and disorders. Encouraging healthy eating habits is a fundamental strategy to tackle current eating and nutritional problems. The scope of this research was to evaluate if the participation of individuals in group nutritional intervention was capable of modifying their eating habits. The research was conducted at a public health center in Porto Alegre in the state of Rio Grande do Sul. It involved an experimental study using qualitative and quantitative research, in which group participants were evaluated before and after the nutritional intervention. The final sample included 10 participants comprised of men and women aged 48 on average. Most of them had completed high school, earned an average family income of 2.5 minimum wages and were overweight. The results proved that the objective of the study was successful, since the group manifested an improvement in eating habits and consequent weight loss. The conclusion is that group intervention with emphasis on eating habits and nutrition is effective and its implementation is recommended in the routine of the services of the Brazilian Unified Health System.

A review of consumer awareness, understanding and use of food-based dietary guidelines

Food-based dietary guidelines (FBDG) have primarily been designed for the consumer to encourage healthy, habitual food choices, decrease chronic disease risk and improve public health. However, minimal research has been conducted to evaluate whether FBDG are utilised by the public. The present review used a framework of three concepts, awareness, understanding and use, to summarise consumer evidence related to national FBDG and food guides. Searches of nine electronic databases, reference lists and Internet grey literature elicited 939 articles. Predetermined exclusion criteria selected twenty-eight studies for review. These consisted of qualitative, quantitative and mixed study designs, non-clinical participants, related to official FBDG for the general public, and involved measures of consumer awareness, understanding or use of FBDG. The three concepts of awareness, understanding and use were often discussed interchangeably. Nevertheless, a greater amount of evidence for consumer awareness and understanding was reported than consumer use of FBDG. The twenty-eight studies varied in terms of aim, design and method. Study quality also varied with raw qualitative data, and quantitative method details were often omitted. Thus, the reliability and validity of these review findings may be limited. Further research is required to evaluate the efficacy of FBDG as a public health promotion tool. If the purpose of FBDG is to evoke consumer behaviour change, then the framework of consumer awareness, understanding and use of FBDG may be useful to categorise consumer behaviour studies and complement the dietary survey and health outcome data in the process of FBDG evaluation and revision.