Excesso de peso, ambiente percebido e privação social: um estudo da percepção de pais ou responsáveis / Overweight, perceived environment, and social deprivation: a study on the perception of parents or guardians

RESUMO Objetivo: Investigar a percepção de pais ou responsáveis sobre a proximidade residencial a locais de venda de alimentos, de lazer e de atividade física segundo a privação social da vizinhança e testar associações do ambiente percebido com o excesso de peso de seus filhos. Métodos: Estudo transversal conduzido com 408 crianças e adolescentes (6 a 15 anos de idade) de escolas públicas de um município de médio porte brasileiro. A coleta de dados ocorreu de 2011 a 2014. Foram determinados a presença de excesso de peso e o tempo de deslocamento da residência dos participantes aos locais avaliados, questionados durante entrevista telefônica com instrumento de pesquisa estruturado. O indicador de privação social adotado foi o Índice de Vulnerabilidade da Saúde. Modelos de regressão logística foram construídos para predizer a proximidade percebida (privação social como variável explicativa) e para avaliar os fatores do ambiente percebido (variáveis explicativas) associados ao excesso de peso (desfecho). Resultados: Moradores de áreas com maior vulnerabilidade social apresentaram chances de percepção de proximidade 50 a 71% menores para supermercados, feiras/sacolões, parques, áreas de lazer/centros comunitários e academias de ginástica, quando comparados a residentes de áreas com menor vulnerabilidade. A percepção de proximidade a parques reduziu em 73% a chance de excesso de peso em crianças e adolescentes, com Odds Ratio (OR) de 0,27 (IC95% 0,07-0,95; p<0,05). Conclusões: A percepção ambiental sobre a infraestrutura da área residencial pode estar relacionada com a privação social da vizinhança e a presença de excesso de peso em crianças e adolescentes.

ABSTRACT Objective: To investigate parents' or guardians' perception of their residential proximity to food retailers, leisure areas, and spaces for physical activity according to neighborhood social deprivation, and test associations between the perceived environment and their children's overweight. Methods: Cross-sectional study conducted with 408 children and adolescents (6- to 15-year-olds) attending public schools in a medium-sized Brazilian city. Data were collected from 2011 to 2014. A telephone interview using a structured research tool determined the presence of overweight and the walking time between the participants' home and the places evaluated. The indicator of social deprivation adopted was the Health Vulnerability Index. Logistic regression models were constructed to predict the perception of proximity (social deprivation as an explanatory variable) and evaluate perceived environmental factors (explanatory variables) associated with overweight (outcome). Results: Residents of areas with higher social vulnerability showed a probability of perceived proximity 50 to 71% lower to supermarkets, street/produce markets, parks, recreation areas/community centers, and gyms compared to residents of less vulnerable areas. The perceived proximity to parks reduced the chance of overweight in children and adolescents in 73%, with an odds ratio (OR) of 0.27 (95%CI 0.07-0.95; p<0.05). Conclusions: The perceived environment of the residential area infrastructure might be related to neighborhood social deprivation and the presence of overweight in children and adolescents.

The food environment of Brazilian public and private schools / O ambiente alimentar das escolas públicas e privadas no Brasil / El ambiente alimentario de las escuelas públicas y privadas en Brasil

Abstract: This study's aim was to characterize the food environment of Brazilian public and private schools. This was a national school-based cross-sectional study with 1,247 schools - among which 81.09% were public and 18.91% were private - in 124 Brazilian municipalities. The data originated from the Questionnaire on Aspects of the School Environment, used in the Study of Cardiovascular Risk in Adolescents (ERICA) in 2013 and 2014. Data analysis was conducted in 2017. The chi-square test was used to compare proportions. A greater proportion of public schools offered school meals (98.15%) in comparison to private schools (8.07%) (p < 0.001). The internal sale of food and beverages was more prevalent in private schools (97.75% vs. 45.06%, p < 0.001). Also, sale and advertisement of processed and ultra-processed foods (sodas, cookies, savory snacks, sandwiches and pizza), as well as the presence of vending machines for industrialized products (18.02% vs. 4%) (p < 0.001) were more common in private schools. Street vendors at the school gate or surroundings were identified in 41.32% of the public schools and 47.75% of the private schools (p > 0.05). These findings reveal the predominance of obesogenic environments mainly in private schools, and can contribute to the design of Brazilian public policies to promote a healthy school food environment.

Resumo: O estudo teve como objetivo caracterizar o ambiente alimentar das escolas públicas e privadas no Brasil. Este foi um estudo transversal nacional de base escolar com 1.247 escolas (81,09% públicas e 18,91% privadas) em 124 municípios brasileiros. Os dados foram obtidos do Questionário sobre Aspectos do Ambiente Escolar utilizado no Estudo de Riscos Cardiovasculares em Adolescentes (ERICA) em 2013 e 2014. Os dados foram analisados em 2017. O teste do qui-quadrado foi usado para comparar as proporções. Proporcionalmente mais escolas públicas ofereciam refeições escolares (98,15%), em comparação com as escolas privadas (8,07%) (p < 0,001). A venda de alimentos e bebidas no ambiente escolar interno era mais prevalente nas escolas privadas (97,75% vs. 45,06%, p < 0,001). Além disso, a propaganda e venda de alimentos processados e ultra-processados (refrigerantes, biscoitos, salgadinhos, sanduiches e pizza) também eram mais comuns nas escolas privadas, assim como, a presença de máquinas de autoatendimento com venda de produtos industrializados (18,02% vs. 4%) (p < 0,001). Os vendedores ambulantes no portão ou nos arredores da escola foram identificados em 41,32% das escolas públicas e 47,75% das escolas privadas (p > 0,05). Os achados revelam a predominância de ambientes obesogênicos, especialmente nas escolas privadas, e podem contribuir para a elaboração de políticas públicas brasileiras para promover um ambiente alimentar saudável nas escolas.

Resumen: El objetivo de este estudio fue caracterizar el ambiente alimentario de las escuelas públicas y privadas en Brasil. Se trata de un estudio transversal nacional con base escolar, en 1.247 escuelas (81,09% públicas y 18,91% privadas), de 124 municipios brasileños. Los datos se obtuvieron del Cuestionario sobre Aspectos del Ambiente Escolar, utilizado en el Estudio de Riesgos Cardiovasculares en Adolescentes (ERICA) en 2013 y 2014. Los datos fueron analizados en 2017. El test de chi-cuadrado se usó para comparar las proporciones. Proporcionalmente, más escuelas públicas ofrecían comidas escolares (98,15%), en comparación con las escuelas privadas (8,07%) (p < 0,001). La venta de alimentos y bebidas en el ambiente interno escolar era más prevalente en las escuelas privadas (97,75% vs. 45,06%, p < 0,001). Además, la propaganda y venta de alimentos procesados y ultraprocesados (refrescos, galletas, aperitivos, sándwiches y pizza) también eran más comunes en las escuelas privadas, así como la presencia de máquinas de autoservicio con venta de productos industrializados (18,02% vs. 4%) (p < 0,001). Los vendedores ambulantes a la puerta de la escuela o en los alrededores de la escuela fueron identificados en un 41,32% de las escuelas públicas y 47,75% de las escuelas privadas (p > 0,05). Los hallazgos revelan la predominancia de ambientes obesogénicos, especialmente en las escuelas privadas, y pueden contribuir a la elaboración de políticas públicas brasileñas para promover un ambiente alimentario saludable en las escuelas.

Perceptions of neighborhood environments and their association with overweight in children, adolescents, and caretakers in a medium-sized city in Brazil

Background: Previous studies conducted in developed countries have suggested associations between perceptions of neighborhood characteristics and weight gain. However, there are few studies regarding the adult perception of the residential environment and overweight in children and adolescents in countries with low and medium income. The aim of the study was to assess the associations between caretakers'perceptions of environmental characteristics and overweight in themselves and in their children, in a medium-sized city in Brazil. Methods: Cross-sectional study was performed with 708 children and adolescents and their caretakers. Anthropometric measurements and a structured questionnaire filled out by caretakers concerning child and family characteristics were completed. For environmental assessment, 408 caretakers answered the Portugues eversion of the"Neighborhood Environment Walkability Scale"by telephone call. A 95% confidence interval (95%CI)was used in the analysis. Unadjusted prevalence ratios (PR) were calculated, as were PR adjusted for age, gender, family income, and total time of exercise the children or adolescents practiced (from Poisson regression models predicting children's and adolescents'overweight), and for age and family income (from Poisson regression models predicting caretakers'overweight). Statistical significance was defined as ap value <0.05.Results:Adult perceptions about the absence of sidewalks on most streets (PR = 0.49, 95%CI = 0.42­0.98) and the absence of interesting things to look at (esthetics) in the neighborhood (PR = 0.65, 95%CI = 0.44­0.90) were inversely associated with the prevalence of overweight in the children and adolescents after adjustment. The absence of hillsin the neighborhood (PR = 1.24, 95%CI = 1.05­1.45) and the perception of heavy exhaust fumes (PR = 1.26, 95%CI =1.02­1.56) were directly associated with the prevalence of overweight in the caretakers. Finally, the high speed of traffic on the street (PR = 0.76, 95%CI = 0.63­0.92) was inversely associated with the prevalence of adult overweight. Conclusions: The results showed, in Brazil, the importance of understanding aspects related to obesogenic environment in the context of medium-sized Brazilian cities.

Consumo alimentar e síndrome metabólica em adolescentes / Dietary consumption and metabolic syndrome in adolescents

OBJETIVOS: Determinar a prevalência de síndrome metabólica em adolescentes e comparar o consumo alimentar dos indivíduos com e sem a síndrome. MÉTODOS: Foi conduzido um estudo transversal com adolescentes de 15 a 17 anos de idade, matriculados em escolas públicas e privadas do município de Juiz de Fora, Minas Gerais, Brasil. Utilizou-se o índice de massa corporal para determinar o estado nutricional, classificado de acordo com a Organização Mundial de Saúde. A medida de circunferência da cintura foi aferida segundo Petroski 2003. Para o diagnóstico da síndrome metabólica foram coletados dados de triglicerídeos, colesterol ligado à lipoproteína de alta densidade, glicemia de jejum e pressão arterial e utilizados os critérios da International Diabetes Federation. Para a avaliação dietética utilizou-se um registro alimentar de três dias não consecutivos. Na análise estatística para a associação entre os grupos, foram usados os testes qui quadrado e exato de Fisher e os testes t de Student (teste paramétrico) ou Mann Whitney (não paramétrico). RESULTADOS: Foram avaliados 302 adolescentes, sendo 51,99% do sexo masculino e 73,51% estudantes de escolas públicas A prevalência de obesidade foi de 27,48% e a de síndrome metabólica de 3,97%, sendo esta de 4,83% entre as meninas e 3,18% entre os meninos (p=0,46). A prevalência de síndrome metabólica entre os alunos de escolas públicas foi de 4,50% e entre os de escolas privadas de 2,50% (p=0,73). Na comparação entre os grupos com e sem a síndrome, não foram observadas diferenças estatísticas significativas na adequação calórica e de micronutrientes, exceto de vitamina D (p=0,01). Verificou-se que os adolescentes com síndrome metabólica consumiam menos vitamina D do que aqueles sem a síndrome. CONCLUSÕES: A prevalência de síndrome metabólica encontrada foi relevante, considerando-se sua complexidade, gravidade e a faixa etária em estudo. Detectou-se menor ingestão de vitamina D entre os adolescentes com síndrome metabólica.

AIMS: To determine the prevalence of metabolic syndrome in adolescents and to compare the dietary intake of individuals with and without the syndrome. METHODS: A cross-sectional study was conducted with adolescents aged 15 to 17 years, enrolled in public and private schools in Juiz de Fora, Minas Gerais, Brazil. Body mass index was used to determine the nutritional status, classified according to the World Health Organization. Waist circumference was measured according to Petroski (2003). Triglyceride, high-density lipoprotein cholesterol, fasting blood glucose, and blood pressure were assessed and the International Diabetes Federation criteria were used for the diagnosis of metabolic syndrome. A non-consecutive 3-day food record was used for dietary assessment. The chi-square test, Fisher's exact test, Student's parametric t test or the Mann-Whitney U test were used for associations between the groups. RESULTS: A total of 302 adolescents ­ 51.99% males and 73.51% from public schools ­ were evaluated. The prevalence of obesity was 27.48% and that of metabolic syndrome was 3.97%; 4.83% among girls and 3.18% among boys (p=0.46). The prevalence of metabolic syndrome among public school students was 4.50% compared with 2.50% (p=0.73) among those from private schools. In the comparison between the groups with and without metabolic syndrome, there were no statistically significant differences in dietary energy and micronutrient adequacy, except for vitamin D (p=0.01). Adolescents with metabolic syndrome consumed less vitamin D than those without the syndrome. CONCLUSIONS: The prevalence of metabolic syndrome was found to be relevant considering its complexity, severity, and the age group studied. Lower vitamin D intake was observed among adolescents with metabolic syndrome

Assessing the nutritional information for children younger than two years old available on popular websites / Avaliação das informações nutricionais referentes às crianças de até dois anos disponíveis em sites populares

OBJECTIVE: To analyze whether the information found on popular Internet sites are in accordance with the steps recommended by the Food Guide for Children Younger than Two Years of the Ministry of Health (2010). METHODS: Descriptive/comparative study, carried out between August and October 2014, which carried out a search for popular sites (for lay people) in Portuguese, containing information on nutrition of children younger than two years. The Google search engine was used. These findings were compared with the Food Guide for Children Younger than Two Years of the Ministry of Health (2010). It was verified whether the information shown on the websites was in accordance with the Guide. RESULTS: A total of 50 sites were analyzed, including blogs, food company websites and websites specialized in child nutrition. Only 10% of those pages correctly showed every step of the Food Guide. The recommendations were: exclusive breastfeeding up to six months of life (80%); complementary feeding from six months of life (36%); baby food consistency according to the guide (48%); encouraging the consumption of fruits and vegetables daily (60%). Regarding the complementary feeding safety and hygiene, 26% contained correct information. Only 36% correctly warned about which foods should be avoided in the first years of life. CONCLUSIONS: The information found on the sites is largely in disagreement with the Ministry of Health recommendations, which can lead to misconceptions in the nutritional care of the children younger than two years.

OBJETIVO: Analisar se as informações veiculadas em sites populares estão de acordo com os passos recomendados no Guia Alimentar para Crianças Menores de Dois Anos do Ministério da Saúde (2010). MÉTODOS: Estudo descritivo/comparativo, executado entre agosto e outubro de 2014, no qual foi feita uma busca por sites populares (para leigos) na língua portuguesa que continham informações sobre a alimentação de crianças menores de dois anos. A ferramenta de busca usada foi o Google. As informações encontradas foram comparadas com o Guia Alimentar para Crianças Menores de Dois Anos do Ministério da Saúde (2010). Foi verificado nos sites se a informação apresentada estava de acordo com o Guia. RESULTADOS: Foram analisados 50 sites, entre os quais blogs, sites de empresas alimentícias e sites especializados em nutrição infantil. Apenas 10% dessas páginas apresentaram corretamente todos os passos do Guia Alimentar. As recomendações foram: aleitamento materno exclusivo até o sexto mês (80%); alimentação complementar a partir dos 6 meses de vida (36%); consistência da papa salgada de acordo com o Guia (48%); incentivo ao consumo de frutas, verduras e legumes diariamente (60%). Sobre a segurança e a higiene da alimentação complementar, 26% continham informações corretas. Somente 36% alertavam corretamente sobre quais alimentos devem ser evitados nos primeiros anos de vida. CONCLUSÕES: As informações contidas nos sites apresentam, em grande parte, discordância com o que é preconizado pelo Ministério da Saúde, o que pode acarretar equívocos no cuidado nutricional com os menores de dois anos.