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Levis C, Mejía Toro C, Patiño SRG, Villalobos-Daniel VE, Spinillo C, Gomes FDS. Building Capacity and Advancing Regulatory Measures to Improve Food Environments in the Region of the Americas. Nutrients 2024; 16:1202. [PMID: 38674892 PMCID: PMC11054736 DOI: 10.3390/nu16081202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Noncommunicable diseases (NCDs) are the main cause of death globally (70%) and in the Region of the Americas (80%), and poor diets are a leading driver of NCDs. In response, the Pan American Health Organization (PAHO)/World Health Organization (WHO) introduced a set of evidence-based regulatory measures to help countries improve diets through the reduced consumption of processed and ultra-processed foods. This paper aims to describe the needs of and propose actions for key actors to advance these measures. A workshop was designed to assess member states' regulatory capacity. A thematic analysis was conducted to analyze regional needs, successes and challenges. Thereafter, the Government Capacity-Building Framework for the prevention and control of NCDs was used to examine findings. The findings were organized in two sets: (i) PAHO/WHO actions to support member states and (ii) key actors' actions to advance regulatory policies. The results show notable regulatory progress across the Region of the Americas. However, progress differs between countries, with opportunities to strengthen measures in most countries, mainly in conflict of interest management. The results identified important actions to strengthen the regulatory capacity of PAHO/WHO member states. To maximize momentum for these actions, timelines must be identified, and political commitment can be boosted by applying human rights-based and food system-wide approaches.
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Affiliation(s)
- Carmen Levis
- Pan American Health Organization, Washington, DC 20037, USA; (V.E.V.-D.); (F.d.S.G.)
- NCD Alliance, 1202 Geneva, Switzerland
| | - Carolina Mejía Toro
- School of Population Health, University of Auckland, Grafton, Auckland 1023, New Zealand
- INFORMAS (International Network for Food and Obesity/Noncommunicable Diseases, Research, Monitoring and Action Support), Grafton, Auckland 1023, New Zealand
| | | | - Victor Eduardo Villalobos-Daniel
- Pan American Health Organization, Washington, DC 20037, USA; (V.E.V.-D.); (F.d.S.G.)
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca 62100, Mexico
| | - Carla Spinillo
- Department of Design, The Federal University of Paraná, Curitiba 80060, Brazil;
| | - Fabio da Silva Gomes
- Pan American Health Organization, Washington, DC 20037, USA; (V.E.V.-D.); (F.d.S.G.)
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Gomes FDS, Corvalán C, Deliza R, Barquera S. Editorial: Strengthening food labeling policies in Brazil. Front Nutr 2023; 10:1196243. [PMID: 37215225 PMCID: PMC10192892 DOI: 10.3389/fnut.2023.1196243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 05/24/2023] Open
Affiliation(s)
- Fabio da Silva Gomes
- Pan American Health Organization/World Health Organization, Department of Noncommunicable Diseases and Mental Health, Washington, DC, United States
| | - Camila Corvalán
- Center for Food Environment Research (CIAPEC), Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Rosires Deliza
- Embrapa Agroindústria de Alimentos, Rio de Janeiro, RJ, Brazil
| | - Simon Barquera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Mexico
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Allemandi LA, Flexner N, Nederveen L, Gomes FDS. Building capacity in reducing population dietary sodium intake in the Americas. Rev Panam Salud Publica 2022; 46:e198. [DOI: 10.26633/rpsp.2022.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
Objective.
To present some resources developed as part of the technical support of the Pan American Health Organization (PAHO) to Member States to reduce population dietary sodium intake, and to discuss the main challenges and opportunities to accelerate action toward sodium intake reduction in the Americas.
Methods.
Sources of information include a mapping of salt reduction policies conducted in 2019, reports from working group meetings, interviews conducted in 2020 and 2021 in seven countries, and technical documents developed around the Updated PAHO Regional Sodium Reduction Targets.
Results.
These tools show that, despite progress, challenges to succeed in this agenda persist. Priority given to sodium reduction is low in most countries, with insufficient resource allocation. There is a lack of intersectoral coordinated action, and a systemic approach to food systems is commonly missing. Surveillance mechanisms of sodium intake are insufficient, and industry interference in policy processes is commonly identified, undermining policy progress and success. There are also important regional opportunities to address these challenges. These include common ground for future collaborations by updating, strengthening, and complementing these existing tools, and technical and financial support for data generation.
Conclusions.
PAHO is committed to continue to support countries in the process of promoting, implementing, and monitoring cost-effective sodium reduction interventions. One key policy priority in this agenda is the adoption of the Updated PAHO Regional Sodium Reduction Targets with a mandatory approach, together with the comprehensive and complementary implementation of other strategies. Strong political will and commitment of countries will be critical to translate goals into concrete achievements in the Americas.
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Affiliation(s)
| | - Nadia Flexner
- Pan American Health Organization, Washington, D.C., United States of America
| | - Leo Nederveen
- Pan American Health Organization, Washington, D.C., United States of America
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Fernandes TFDC, Ferreira NB, Campagnoli RR, Gomes FDS, Braga F, David IA, Lobo I. Impact of textual warnings on emotional brain responses to ultra-processed food products. Front Nutr 2022; 9:895317. [PMID: 36438758 PMCID: PMC9686398 DOI: 10.3389/fnut.2022.895317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
Background and objectives Ultra-processed food products (UPF) have been associated with numerous non-communicable diseases. Despite this, the addictive nature of UPF, and the aggressive marketing strategies used to promote them, has created a strong emotional connection between UPF and consumers, and supports their increasing UPF global consumption. In view of the emotional link that consumers often have with UPF, modulating emotional reactions to UPF (by using strategies such as textual warnings) is important in changing consumers' behavior. Since emotions are better understood by assessing individuals' implicit reactions, we conducted an electroencephalographic study applying the event-related potential technique to investigate whether textual warnings were able to modulate the brain responses to UPF stimuli. Materials and methods Twenty-six participants (19 women) viewed pictures of UPF preceded by a warning sentence about the health risks of consuming UPF or a control sentence while the electroencephalogram was recorded. In addition, the participants rated the picture in respect of pleasantness, arousal, and intention to consume. As emotions are associated with motivational circuits in the brain, we focused on a well-known event-related potential brain marker of the motivational relevance associated with emotional stimuli, namely late positive potential (LPP). Results The late positive potential amplitude was larger for pictures depicting UPF under the warning condition compared to the control condition, a result that was accompanied by lower pleasantness ratings during the warning condition (compared to the control). Conclusion Textual warnings about the negative health consequences of consuming UPF changed the emotional responses toward UPF, possibly increasing the motivation to avoid UPF. These results shed new light on the impact of textual warnings on UPF-evoked emotions.
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Affiliation(s)
- Thayane Ferreira da Costa Fernandes
- Laboratório de Psicobiologia, Instituto de Ciências Médicas, Universidade Federal do Rio de Janeiro, Macaé, RJ, Brazil,Instituto de Biodiversidade e Sustentabilidade, Universidade Federal do Rio de Janeiro, Macaé, RJ, Brazil
| | - Naiane Beatriz Ferreira
- Instituto de Biodiversidade e Sustentabilidade, Universidade Federal do Rio de Janeiro, Macaé, RJ, Brazil
| | - Rafaela Ramos Campagnoli
- Laboratório de Neurofisiologia do Comportamento, Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, RJ, Brazil,Departamento de Neurobiologia, Instituto de Biologia, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Fabio da Silva Gomes
- Pan American Health Organization, World Health Organization, Washington, DC, United States
| | - Filipe Braga
- Laboratório de Psicobiologia, Instituto de Ciências Médicas, Universidade Federal do Rio de Janeiro, Macaé, RJ, Brazil
| | - Isabel Antunes David
- Laboratório de Neurofisiologia do Comportamento, Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, RJ, Brazil,Departamento de Neurobiologia, Instituto de Biologia, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Isabela Lobo
- Laboratório de Psicobiologia, Instituto de Ciências Médicas, Universidade Federal do Rio de Janeiro, Macaé, RJ, Brazil,Instituto de Biodiversidade e Sustentabilidade, Universidade Federal do Rio de Janeiro, Macaé, RJ, Brazil,*Correspondence: Isabela Lobo,
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Nilson EAF, Khandpur N, da Silva Gomes F. Development and application of the TFA macrosimulation model: a case study of modelling the impact of trans fatty acid (TFA) elimination policies in Brazil. BMC Public Health 2022; 22:2010. [PMID: 36324096 PMCID: PMC9632015 DOI: 10.1186/s12889-022-14361-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction The consumption of trans-fatty acids (TFA) is directly associated with cardiovascular disease risk and is responsible for a significant health burden globally. The policy strategies for reducing TFA include limiting their content in foods and eliminating partially hydrogenated oils (PHO) in the market. This study aims to describe a comparative risk assessment macrosimulation model and to apply this tool to estimate the potential reductions in CVD mortality gained from the compared scenarios of TFA reduction/elimination in Brazil. Methodology We developed and implemented a comparative risk assessment macrosimulation model estimates the potential CVD mortality reduction (coronary heart disease – CHD- and stroke) if TFA intake is reduced in diets. The TFA macrosimulation model estimates the change in the annual number of NCD deaths between baseline with current TFA consumption levels and alternate or counterfactual scenarios, such as considering different limits to TFA content in foods and the elimination of PHO in Brazil in 2018. The model incorporated additional outputs related to other impacts of TFA reduction on DPP, such as Years of Life Lost, Years of Productive Life Lost, and related economic impacts of premature deaths. Results In 2018, a 2% limit for TFA in the oils and fats and a 5% limit of TFAs for other foods could avert or postpone approximately 2,000 deaths (UI 95% 1,899-2,142) and save US$ 32.1 million savings in productivity losses to the economy associated to premature deaths. An intermediate scenario, applying a 2% limit of TFA in all food products In Brazil could prevent or postpone approximately 6,300 deaths (UI 95% 5,925-6,684) and the premature deaths prevented would represent US$ 100.2 million in economic saving. Finally, by banning PHO, approximately 10,500 deaths could be prevented or postponed (UI 95% 9,963 − 10,909), corresponding to US$ 166.7 million in savings to the economy because of premature deaths. Conclusion The TFA macrosimulation model can efficiently compare different policy scenarios for trans fats reduction policies at the country level and proves that the elimination of PHOs from the food market in Brazil may significantly reduce the health burden of trans fatty acids in the country compared to other policy options. The model also represents a useful public health tool to support TFA reduction and elimination policies in other countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14361-9.
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Affiliation(s)
- Eduardo Augusto Fernandes Nilson
- grid.11899.380000 0004 1937 0722Center for Epidemiological Research in Nutrition and Public Health, University of São Paulo, São Paulo, Brazil
| | - Neha Khandpur
- grid.11899.380000 0004 1937 0722Center for Epidemiological Research in Nutrition and Public Health, University of São Paulo, São Paulo, Brazil
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Roche M, Alvarado M, Sandoval RC, Gomes FDS, Paraje G. Comparing taxes as a percentage of sugar-sweetened beverage prices in Latin America and the Caribbean. Lancet Reg Health Am 2022; 11:None. [PMID: 35875252 PMCID: PMC9290324 DOI: 10.1016/j.lana.2022.100257] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Excise taxes can be used to reduce the consumption of sugar-sweetened beverages (SSBs), an important preventable risk factor for noncommunicable diseases. This study aimed to compare novel standardized indicators of the level of taxes applied on SSBs as a percentage of the price across beverage categories in Latin America and the Caribbean. Methods We used a method developed by the Pan American Health Organization and adapted from the World Health Organization's tobacco tax share. The analysis focused on the most sold brand of five categories of non-alcoholic beverages. Data were collected by surveying ministries of finance and reviewing tax legislation in effect as of March 2019. Findings Of the 27 countries analyzed, 17 applied excise taxes on SSBs. Of these, median excise taxes represented the highest share of the price for large sugar-sweetened carbonated drinks (6·5%) and the lowest for energy drinks (2·3%). In countries where excise taxes were applied on bottled waters, tax incidence exceeded the one applied on most SSBs. Overall, excise tax shares were higher in Latin America than in the Caribbean. Including all other indirect taxes (e.g., value added tax), median total tax shares were between 12·8% and 17·5%. At least two countries earmarked part of SSB excise tax revenues for health purposes. Interpretation Excise tax levels are generally low in the region. From a public health perspective, tax rates could be increased, and tax designs improved (e.g., excluding bottled waters). The method describe here provides a feasible and informative way to monitor SSB taxation and could be replicated in other regions and over time. Funding Bloomberg Philanthropies through the Global Health Advocacy Incubator.
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Key Words
- CIF, Cost, insurance, and freight
- Fiscal policies
- Health economics
- IMF, International Monetary Fund
- LAC, Latin America and the Caribbean
- NCD, Noncommunicable disease
- Noncommunicable diseases
- Nutrition policy
- Obesity
- PAHO, Pan American Health Organization
- PPP, Purchasing power parity
- SSB, Sugar-sweetened beverage
- Sugar-sweetened beverages
- VAT, Value added or sales taxes
- WHO, World Health Organization
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Affiliation(s)
- Maxime Roche
- Centre for Health Economics and Policy Innovation (CHEPI), Imperial College Business School, Exhibition Rd, London SW7 2AZ, UK
| | - Miriam Alvarado
- MRC Epidemiology Unit, Cambridge Biomedical Campus, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
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Rincón-Gallardo Patiño S, Constantinou S, Gorlick C, da Silva Gomes F. Evaluating progress and addressing actions to eliminate industrially produced trans-fatty acids in the Americas. Rev Panam Salud Publica 2022; 46:e130. [PMID: 36071916 PMCID: PMC9440733 DOI: 10.26633/rpsp.2022.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/29/2022] [Indexed: 01/12/2023] Open
Abstract
Objective. To evaluate the progress toward the 2023 target for the elimination of industrially produced trans-fatty acids (IP-TFA) in the Region of the Americas and to highlight the achievements of the four strategic lines of action from the Plan of Action for the Elimination of IP-TFA 2020-2025. Methods. A survey based on the World Health Organization (WHO) REPLACE package was used to collect data. The REPLACE package outlines six strategic action areas (Review, Promote, Legislate, Assess, Create, Enforce) to support the prompt, complete, and sustained elimination of IP-TFA from the food supply. Information was cross-checked and updated until December 2021. Results. Thirty countries in the Region responded to the survey between November 2019 and July 2020, an 85.7% response rate. As of December 2021, 21 additional indicators of the Regional Plan of Action were met, out of which, four consisted of new enactments of PAHO/WHO best practice policies for the elimination of IP-TFA by countries since baseline data was collected in 2018. This has resulted in a 63.0% increase in the proportion of the population in the Americas protected from consuming IP-TFA in 2021, compared to the baseline in 2018. Conclusion. Despite results showing progress in the Region, actions are needed to strengthen country capacity building and strategies to eliminate IP-TFA and fully achieve the 2023 goal.
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Delgado Zegarra J, da Silva Gomes F. [Nutrient profile of food products exempted from the application of front-ofpackage warnings during the first stage of the Healthy Eating Law in Peru: case studyPerfil nutricional de produtos alimentícios isentos da aplicação de advertências na parte frontal da embalagem durante a primeira etapa da Lei de Alimentação Saudável no Peru: estudo de caso]. Rev Panam Salud Publica 2021; 45:e153. [PMID: 34934415 PMCID: PMC8678099 DOI: 10.26633/rpsp.2021.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/15/2021] [Indexed: 12/17/2022] Open
Abstract
Objective Identify the nutritional profile of food products exempted from presenting one or more front-ofpackage nutritional warnings during the first stage of Law 30,021 on the Promotion of Healthy Eating for Children and Adolescents in Peru. Methods Data were collected on 188 products from points of sale in the city of Lima. The convenience sample included products that until September 17, 2021 were exempted by the legislation from presenting any of the warning labels for sugar, sodium, or saturated fats. An assessment was made of the proportion of products that would be required to apply one or more warning labels when the second stage of the legislation takes effect. It was also calculated how many products exempted from the application of warning labels contain excess sugar, sodium, or saturated fats, according to the criteria of the Pan American Health Organization (PAHO). Results 76.1% of the products exceeded at least one of the thresholds for sugar, sodium, or saturated fats that entered in force in September 2021. The proportion of products that the law exempts from warnings and that contain excess sugar, sodium, or saturated fats according to PAHO will be 4.2, 3.4, and 2.3 times lower, respectively, in the second stage. Conclusion During the first stage of the law's entry into force, 58%, 42%, and 28.2% of the products exempted from the presentation of warning labels contained excess sugar, saturated fats, or sodium, respectively, according to PAHO.
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Affiliation(s)
- Jaime Delgado Zegarra
- Instituto de Consumo de la Universidad de San Martín de Porres Instituto de Consumo de la Universidad de San Martín de Porres Lima Perú
| | - Fabio da Silva Gomes
- Organización Panamericana de la Salud Organización Panamericana de la Salud Washington D.C. Estados Unidos de América
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Nisbett N, Friel S, Aryeetey R, Gomes FDS, Harris J, Backholer K, Baker P, Blue Bird Jernigan V, Phulkerd S. Equity and expertise in the UN Food Systems Summit. BMJ Glob Health 2021; 6:bmjgh-2021-006569. [PMID: 34226240 PMCID: PMC8258590 DOI: 10.1136/bmjgh-2021-006569] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Nicholas Nisbett
- Health and Nutrition Research Cluster, Institute of Development Studies at the University of Sussex, Brighton, UK
| | - Sharon Friel
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | | | | | - Jody Harris
- Health and Nutrition Research Cluster, Institute of Development Studies at the University of Sussex, Brighton, UK,Healthy Diets Flagship, World Vegetable Centre, Bangkok, Thailand
| | - Kathryn Backholer
- Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Victoria, Australia
| | | | - Sirinya Phulkerd
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom, Thailand
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Ralston R, Hil SE, da Silva Gomes F, Collin J. Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool. Int J Health Policy Manag 2021; 10:255-265. [PMID: 32610752 PMCID: PMC9056191 DOI: 10.34172/ijhpm.2020.52] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/05/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND With multi-stakeholder approaches central to efforts to address global health challenges, debates around conflict of interest (COI) are increasingly prominent. The World Health Organization (WHO) recently developed a proposed tool to support member states in preventing and managing COI in nutrition policy. We analysed responses to an online consultation to explore how actors from across sectors understand COI and the ways in which they use this concept to frame the terms of commercial sector engagement in health governance. METHODS Submissions from 44 Member States, international organisations, non-governmental organizations (NGOs), academic institutions and commercial sector actors were coded using a thematic framework informed by framing theory. Respondents' orientation to the tool aligned with two broad frames, ie, a 'collaboration and partnership' frame that endorsed multi-stakeholder approaches and a 'restricted engagement' frame that highlighted core tensions between public health and food industry actors. RESULTS Responses to the WHO tool reflected contrasting conceptualisations of COI and implications for health governance. While most Member States, NGOs, and academic institutions strongly supported the tool, commercial sector organisations depicted it as inappropriate, unworkable and incompatible with the Sustainable Development Goals (SGDs). Commercial sector respondents advanced a narrow, individual-level understanding of COI, seen as adequately addressed by existing mechanisms for disclosure, and viewed the WHO tool as unduly restricting scope for private sector engagement in nutrition policy. In contrast, health-focused NGOs and several Member States drew on a more expansive understanding of COI that recognised scope for wider tensions between public health goals and commercial interests and associated governance challenges. These submissions mostly welcomed the tool as an innovative approach to preventing and managing such conflicts, although some NGOs sought broader exclusion of corporate actors from policy engagement. CONCLUSION Submissions on the WHO tool illustrate how contrasting positions on COI are central to understanding broader debates in nutrition policy and across global health governance. Effective health governance requires greater understanding of how COI can be conceptualised and managed amid high levels of contestation on policy engagement with commercial sector actors. This requires both ongoing innovation in governance tools and more extensive conceptual and empirical research.
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Affiliation(s)
- Rob Ralston
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, Edinburgh, UK.,SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), London, UK
| | - Sarah E Hil
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, Edinburgh, UK.,SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), London, UK
| | - Fabio da Silva Gomes
- Department of Noncommunicable Diseases and Mental Health, Pan-American Health Organization/World Health Organization, Washington, DC, USA
| | - Jeff Collin
- Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, Edinburgh, UK.,SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), London, UK
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Pereira TN, Gomes FDS, Carvalho CMPD, Martins APB, Duran ACDFL, Hassan BK, Cruz JI, Mais LA, Ferraz MDA, Mialon M, Johns P, Bandeira LM. Medidas regulatórias de proteção da alimentação adequada e saudável no Brasil: uma análise de 20 anos. CAD SAUDE PUBLICA 2021; 37Suppl 1:e00153120. [DOI: 10.1590/0102-311x00153120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/02/2020] [Indexed: 11/22/2022] Open
Abstract
Medidas regulatórias estão entre as estratégias de promoção da alimentação adequada e saudável preconizadas pela Política Nacional de Alimentação e Nutrição (PNAN). Embora outras ações de promoção da alimentação adequada e saudável tenham avançado no Brasil, essas medidas progridem lentamente. O objetivo do trabalho é identificar e descrever fatores relacionados ao desenvolvimento e à implementação das principais medidas regulatórias de proteção da alimentação adequada e saudável no Brasil nos últimos 20 anos. É um estudo qualitativo documental que avaliou algumas medidas regulatórias de proteção à alimentação adequada e saudável federais, propostas ou em discussão, entre 1999 e 2020. São elas: regulação da publicidade de alimentos; regulação da comercialização de alimentos no ambiente escolar; implantação da rotulagem nutricional frontal obrigatória de alimentos; e tributação de bebidas adoçadas. A maioria das barreiras identificadas foram estratégias de atividade política corporativa protagonizadas pelo setor privado, principalmente, pela indústria de alimentos. Dentre as estratégias de atividade política corporativa utilizadas em diversas etapas dos processos políticos destacam-se: ações judiciais contra a ação do Estado; substituição de políticas sugerindo alternativas voluntárias ou inefetivas; oposição, fragmentação e desestabilização, com busca de apoio da comunidade. No período estudado, nenhuma das medidas foi aprovada. Diante desse cenário, os obstáculos para aprovação das medidas regulatórias de proteção a alimentação adequada e saudável necessitam ser superados no Brasil.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Paula Johns
- Aliança de Controle do Tabagismo e Promoção da Saúde, Brasil
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Hämäläinen RM, Breda J, da Silva Gomes F, Gongal G, Khan W, Mendes R, Nederveen L, Ramanandraibe N, Sako B, Whiting S. New global physical activity guidelines for a more active and healthier world: the WHO Regional Offices perspective. Br J Sports Med 2020; 54:1449-1450. [DOI: 10.1136/bjsports-2020-103531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 11/03/2022]
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Rincón-Gallardo Patiño S, Rajamohan S, Meaney K, Coupey E, Serrano E, Hedrick VE, da Silva Gomes F, Polys N, Kraak V. Development of a Responsible Policy Index to Improve Statutory and Self-Regulatory Policies that Protect Children's Diet and Health in the America's Region. Int J Environ Res Public Health 2020; 17:ijerph17020495. [PMID: 31941054 PMCID: PMC7013653 DOI: 10.3390/ijerph17020495] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 01/15/2023]
Abstract
In 2010, 193 Member States of the World Health Organization (WHO) endorsed World Health Assembly Resolution WHA63.14 to restrict the marketing of food and beverage products high in fat, sugar and salt (HFSS) to children to prevent obesity and non-communicable diseases (NCDs). No study has examined HFSS marketing policies across the WHO regional office countries in the Americas. Between 2018 and 2019, a transdisciplinary team examined policies to restrict HFSS food and beverage product marketing to children to develop a responsible policy index (RESPI) that provides a quality score based on policy characteristics and marketing techniques. After designing the RESPI, we conducted a comprehensive literature review through October 2019 to examine policies in 14 countries in the WHO Americans Region. We categorized policies (n = 38) as either self-regulatory or statutory and calculated the RESPI scores, ranked from 0 (lowest) to 10 (highest). Results showed Brazil, Canada, Chile, and Uruguay had the highest RESPI scores associated with statutory policies that restricted point of sale, cartoon, licensed media characters and celebrities; and HFSS products in schools and child care settings, and broadcast and print media. Policymakers can use the RESPI tool to evaluate marketing policies within and across geopolitical boundaries to protect children's diet and health.
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Affiliation(s)
- Sofía Rincón-Gallardo Patiño
- Department of Human Nutrition, Foods, and Exercise, College of Agriculture and Life Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA; (E.S.); (V.E.H.); (V.K.)
- Correspondence: ; Tel.: +1-540-831-9719
| | - Srijith Rajamohan
- Advanced Research Computing, Information Technology, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA; (S.R.); (N.P.)
| | - Kathleen Meaney
- School of Visual Arts, College of Architecture and Urban Studies, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA;
| | - Eloise Coupey
- Department of Marketing, Pamplin College of Business, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA;
| | - Elena Serrano
- Department of Human Nutrition, Foods, and Exercise, College of Agriculture and Life Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA; (E.S.); (V.E.H.); (V.K.)
| | - Valisa E. Hedrick
- Department of Human Nutrition, Foods, and Exercise, College of Agriculture and Life Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA; (E.S.); (V.E.H.); (V.K.)
| | - Fabio da Silva Gomes
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, World Health Organization, Washington, DC 20037, USA;
| | - Nicholas Polys
- Advanced Research Computing, Information Technology, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA; (S.R.); (N.P.)
| | - Vivica Kraak
- Department of Human Nutrition, Foods, and Exercise, College of Agriculture and Life Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA; (E.S.); (V.E.H.); (V.K.)
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Carneiro LBV, Castro IRRD, Juvanhol LL, Gomes FDS, Cardoso LDO. Associação entre insegurança alimentar e níveis de hemoglobina e retinol em crianças assistidas pelo Sistema Único de Saúde no Município do Rio de Janeiro, Brasil. CAD SAUDE PUBLICA 2020; 36:e00243418. [DOI: 10.1590/0102-311x00243418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/20/2019] [Indexed: 11/22/2022] Open
Abstract
Neste trabalho foi analisada a associação entre insegurança alimentar e níveis de hemoglobina e retinol em crianças de 6 a 59 meses de idade. Trata-se de um estudo seccional, realizado em 2014, com amostra representativa da população de crianças nessa faixa etária, atendidas em unidades básicas de saúde do Município do Rio de Janeiro, Brasil. Para a análise dos níveis de insegurança alimentar foi utilizada a Escala Brasileira de Insegurança Alimentar e, para a determinação de hemoglobina e de retinol sérico, foi realizada a punção venosa. A associação entre as variáveis foi avaliada por intermédio de modelos de regressão quantílica. Do total de crianças estudadas, 40,3% apresentavam insegurança alimentar e as prevalências de anemia e de deficiência de vitamina A foram 13,7% e 13%, respectivamente. Os resultados do estudo revelaram associação inversa, estatisticamente significativa, entre insegurança alimentar leve e níveis de retinol. Para os demais níveis de insegurança alimentar (moderada e grave), os resultados também sugerem a presença de associação inversa para hemoglobina e, quanto aos níveis de retinol, as estimativas pontuais parecem menores em crianças com insegurança alimentar grave, entretanto, estas estimativas não foram estatisticamente significativas. Esses resultados sugerem que a insegurança alimentar pode estar associada com carências de micronutrientes em crianças menores de 5 anos.
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da Silva ACF, Recine E, Johns P, Gomes FDS, Ferraz MDA, Faerstein E. History and challenges of Brazilian social movements for the achievement of the right to adequate food. Glob Public Health 2018; 14:875-883. [DOI: 10.1080/17441692.2018.1439516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Elisabetta Recine
- Observatory of Food and Nutrition Security Policies, Department of Nutrition, University of Brasilia, Brasília, Brazil
| | - Paula Johns
- ACT Health promotion, Rio de Janeiro, Brazil
| | - Fabio da Silva Gomes
- Department of Noncommunicable Diseases and Mental Health, Pan-American Health Organization/World Health Organization, Washington, DC, USA
| | | | - Eduardo Faerstein
- Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Gomes FDS, Silva GAE, Castro IRRD. Aquisição domiciliar de refrigerantes e de biscoitos reduz o efeito de uma intervenção de promoção de frutas e hortaliças. CAD SAUDE PUBLICA 2017; 33:e00023316. [DOI: 10.1590/0102-311x00023316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/30/2016] [Indexed: 11/22/2022] Open
Abstract
Resumo: O presente estudo examina a influência do aumento da disponibilidade intradomiciliar de refrigerantes e biscoitos sobre os efeitos de uma intervenção de promoção do consumo de frutas e hortaliças. Foram analisados os dados de 70 famílias que viviam em comunidades de baixa renda na cidade do Rio de Janeiro, Brasil, que foram selecionadas por meio de uma amostra probabilística estratificada e completaram registro alimentar de 30 dias antes e depois da intervenção. A intervenção contribuiu para um aumento significativo na disponibilidade intradomiciliar de frutas e hortaliças (+2,7 p.p.; IC95%: 1,5; 4,0), superando a tendência de estagnação na população brasileira. Já a aquisição de refrigerantes e biscoitos, que não foi objeto da intervenção, acompanhou a tendência crescente de consumo destes produtos (+5,8 p.p.; IC95%: 3,3; 8,4). As famílias que aumentaram a aquisição de refrigerantes e biscoitos apresentaram menores aumentos, ou decréscimos, na aquisição de frutas e hortaliças (p < 0,05) e tiveram uma chance quase quatro vezes menor de experimentar algum aumento na disponibilidade intradomiciliar de frutas e hortaliças.
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Romieu I, Margetts B, Barquera S, Gomes FDS, Gunter M, Hwalla N, Kampman E, Leitzmann M, Potischman N, Slimani N, Vorster E, Willett WC, Winichagoon P, Wiseman M. Strengthening the evidence base for nutrition and cancer in low and middle income countries. J Glob Health 2016; 6:020306. [PMID: 27606056 PMCID: PMC5012230 DOI: 10.7189/jogh.06.020306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Isabelle Romieu
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Barrie Margetts
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Simón Barquera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Fabio da Silva Gomes
- Food, Nutrition and Cancer Division, National Cancer Institute of Brazil (INCA), Rio de Janeiro, Brazil
| | - Marc Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Nahla Hwalla
- Faculty of Agricultural & Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Ellen Kampman
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Michael Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Nancy Potischman
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Nadia Slimani
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Este Vorster
- Centre of Excellence for Nutrition (CEN), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Walter C. Willett
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | | | | | - for the International Cancer Research Funders Nutrition Working Group
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
- Food, Nutrition and Cancer Division, National Cancer Institute of Brazil (INCA), Rio de Janeiro, Brazil
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Faculty of Agricultural & Food Sciences, American University of Beirut, Beirut, Lebanon
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
- Centre of Excellence for Nutrition (CEN), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
- Institute of Nutrition, Mahidol University Salaya, Nakhon Pathom, Thailand
- World Cancer Research Fund International, London, UK
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Affiliation(s)
- Fabio da Silva Gomes
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brasil
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Burlandy L, Alexandre VP, Gomes FDS, Castro IRRD, Dias PC, Henriques P, Carvalho CMPD, Castro Júnior PCPD. Políticas de promoção da saúde e potenciais conflitos de interesses que envolvem o setor privado comercial. Ciênc saúde coletiva 2016; 21:1809-18. [DOI: 10.1590/1413-81232015216.06772016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/16/2016] [Indexed: 11/22/2022] Open
Abstract
Resumo O estudo analisou os potenciais conflitos de interesses (CDI) que envolvem o setor privado comercial no âmbito das políticas de promoção da saúde (PS), especialmente em sua interface com o campo da alimentação e nutrição no Brasil. Consideraram-se as influências do ideário internacional nesse processo e, para tal, foram analisadas as duas edições da Política Nacional de Promoção da Saúde (2006 e 2014) e os pactos internacionais que as subsidiaram. O estudo pautou-se em método de análise documental, considerando as seguintes dimensões e categorias de análise: na dimensão do ideário da PS foram identificados os enfoques, os princípios e as estratégias propostos; na dimensão dos CDI foram identificadas a abordagem do tema nos documentos, as relações com o setor privado comercial, e as propostas denominadas “parcerias público-privado”. Concluiu-se que a abordagem de CDI ainda é frágil nessas políticas. O debate é despolitizado quando não são explicitadas as assimetrias de poder entre os setores envolvidos nas relações público-privado, ou quando são desconsideradas as práticas do setor privado comercial que ferem objetivos, princípios e valores das políticas de PS.
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Azevedo e Silva G, de Rezende LFM, Gomes FDS, de Souza Júnior PRB, Szwarcwald CL, Eluf Neto J. Lifestyle among former cancer patients in Brazil in 2013. Cien Saude Colet 2016; 21:379-88. [PMID: 26910146 DOI: 10.1590/1413-81232015211.24722015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 12/02/2015] [Indexed: 12/15/2022] Open
Abstract
People who have been diagnosed with cancer tend to adopt healthier lifestyles. This study analyzes the prevalence of smoking, eating fruits and vegetables, exercise and the use of alcoholic beverages among individuals who reported to have been diagnosed with cancer in the PNS (Pesquisa Nacional de Saúde or National Health Survey). The prevalence and corresponding 95% confidence intervals were calculated for consuming fruits and vegetables, sedentary lifestyle (no exercise), use of alcoholic beverages, being overweight and tobacco use. The associa-tion between having received a diagnosis of cancer and the risk and protection factors was analyzed using a Poisson regression, adjusted by sociodemographic variables and other chronic comorbidities. The analyses were stratified by time since the diagnosis and the type of cancer related to the factors analyzed. The types of cancer most often reported were breast and cervix in women, and prostate and stomach in men. Among those who had cancer diagnoses, there was a higher consumption of fruits and vegetables, higher proportion of ex-smokers, however, increased use of alcohol. There was no difference in the frequency of exercise or incidence of being overweight between the two groups. Measures to promote health and prevent chronic diseases should be implemented in the follow-up of people who have had cancer, in an effort to ensure integrated healthcare.
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Affiliation(s)
- Gulnar Azevedo e Silva
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil,
| | | | | | | | - Celia Landman Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Ministério da Saúde, Rio de Janeiro, RJ, Brasil
| | - José Eluf Neto
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brasil
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Azevedo e Silva G, de Moura L, Curado MP, Gomes FDS, Otero U, de Rezende LFM, Daumas RP, Guimarães RM, Meira KC, Leite IDC, Valente JG, Moreira RI, Koifman R, Malta DC, Mello MSDC, Guedes TWG, Boffetta P. The Fraction of Cancer Attributable to Ways of Life, Infections, Occupation, and Environmental Agents in Brazil in 2020. PLoS One 2016; 11:e0148761. [PMID: 26863517 PMCID: PMC4749327 DOI: 10.1371/journal.pone.0148761] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/09/2015] [Indexed: 12/12/2022] Open
Abstract
Many human cancers develop as a result of exposure to risk factors related to the environment and ways of life. The aim of this study was to estimate attributable fractions of 25 types of cancers resulting from exposure to modifiable risk factors in Brazil. The prevalence of exposure to selected risk factors among adults was obtained from population-based surveys conducted from 2000 to 2008. Risk estimates were based on data drawn from meta-analyses or large, high quality studies. Population-attributable fractions (PAF) for a combination of risk factors, as well as the number of preventable deaths and cancer cases, were calculated for 2020. The known preventable risk factors studied will account for 34% of cancer cases among men and 35% among women in 2020, and for 46% and 39% deaths, respectively. The highest attributable fractions were estimated for tobacco smoking, infections, low consumption of fruits and vegetables, excess weight, reproductive factors, and physical inactivity. This is the first study to systematically estimate the fraction of cancer attributable to potentially modifiable risk factors in Brazil. Strategies for primary prevention of tobacco smoking and control of infection and the promotion of a healthy diet and physical activity should be the main priorities in policies for cancer prevention in the country.
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Affiliation(s)
- Gulnar Azevedo e Silva
- Instituto de Medicina Social, University of Rio de Janeiro State, Rio de Janeiro, Rio de Janeiro State, Brazil
| | - Lenildo de Moura
- Pan-Americana Health Organization, Brasília, Distrito Federal, Brazil
| | - Maria Paula Curado
- AC Camargo Cancer Center, Hospital AC Camargo, São Paulo, São Paulo State, Brazil
- International Prevention Research Institute, Lyon, France
| | - Fabio da Silva Gomes
- National Cancer Institute, Ministry of Health, Rio de Janeiro, Rio de Janeiro State, Brazil
| | - Ubirani Otero
- National Cancer Institute, Ministry of Health, Rio de Janeiro, Rio de Janeiro State, Brazil
| | | | - Regina Paiva Daumas
- National School of Public Health, Oswaldo Cruz Foundation, Ministry of Health, Rio de Janeiro, Rio de Janeiro State, Brazil
| | - Raphael Mendonça Guimarães
- Joaquim Venâncio Polytechnic School of Health, Oswaldo Cruz Foundation, Ministry of Health, Rio de Janeiro, Rio de Janeiro State, Brazil
| | - Karina Cardoso Meira
- Nursing School, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Iuri da Costa Leite
- National School of Public Health, Oswaldo Cruz Foundation, Ministry of Health, Rio de Janeiro, Rio de Janeiro State, Brazil
| | - Joaquim Gonçalves Valente
- National School of Public Health, Oswaldo Cruz Foundation, Ministry of Health, Rio de Janeiro, Rio de Janeiro State, Brazil
| | - Ronaldo Ismério Moreira
- National Institute of Infectolgy, Oswaldo Cruz Foundation, Ministry of Health, Rio de Janeiro, Rio de Janeiro State, Brazil
| | - Rosalina Koifman
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, São Paulo State, Brazil
| | | | | | | | - Paolo Boffetta
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
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Remédios JLD, Cardoso LDO, Gomes FDS, Wahrlich V, Castro IRRD. Percentis para o perímetro de cintura de adolescentes do município do Rio de Janeiro. REV NUTR 2015. [DOI: 10.1590/1415-52732015000300004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Descrever o perímetro da cintura e apresentar estimativas de pontos críticos para classificação de risco e alto risco de excesso de gordura abdominal segundo sexo e faixa etária. MÉTODOS: Foi estudada uma amostra probabilística de adolescentes (n=3 . 175) da rede pública de ensino do Rio de Janeiro. O perímetro da cintura foi aferido no ponto médio entre a borda inferior da costela e a crista ilíaca. Os percentis de perímetro da cintura estudados foram estimados segundo método LMS (Lambda, Mu, Sigma) proposto por Cole em 1990. Os pontos de corte adotados para definição de risco e alto risco de excesso de gordura abdominal foram os propostos por Jolliffe & Janssen em 2007. RESULTADOS: Comparando os valores estimados, meninas apresentaram valores de perímetro da cintura maiores que os de meninos para todos os percentis (exceto para o P90) em todas as idades. Os valores críticos estimados foram menores entre as meninas e aumentaram com a idade em ambos os sexos. Em geral, para ambos os sexos, os valores estimados foram menores do que os propostos pela referência adotada. CONCLUSÃO: Os achados ratificam a importância da aferição dessa medida em adolescentes, sendo apresentados pontos críticos de perímetro da cintura para classificação antropométrica desse grupo populacional segundo essa medida, o que até o momento não havia sido proposto com base em dados de adolescentes brasileiros.
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Brito A, Cabrera A, da Silva Gomes F, Crispim SP, Jáuregui A, Kanter R, Chamorro R, Schlüssel MM, Chávez R, Ríos-Castillo I, Kroker MF, Defagó MD, Chacón AV, Gatica G, Natero MV, Arango C, Mejicano AG, Masi CA, Roldán EI, Hernández ME, López JR, Carrasco M, Peña LA, Viera C. VI Latin American Workshop on Leadership in Nutrition, Cuba 2012: The first harvest. Nutrition 2014; 30:369-70. [DOI: 10.1016/j.nut.2013.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 08/14/2013] [Accepted: 08/18/2013] [Indexed: 10/25/2022]
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Levy RB, Castro IRRD, Cardoso LDO, Tavares LF, Sardinha LMV, Gomes FDS, Costa AWND. Consumo e comportamento alimentar entre adolescentes brasileiros: Pesquisa Nacional de Saúde do Escolar (PeNSE), 2009. Ciênc saúde coletiva 2010; 15 Suppl 2:3085-97. [DOI: 10.1590/s1413-81232010000800013] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 08/05/2010] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste artigo é descrever características de consumo e comportamento alimentar de adolescentes brasileiros e sua associação com fatores sociodemográficos. Estudou-se, em 2009, amostra representativa de alunos do 9º ano do ensino fundamental de escolas públicas e privadas das 26 capitais brasileiras e do Distrito Federal. Utilizou-se questionário autoaplicável sobre atributos sociodemográficos, consumo e comportamento alimentar, entre outros. Estimativas dos indicadores construídos foram apresentadas para o total da população e por sexo. A associação de cada um dos indicadores com variáveis sociodemográficas foi examinada por meio de regressão logística. A maioria dos adolescentes consumia regularmente feijão (62,6%), leite (53,6%) e guloseimas (50,9%), realizava pelo menos o almoço ou o jantar com a mãe ou responsável (62,6%) e comia assistindo televisão ou estudando (50,9%). Em geral, as meninas estavam mais expostas a práticas alimentares não desejáveis, e o melhor nível socioeconômico associou-se a maiores prevalências dos indicadores estudados. Os resultados revelaram consumo regular dos marcadores de alimentação não saudável e consumo inferior ao recomendado dos de alimentação saudável, apontando a necessidade de ações de promoção de saúde dirigidas a jovens.
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Abstract
A antropometria tem sido apontada como o parâmetro mais indicado para avaliar o estado nutricional coletivo. A avaliação nutricional coletiva de adolescentes possui uma dinâmica muito peculiar por se tratar de um momento de intensas mudanças fisiológicas e psicossociais, diretamente associadas à dinâmica nutricional deste grupo. O acompanhamento dessa dinâmica e de suas variáveis intervenientes e interativas é, portanto, um tema de discussão extremamente relevante. Esta revisão tem por objetivo apresentar as aplicações de parâmetros antropométricos à avaliação do estado nutricional de adolescentes. Conclui-se que, enquanto não houver metodologia simples de avaliação da composição corporal, para estudos epidemológicos deve-se manter o uso do índice de massa corporal, associado ou não às variáveis de dobra cutânea e perímetros. Apesar das dificuldades e limitações, as evidências apontam para uma fundamental incorporação das informações sobre a maturação sexual à avaliação do estado nutricional coletivo de adolescentes. Além disso, as investigações devem atentar mais aos parâmetros de definição da população que estará sendo estudada, cuidando, para permitir a comparação entre os estudos.
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Affiliation(s)
- Fabio da Silva Gomes
- Fundação Instituto Brasileiro de Geografia e Estatística, Brasil; Instituto Nacional de Câncer, Brasil
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Gomes FDS, Anjos LAD, Vasconcellos MTLD. Associação entre o estado nutricional antropométrico e a situação sócio-econômica de adolescentes em Niterói, Rio de Janeiro, Brasil. CAD SAUDE PUBLICA 2009; 25:2446-54. [DOI: 10.1590/s0102-311x2009001100014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Accepted: 07/29/2009] [Indexed: 11/21/2022] Open
Abstract
Investigou-se a relação entre o estado nutricional e a situação sócio-econômica familiar de adolescentes moradores de Niterói, Rio de Janeiro, Brasil. Os dados de 523 adolescentes, pertencentes a uma amostra probabilística de 1.734 domicílios, foram coletados entre janeiro e dezembro de 2003 e representam os 71.922 jovens residentes em Niterói. As análises incluíram a estimação de intervalos de confiança de razões de prevalência e testes de distribuições proporcionais e de independência entre classes de estado nutricional e classes de renda familiar per capita e as faixas de número de moradores do domicílio. Foi encontrada uma associação positiva significativa entre baixo peso/magreza e o número de moradores do domicílio (sexo masculino: p < 0,05; sexo feminino: p < 0,001). O número de moradores do domicílio encontra-se diretamente associado ao baixo peso/magreza em adolescentes. Foi evidenciada uma tendência positiva de aumento na proporção de adolescentes com sobrepeso/obesidade segundo os quintos de renda familiar per capita.
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Affiliation(s)
- Fabio da Silva Gomes
- Escola Nacional de Ciências Estatísticas, Brasil; Instituto Nacional de Câncer, Brasil
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Gomes FDS, Anjos LAD, Vasconcellos MTLD. Influence of different body mass index cut-off values in assessing the nutritional status of adolescents in a household survey. CAD SAUDE PUBLICA 2009; 25:1850-7. [DOI: 10.1590/s0102-311x2009000800021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 04/06/2009] [Indexed: 11/21/2022] Open
Abstract
The purpose of this study was to evaluate the anthropometric nutritional status of the adolescent population of Niterói, Rio de Janeiro State, Brazil, and the influence of changes in the adopted body mass index (BMI) cut-offs in the nutritional status assessment of the adolescent population. A population-based survey conducted in 2003 obtained data from a probabilistic sample of 1,734 households and 523 adolescents. The multiple proportions test and prevalence ratios were used to analyze differences between estimates obtained from different BMI cut-offs. Changes in cut-off values from the old to the new recommendation of the World Health Organization (WHO) resulted in a significant increase in overweight prevalence among total, male and female adolescent population (25%, 27% and 23%, respectively) (p < 0.05). There were significant increases in the prevalence of low-BMI-for-age among the total (29% increase) and male (39%) adolescent populations when the proposal of the International Obesity Task Force was compared to current WHO BMI-for-age cut-offs (p < 0.05). It is shown that a simple change in cut-off values used to define the anthropometric nutritional status can significantly modify the nutritional profile of an adolescent population.
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Abstract
Recomendações e prescrições de metas à população, muitas vezes, são construídas apenas com base em definições técnico-científicas, ignorando processos sócio-construtivos dos riscos que envolvem valores, percepções e experiências. Dessa forma, barreiras importantes podem dificultar o avanço de políticas de implementação dessas recomendações. Este artigo apresenta contribuições multidisciplinares à construção de recomendações e metas prescritas, essencialmente no que tange ao consumo de frutas, legumes e verduras, discutindo sobre algumas barreiras psicossociais e macro-estruturais para o consumo desses alimentos e suas implicações para as intervenções de base populacional. Assumindo um propósito reflexivo, o artigo conduz uma revisão crítica analisando a problemática em questão à luz de teorias estruturalistas sobre a construção social do risco. Recomendações e prescrições de metas definidas foram analisadas considerando o risco, seus determinantes sociais, componentes e conceitos agregados como fatores multidimensionais. Lições importantes extraídas da revisão incluem: 1) a necessidade de incorporar as contribuições populares à definição da agenda, conteúdo, estratégias de comunicação e implementação da política de alimentação; 2) a essencialidade da retomada dos aspectos não-nutricionais do alimento como componentes indispensáveis à valorização e promoção do consumo de frutas, legumes e verduras; e 3) a necessidade de adotar um conceito de alimentação saudável, que acompanhe a amplitude do conceito de saúde. A análise indica que as mensagens devem aproximar-se mais da valorização da cultura e tradição, evitando referências à alimentação saudável, essencialmente ou exclusivamente baseadas em nutrientes, doenças, longevidade e sofisticação.
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Affiliation(s)
- Fabio da Silva Gomes
- Ministério da Saúde, Brasil; Instituto Brasileiro de Geografia e Estatística, Brasil
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Abstract
Este artigo discute as possibilidades de proteção contra o desenvolvimento do câncer, proporcionadas por carotenóides provenientes da alimentação, com base em uma revisão da literatura. Os carotenóides têm demonstrado uma ação protetora contra a carcinogênese, tanto em estudos in vitro como in vivo, com animais e humanos. Entre eles, a beta-criptoxantina, a fucoxantina, a astaxantina, a capsantina, a crocetina e o fitoeno, têm sido pouco explorados, e a literatura ainda se mostra extremamente limitada e pouco conclusiva. Estudos experimentais com humanos demonstraram não haver efeito, ou efeito reverso, do beta-caroteno, no entanto, não incluíram anteriormente variáveis intervenientes e interativas que deveriam ter sido controladas. A partir da evidência científica, baseada em estudos epidemiológicos e ensaios experimentais recentes, e da elucidação dos mecanismos de atuação de fitoquímicos relacionados à maior proteção contra o câncer, conclui-se que a alimentação rica em carotenóides provenientes das frutas, legumes e verduras, representa um possível fator de proteção contra o desenvolvimento do câncer.
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