A ciência da nutrição em trânsito: da nutrição e dietética à nutrigenômica

Advances and setbacks in the 20 years of the Brazilian National Food and Nutrition Policy

We sought to analyze the processes of formulation, updating and implementation of the Brazilian National Food and Nutrition Policy (PNAN), from 1999 to April 2020. This is a discussion paper, using institutional documentary sources, bibliographic search in national and international databases, as well as theses and dissertations. The theory of the cycle of public policies was adopted to systematize and present the set of information. PNAN was established in 1999 and updated ten years later, in a participatory process, based on an innovative approach centered on the paradigms of healthy food practices, the human right to food and nutritional security, aligned with the Brazilian Unified National. Regarding implementation, there are advances related to the publication of Food Guides with national guidelines; to the promotion of research in food and nutrition; to collective action to build the regulatory agenda, even if with disputes, and to the decentralization of financial resources for the execution of PNAN actions. The monitoring and evaluation focused on the food and nutritional situation; we found that there were insufficient mechanisms to feed back the policy. After 20 years, PNAN maintains the challenge of effectively fulfilling its historic commitment: the universal guarantee of the human right to adequate and healthy food.

Panorama da nutrigenômica no Brasil sob a perspectiva da Bioética

A nutrigenômica tem configurado, no meio científico e popular, como alternativa para prevenir doenças, cuja predisposição determinada geneticamente pode ser evitada ou estimulada, de- pendendo do ambiente no qual o indivíduo se insere. Este estudo questionou o potencial da nutrigenômica em mitigar ou gerar vulnerabilidades. Objetivou-se traçar o panorama da nutrigenômica no Brasil sob a perspectiva da Bioética. O estudo consistiu em um mapeamento quantitativo do panora- ma da nutrigenômica no cenário científico e popular do Brasil, e em uma análise bibliográfica exploratória com o intuito de identificar os agentes e pacientes morais, bem como as vulnerabilidades com vistas a promover uma reflexão à luz da Bioética. O cenário da nutrigenômica no Brasil, elaborado a partir de 18 textos científicos e de 600 conteúdos populares, indicou a prematuridade da área no contexto científico em confronto com uma ampla incorporação pelo meio popular. A incorporação da Bioética na questão foi analisada em 44 artigos científicos, a partir dos quais foram identificados como aspectos condicionantes de decisões do agente moral os contextos filosófico, biológico, cultural, legal e sanitário nos quais se insere. Foram elencadas as vulnerabilidades e mudanças de paradigmas necessárias para sua implementação no Brasil, a fim de diminuir o potencial de geração de vulnerabilidades. A Bioética pode e deve ter uma atuação mais ampla e efetiva nas questões da nutrigenômica ao normatizar, balizar e orientar o desenvolvimento dessa área promissora. Assim, deve visar às mudanças de paradigmas da ciência, dos profissionais, do mercado, do paciente e do consumidor para serem suprimidos os aspectos potenciais de geração das vulnerabilidades identificadas e contribuir para a qualidade de vida de todos os seres vivos desta e de futuras gerações.

[Ingredients for an exotic dish: health and diet on the agenda of the first Amazonian Medical Congress (Belém, 1939)]

The context in which the first Amazonian Medical Congress was organized and held in Belém, Brazil, in August 1939, is presented. Within the tradition of scientific communication of its time, the event brought together some of the region's medical elites and also had nationally and internationally renowned guest participants, including Josué de Castro and Dante Costa. Taking the printed matter produced by the congress and news stories printed in the local press as its main sources, this study examines the accompanying debates on dietary deficiencies in the Amazon, observing academic and political understandings of the different aspects of the phenomenon for the region.

Nutrigenomics: Epigenetics and cancer prevention: A comprehensive review

Due to change in lifestyle and food habits, people are more at risk of diet-related diseases and cancers. It is also established that dietary modifications significantly reduce the risk of diseases. Nutrigenomics is relatively fresh discipline, but possess an enormous potential that can apply for prevention and management of certain carcinomas and diseases. This review enables us to generate useful information for scientists and health professionals regarding the role of Nutrigenomics in the prevention of diet and lifestyle-related diseases like cancer. It influences health conditions of individuals and susceptibility of disease by defining the metabolic response and gene expression. Epigenetic modifications can perform a significant role in disease occurrence and pathogenesis. DNA methylation and chromatin remodeling are the most common epigenetic mechanisms. Omega 3 fatty acids are the best example of nutrients and gene interaction not involving DNA methylation while certain bioactive food compounds have a proven role in cancer prevention through an epigenetic mechanism. Dietary polyphenols substantially take part in prevention of oral, breast, skin, esophageal, colorectal, prostate, pancreatic and lung cancers. Moreover, minerals and vitamins involve regulatory processes. Zinc, Selenium and folate involve in DNA repairing process have anticancer properties. Consumption of multivitamins prevents methylation of cancer cells.

Public policies of food and nutrition in Brazil: From Lula to Temer

ABSTRACT Objective To analyze public policies on food and nutrition in Brazil, with emphasis on the last fifteen years (2003-2018). Methods Historical-documentary analysis based on a bibliographical survey on indexed bases and exploratory visits to websites of government agencies. Results The scientific and governmental findings were organized according to the Lula, Dilma and Temer governments. They explore the development of several public policies and welfare programs in food and nutrition, focusing mainly on Brazilian Hunger Eradication Program, Assistance for Needy Families Program, National Policy on Food and Nutrition Security, Food Acquisition Program, National School Nutrition Program, National Food and Nutrition Security Policy, National Food and Nutrition Surveillance System and Brazilian Misery Eradication Program. The centrality of the idea of the fight against hunger and misery in public policies during Lula’s first and second terms and Dilma’s first term stand out. Dilma’s second term is marked by the focus on healthy eating, as well as presenting the first signs of fragilization of public policies on food and nutrition. Currently, the Temer government is characterized by processes of institutional and programmatic rupture, budget cuts and setbacks in acquired rights. There is evidence of the need to activate national and international instruments to enforce the human right to adequate food and consequent strengthening of public policies on food and nutrition. Conclusion This period presents an expansion and qualification of public policies on food and nutrition, mainly in the Lula and Dilma administration, with setbacks in the Temer administration, in which continuous budget cuts weaken social, hunger reduction, poverty reduction and food and nutrition security policies.

Mapping the implementation of evidence-based nutritional management in primary health care settings: a scoping review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this scoping review is to systematically map and categorize the wide variety of interventions and programs that might be classified under the umbrella term "evidence-based nutritional management in primary healthcare". The development of this scoping review will provide a better understanding of how evidence-based nutritional management has been implemented by healthcare professionals in primary health care settings, especially of barriers and facilitators to implementing evidence-based nutritional management. Therefore, three research questions were chosen to guide the scoping review.

The concept of cooking skills: A review with contributions to the scientific debate

ABSTRACT This paper aimed to conduct a literature review about the concept of cooking skills to contribute to the scientific debate about the subject. A systematic search was performed in the Scopus, PubMed/MedLine and Web of Science databases as well as the periodicals of the Federal Agency for Support and Evaluation of Graduate Education in Brazil Coordenação de Aperfeiçoamento de Pessoal de Nível Superior website, using the following Portuguese and English keywords: cooking skills, cooking and food/meal preparation. We also consulted references cited by these papers, electronic dictionaries (in Portuguese, English and French), technical documents found on public and private institutional websites, as well as books. Basic, etymological/vernacular and systematic definitions for cooking were identified, including historical global and national contexts. To conceptualize cooking skills, categories related to food and individuals were established, purposing a conceptual model. The category related to food referred to the use of unprocessed/minimal processed foods (which require procedures prior to their preparation), and/or processed/ultra-processed foods (which need a little or no preparation, such as re-heating). The category related to individuals involved dimensions such as confidence, attitudes, behavior, and individual knowledge used to prepare foods. The historical definitions of cooking allowed us to clarify the concept of cooking skills. Considering the global context of valuing and recovering cooking for the promotion of healthy eating, this review can contribute to the scientific discussion about the concept of cooking skills. The purposed conceptual model enables parameters to be established for further investigations, allowing cooking interventions to be directed toward promoting healthy eating.

The scientific production of Nutrition published by the Scientific Electronic Library under the gaze of the evaluation of the Coordination for the Development of Higher Education Personnel

ABSTRACT Objective: Perform analysis of the scientific production of Nutrition published by the Scientific Electronic Library under the gaze of the evaluation of Coordenação de Aperfeiçoamento de Pessoal de Nível Superior. Methods: Systematic search was performed in the 286 current title journals, using the "article search" path, the "subject index" window and the "Nutrition" indexer. The articles and periodicals selected were analyzed in order to answer the following questions: Which journals from Scientific Electronic Library publish articles on Nutrition? Do these journals have an impact factor as measured by the Journal Citation Reports? Which are? What is the classification of these journals by the areas of evaluation of Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, specifically by the area of Nutrition? Results: We analyzed 779 articles published in 85 journals. The majority of articles (n=698; 89.6%) were related to the area of Health Sciences. The five journals with higher volumes of articles were: Brazilian Journal of Nutrition, Reports in Public Health, Public Health Journal, Science & Public Health and Journal of Pediatrics. Most (62.4%) does not have Journal Citation Reports. The Nutrition area not rated any journal in strata A1 and A2, classifying them from B1 to B4. For eight areas analyzed their specific journals were induced to the upper strata of Qualis (A1, A2 and B1). Conclusion: The analyzed journals are the main vehicles of circulation of scientific paradigms of national scientific communities. Considering the correlation of forces between the vehicles of circulation of scientific knowledge in the international context, stimuli for valorization and qualification of these journals are essential.

Bibliometric analysis of undergraduate final research projects in Nutrition courses in the state of Rio Grande do Norte, Brazil

ABSTRACT Objective: To evaluate the profile of academic production of undergraduates in Nutrition courses in the state of Rio Grande do Norte, Brazil. Methods: The bibliometric study was conducted with undergraduate final research projects from five courses in Nutrition in the state of Rio Grande do Norte during 2013 and 2014. The following variables were collected: institution, title of project, number of authors, academic degree of the advisor, study design, area of study interest, type of study, study setting, submission to the ethics committee, and keywords. Pearson's Chi-square test was used to assess the variable area of study interest with a significance level at p≤0.05 and 95% confidence interval. Results: Of the 195 projects analyzed, 79.0% were developed at universities. We found a higher frequency of academic articles (68.2%) developed by a single student (65.6%), advised by a professor with a Masters degree (57.9%), with a cross-sectional study design (48.2%), and without submission to the research ethics committee (49.2%). The mean adequacy of keywords was 50.0%. Conclusion: The quantitative approach was the most predominant characteristic of the final research projects and the most frequently researched area of knowledge was public health. The methodological approaches of the research projects were considered weak, which suggests the need to improve the quality of scientific methodology during undergraduate studies, considering the important benefits derive from researches as an active methodology.

A inserção do nutricionista na Atenção Básica: uma proposta para o matriciamento da atenção nutricional

Resumo Em 2008 houve a integração do nutricionista nos Núcleos de Apoio à Saúde da Família. Com foco no desenvolvimento de apoio assistencial e técnico-pedagógico às Equipes de Saúde da Família, o objetivo do trabalho foi desenvolver uma proposta de ações matriciais de nutrição dirigidas à mulher e à criança na Estratégia de Saúde da Família. O trabalho foi desenvolvido em uma Unidade Básica de Saúde e dividido em Ciclo I, a partir das entrevistas com famílias de crianças de 0 a 6 anos para compor o reconhecimento do território; e Ciclos II e III, a partir do desenvolvimento de atividades intersetoriais de campo para promover a segurança alimentar e nutricional com base no apoio matricial. Com o diagnóstico de vulnerabilidade social, risco nutricional das crianças, indicadores de desmame precoce e consumo alimentar inadequado, foram desenvolvidas ações com o objetivo de propor um modelo matricial de ações de nutrição em três cenários: comunidade, família e indivíduo. Dentre as atividades desenvolvidas destacam-se oficinas culinárias, atenção ao pré-natal e capacitação de agentes comunitários de saúde. Este trabalho testou formas de desenvolver assistência nutricional a partir da clínica ampliada e reconhecimento do território, visando aprimorar a atuação do nutricionista como educador em saúde.

Hunger, food and drink in Brazilian popular music: a brief overview

The article reflects on how the themes of hunger, consumption of soft drinks and consumption of beans and rice are addressed in Brazilian popular music. We investigate the years of military dictatorship (1964-1985). The focus of the analysis is on the so-called protest song, a musical genre characterized by aesthetic, cultural, political, ideological and social criticism to military rule. The study of the ideology and philosophy of language of Mikhail Bakhtin is the theoretical reference; especially his concepts of "ideological sign" and "word." Analysis reveals that the protest song portrayed elements of the economic, political and social contexts and led to the diffusion of healthy or unhealthy eating habits or ideologies, contributing to the construction of the Brazilian dietary identity.

The construction of scientific knowledge in Food and Nutrition: Analysis of dissertations and theses in the Brazilian post-graduation programs in Nutrition

Objective: To analyze dissertations and theses produced by graduate programs in nutrition in Brazil from 2003 to 2012. We sought to identify: a) The number of studies produced per year b) the scientific approach (quantitative, qualitative, or mixed), and c) the area of knowledge in the scientific field of nutrition. Methods: This is a descriptive study. We investigated seven graduate programs linked to the area of nutrition of the Coordination for the Improvement of Higher Education Personnel, which had the web pages listing the studies. The analysis procedures included reading the titles, identifying the advisor's lines of research, reading the summaries, and reading the methods section. Results: In the study period 758 dissertations and 204 theses were defended, signifying an increase of 229.0% for the all programs. The hegemony of the quantitative approach shows the influence of the philosophical trends linked to positivism and the biological sciences, attracting interest from 92.5% of researchers. The qualitative and mixed approaches contributed only to 7.3% of the studies, expressing the influence of the social sciences and humanities and of the philosophical trends' dialectics and phenomenology about a small group of researchers. Conclusion: The distribution of dissertations and theses in the six areas of knowledge reaffirms the complexity, breadth, epistemological, and methodological heterogeneity; and the configuration of the field of knowledge production in food and nutrition, requiring the construction of collective political projects, seeking the interdisciplinarity of the different areas that structure the field.

Formação em Nutrição em Saúde Coletiva na Universidade Federal de Santa Catarina: reflexões sobre o processo de ensino para fortalecer o Sistema Único de Saúde

O objetivo do artigo é relatar a experiência do processo de implantação do projeto pedagógico do Curso de Graduação em Nutrição da Universidade Federal de Santa Catarina visando ao atendimento das Diretrizes Curriculares dos Cursos de Nutrição de 2001, com ênfase na formação em Saúde Coletiva. Trata-se de artigo descritivo que procura refletir sobre a experiência da reestruturação curricular implantada em 2009. A reestruturação curricular proposta pelo Núcleo Docente Estruturante contou com assessoria externa, parceria das Secretarias de Saúde e de Educação de Florianópolis e financiamento do Ministério da Saúde, tendo por base as avaliações realizadas em fóruns com participação de docentes, discentes e nutricionistas. O projeto pedagógico do Curso de Graduação em Nutrição da Universidade Federal de Santa Catarina pautou-se pelos princípios do Direito Humano à Alimentação Adequada, da Segurança Alimentar e Nutricional e da promoção, proteção e recuperação da saúde. O currículo contempla os níveis de complexidade de atenção à saúde do Sistema Único de Saúde, com integração entre disciplinas que desenvolvem metodologias ativas, durante as aulas teóricas e práticas. Outros cenários de prática são: unidades educativas, locais de produção e comercialização de alimentos e unidades de alimentação e nutrição. Os coordenadores pedagógicos realizam interlocução entre secretarias, profissionais, docentes e discentes. O currículo tem sido avaliado e reestruturado continuamente. Apesar dos avanços, são apontados como desafios: a integração ensino-serviço, o número reduzido de nutricionistas nos cenários de prática, a estrutura disciplinar e o grande número de estudantes nas turmas práticas.

Educação popular e nutrição social: considerações teóricas sobre um diálogo possível

No setor saúde, a Educação Popular tem desvelado historicamente perspectivas teóricas e metodológicas relevantes na busca por novos horizontes para formação de profissionais, dentre os quais também se incluem os nutricionistas. Caminhos vêm sendo delineados para uma atuação comprometida com os conceitos da Promoção da Saúde e da Segurança Alimentar e Nutricional, os quais agregam dimensões críticas à Nutrição Social, traduzidas pela percepção compromissada quanto ao papel da ciência da nutrição em comunidades populares e da intervenção do nutricionista nestes espaços. Tendo como objetivo contribuir no aprimoramento das bases teóricas intervenientes neste processo, o presente ensaio pretende sistematizar os atuais desafios, possibilidades e lacunas do encontro entre Educação Popular e Nutrição Social, com ênfase para suas realizações nos cenários da Saúde da Família, e dos movimentos em torno do Direito Humano à Alimentação Adequada e Saudável no Brasil.

A integralidade como eixo da formação em proposta interdisciplinar: estágios de Nutrição e Psicologia no campo da Saúde Coletiva

Trata-se de relato de experiência de estágio interdisciplinar em Nutrição Social e em Psicologia da Universidade Federal de São Paulo campusBaixada Santista, com foco na integralidade da atenção. O trabalho ocorreu entre 2010 e 2012, na Atenção Básica de Saúde do Sistema Único de Saúde no território Centro/Morro do município de Santos, São Paulo. Utilizaram-se registros de campo contendo memórias de supervisões e de reuniões entre professores e equipe de saúde. Construíram-se narrativas e projetos terapêuticos singulares. Em supervisão conjunta de professores de Nutrição e Psicologia, debateram-se situações destacadas pelos estudantes e planos de trabalho construídos para cada ciclo de formação. Isto fundamentou práticas interdisciplinares, reflexões e ações consoantes ao Sistema Único de Saúde, realizadas pelos estagiários. Os resultados corroboram a importância do trabalho interdisciplinar para a promoção da integralidade, constituindo formas de escuta e atenção diferenciadas aos usuários, em estreita relação com os serviços.

Nutrigenomics: definitions and advances of this new science

The search for knowledge regarding healthy/adequate food has increased in the last decades among the world population, researchers, nutritionists, and health professionals. Since ancient times, humans have known that environment and food can interfere with an individual's health condition, and have used food and plants as medicines. With the advance of science, especially after the conclusion of the Human Genome Project (HGP), scientists started questioning if the interaction between genes and food bioactive compounds could positively or negatively influence an individual's health. In order to assess this interaction between genes and nutrients, the term "Nutrigenomics" was created. Hence, Nutrigenomics corresponds to the use of biochemistry, physiology, nutrition, genomics, proteomics, metabolomics, transcriptomics, and epigenomics to seek and explain the existing reciprocal interactions between genes and nutrients at a molecular level. The discovery of these interactions (gene-nutrient) will aid the prescription of customized diets according to each individual's genotype. Thus, it will be possible to mitigate the symptoms of existing diseases or to prevent future illnesses, especially in the area of Nontransmissible Chronic Diseases (NTCDs), which are currently considered an important world public health problem.

Education of dietitian's in Brazil: Minimum clock hours of instruction for a bachelor's degree in nutrition

This essay aims to debate the minimum clock hours of instruction necessary for obtaining a bachelor's degree in nutrition considering the challenges to educate health professionals. Official documents on the minimum clock hours of instruction required by undergraduate nutrition programs were analyzed to investigate compliance with the curriculum guidelines for the area, the law that regulates the profession of dietitian, and the necessary education for the Sistema Único de Saúde (Unified Health Care System). Compared with other health programs, nutrition presented the smallest increase in the minimum clock hours of instruction required for the degree. The changes that occurred in the epidemiological, demographic, and nutritional profile of the population and scientific advances require specific nutrition actions. Since Sistema Único de Saúde focuses on comprehensiveness in the three levels of care, on humanization, and on health care, the theoretical and methodological concepts given in undergraduate programs need to be improved for the dietitians education to meet the Sistema Único de Saúde needs. Incorporation of the knowledge needed for working with food and nutritional phenomena, including its social and cultural dimensions, management of public policies, quantity cooking, and food and nutritional surveillance requires a higher minimum clock hours of instruction. In conclusion, dietitians need a minimum clock hours of instruction of 4,000 to acquire a proper education, integrate into the university life, and coordinate interdisciplinary experiences of the triad teaching/research/extension.

A criação da área "nutrição" na Capes

Este texto foi elaborado com base no documento formulado pelo Fórum Nacional de Coordenadores de Programas de Pós-Graduação em Alimentação e Nutrição, que apresentou a proposta de criação da área de Alimentação e Nutrição junto à Coordenação de Aperfeiçoamento de Pessoal de Nível Superior do Ministério da Educação. Partindo da constituição da Alimentação e Nutrição como campo de conhecimentos e práticas no Brasil, destaca-se o papel aí desempenhado pelo Fórum Nacional de Coordenadores de Programas de Pós-Graduação em Alimentação e Nutrição, no sentido de seu fortalecimento acadêmico. Descreve-se o perfil desses programas desde os anos 1970, com ênfase em seu crescimento numérico e qualitativo. Consideram-se as linhas de pesquisa que os compõem e seus núcleos de saberes como indicativos de sua conformação epistêmica e os grupos de pesquisa brasileiros nesse campo, como potencial de incorporação e de criação de novos cursos de mestrado e doutorado. A nova área denominada de "Nutrição" foi criada em 2011, com programas distri-buídos pelo País, exceto na Região Norte. A partir desse momento, o Fórum Nacional de Coordenadores de Programas de Pós-Graduação em Alimentação e Nutrição, representando os 18 programas que inicialmente compõem a área, juntamente com a coordenação e a comissão designadas pela Coordenação de Aper-feiçoamento de Pessoal de Nível Superior, têm o desafio de fortalecer a formação brasileira pós-graduada stricto sensu no campo científico da Alimentação e Nutrição.