Social inequities in the food retail patterns around schools in Recife, Brazil / Desigualdades sociais no padrão do varejo de alimentos no entorno de escolas em Recife, Brasil

Abstract This study aimed to describe the community food environment surrounding schools and its association with territorial socio-environmental vulnerability in the city with the highest intraurban social inequity index in Brazil. Methods: this ecological observational study includes data on the presence and type of food retail in a 400 m buffer surrounding public and private schools in Recife. We have also described the Health Vulnerability Index (HVI) of census tracts and conducted multivariate analyses. Results: through factor analysis, we observed two grouping patterns of food retail. The "diverse food outlets" pattern was positively associated with middle HVI (β 0.14, 95% confidence interval [CI] - 0.11; 0.16) and higher HVI areas (β 0.15, 95%CI - 0.11; 0.17), while "the large food retail chains" pattern was inversely associated with middle HVI (β -0.42, 95% CI - 0.53; -0.30) and high HVI areas (β -0.32, 95%CI - 0.45; -0.18) and positively associated with private schools (β 0.15, 95%CI - 0.030; 0.27). Conclusion: the greatest variety in food retail is in high HVI areas, and large food retail chains prevail around private schools, especially in low HVI areas.

Resumo Este trabalho objetivou descrever o ambiente alimentar comunitário no entorno das escolas e sua associação com a vulnerabilidade socioambiental territorial na cidade com maior índice de desigualdade social intraurbana do Brasil. Métodos: estudo ecológico observacional, inclui dados sobre a presença e o tipo de varejo de alimentos em uma área de 400 m no entorno de escolas públicas e privadas de Recife. Descrevemos o Índice de Vulnerabilidade à Saúde (IVS) dos setores censitários e realizamos análises multivariadas. Resultados: por meio da análise fatorial, observamos dois padrões de agrupamento de estabelecimentos. O padrão "Diversos pontos de venda de alimentos" foi associado positivamente com IVS médio (β 0,14; intervalo de confiança [IC] 95% - 0,11; 0,16) e áreas de IVS mais alto (β 0,15; IC95% - 0,11; 0,17), enquanto o padrão "Grandes redes varejistas de alimentos" foi inversamente associado às áreas de IVS médio (β -0,42; IC95% - 0,53; -0,30) e alto IVS (β -0,32; IC95% - 0,45; -0,18) e positivamente associado com escolas particulares (β 0,15; IC95% - 0,030; 0,27). Conclusão: a maior variedade de estabelecimentos está em áreas de alto IVS, e grandes redes varejistas de alimentos predominam no entorno de escolas particulares, especialmente em áreas de baixo IVS.

Adherence to school meals and co-occurrence of the healthy and unhealthy food markers among Brazilian adolescents / Adesão à alimentação escolar e coocorrência dos marcadores de alimentação saudável e não saudável entre adolescentes brasileiros

Abstract The aim of this study was to analyze the association between adherence to school meals and the co-occurrence of the regular consumption of healthy and unhealthy eating markers among Brazilian adolescents. Data from 67,881 adolescents in Brazilian public schools who participated in the 2015 National School Health Survey, were used. From the 7-day FFQ, the dependent variable was constructed, co-occurrence of regular consumption (≥ 5x/week) of healthy and unhealthy food markers, which was categorized as regular consumption of none, one or two, or three eating markers. We performed an ordinal logistic regression with adjustment for sociodemographic, eating habits outside of school, and school characteristics variables. The prevalence of the co-occurrence of the regular consumption of three healthy eating markers was 14.5%, and that of three unhealthy markers was 4.9%. High adherence to school meals (every day) was positively associated with regular consumption of healthy eating markers and inversely associated with regular consumption of unhealthy eating markers. The school meals provided by PNAE contribute to the promotion of healthy eating habits among Brazilian adolescents.

Resumo Este estudo tem como objetivo analisar a associação entre a adesão à alimentação escolar e a coocorrência do consumo regular de marcadores de alimentação saudável e não saudável entre adolescentes brasileiros. Foram avaliados 67.881 adolescentes de escolas públicas brasileiras participantes da Pesquisa Nacional de Saúde do Escolar (PeNSE) de 2015. A partir do QFA de sete dias, construiu-se a variável dependente, coocorrência do consumo regular (≥ 5x/semana) de marcadores de alimentação saudável e não saudável, que foi categorizada em consumo regular de nenhum; um ou dois; ou três marcadores de alimentação. Realizou-se regressão logística ordinal com ajuste para variáveis sociodemográficas, hábitos alimentares fora da escola e características da escola. A prevalência da coocorrência do consumo regular de três marcadores de alimentação saudável foi de 14,5%, e de três marcadores de alimentação não saudável foi de 4,9%. A alta adesão à alimentação escolar (todos os dias) foi positivamente associada ao consumo regular de marcadores de alimentação saudável e inversamente associada ao consumo regular de marcadores de alimentação não saudável. A alimentação escolar fornecida pelo PNAE contribui para a promoção de hábitos alimentares saudáveis entre os adolescentes brasileiros.

Desenvolvimento e validação de indicadores de desempenho da gestão do Programa Nacional de Alimentação Escolar / Development and validation of performance indicators of the National School Food Program management

Resumo A avaliação do Programa Nacional de Alimentação Escolar (PNAE) é ação estratégica para garantir a qualidade da gestão. O objetivo deste estudo é desenvolver e validar um instrumento de indicadores de desempenho para avaliação da gestão do PNAE no contexto nacional. Trata-se de um estudo psicométrico de construção e validação de indicadores de desempenho. Foram estabelecidos 12 indicadores, posteriormente, avaliados em painel de especialistas em relação a sete atributos. Para obter consenso foi utilizada a técnica Delphi e a validade de conteúdo foi analisada com a Razão de Validade de Conteúdo. Para a validade de constructo e confiabilidade, nutricionistas que trabalham na execução do PNAE avaliaram a relevância dos indicadores respondendo um questionário online. A taxa de resposta dos especialistas na primeira rodada da técnica Delphi foi de 43,3% (13/30) e de 69,2% (9/13) na segunda rodada. Um novo indicador foi desenvolvido após a avaliação do painel de especialistas. Um total de 281 nutricionistas participaram do estudo da relevância dos indicadores. No geral, a validade de conteúdo e constructo foi alcançada para 13 indicadores. Todos os 13 indicadores se apresentaram relevantes, com potencial para promover a avaliação da gestão operacional do PNAE.

Abstract The evaluation of the National School Food Program (PNAE) is a strategic action to ensure the quality of management. This study aims to develop and validate an instrument of performance indicators to assess the management of the PNAE in the national context. A psychometric study was carried out for the development and validation of performance indicators. Twelve indicators were subsequently established and evaluated by an expert panel concerning seven attributes. The Delphi technique was used for the consensus of the expert panel, and the content validity of the indicators was analyzed with the Content Validity Ratio. Nutritionists working on the implementation of the PNAE assessed the relevance of the indicators by answering an online questionnaire to construct validity and reliability. Thirteen (43.3%, 13/30) experts participated in the Delphi round 1 and nine (69.2%, 9/13) completed the Delphi round 2. A new indicator was developed after the experts' suggestions. Furthermore, 281 nutritionists participated in this study assessing the relevance of the indicators. Overall, content and construct validity were achieved for 13 indicators. All were considered relevant and had the potential to promote the assessment of PNAE operational management.

Inadequação de macro e micronutrientes oferecidos em duas escolas de tempo integral públicas no Nordeste do Brasil / Inadequacy of macro and micronutrients on offer in two full-time public schools in Northeastern Brazil

Resumo O Programa Nacional de Alimentação Escolar garante por meio da transferência de recursos financeiros a alimentação de alunos em escolas públicas e filantrópicas. Na adolescência, a boa nutrição é influenciada pelas taxas de crescimento físico e de alterações na composição corporal, sendo um período importante de vulnerabilidade nutricional. Objetivou-se analisar a adequação de macro e micronutrientes oferecidos aos adolescentes de escolas públicas de tempo integral no Nordeste do Brasil. Os cardápios foram avaliados utilizando os parâmetros para o atendimento de 70% das necessidades nutricionais diárias de macronutrientes e micronutrientes dos alunos beneficiários. Nota-se que, na maioria das faixas etárias, não houve o atendimento das necessidades energéticas, atingindo o percentual máximo de adequação de 86,2%. Houve adequação de proteínas em quatro dias apenas. O valor médio de carboidratos e lipídios estiveram abaixo do recomendado para todos os grupos etários. Os teores de Vitamina C, zinco e cálcio estiveram abaixo na maioria das preparações oferecidas. A quantidade de ferro foi alcançada em todas as faixas etárias. Conclui-se que deve haver um melhor planejamento na elaboração dos cardápios para tentar alcançar as necessidades previstas pelo Programa.

Abstract The National School Food Program guarantees the food of students in public and philanthropic schools by means of the transfer of funds. During adolescence, which is an important period of nutritional vulnerability, a healthy diet is responsible for the rates of physical growth and changes in body composition. The objective was to analyze the adequacy of macro- and micronutrients provided to adolescents in full-time public schools in northeastern Brazil. The menus were evaluated using the parameters to meet 70% of the daily nutritional needs in terms of macronutrients and micronutrients of the students involved. It was found that, for most age groups, energy requirements were not met, attaining the maximum adequacy of 86.2%, and protein ingestion was only sufficient on four days. The average amount of carbohydrates and lipids was below the recommended dose for all age groups. The levels of Vitamin C, zinc and calcium were insufficient in most of the meals on offer, though the iron quota was adequate for all age groups. The conclusion drawn is that enhanced planning needs to be incorporated in the preparation of menus to attempt to attain the requirements stipulated in the Program.

A noção de cultura alimentar em ações de educação alimentar e nutricional em escolas brasileiras: uma análise crítica / The notion of food culture in the actions of food and nutrition education in Brazilian schools: a critical analysis

Resumo O objetivo deste artigo é analisar criticamente como as compreensões a respeito da noção de cultura alimentar têm sido articuladas em artigos científicos sobre educação alimentar e nutricional (EAN) desenvolvidas em escolas brasileiras da educação básica. Para isso, fez-se um registro dos usos e aplicações desse conceito nos textos e leu-se criticamente as formas de relação propostas entre a inclusão da cultura alimentar no planejamento teórico-metodológico e a prática das ações analisadas. O artigo parte de uma pesquisa qualitativa de base documental. O escopo teórico da socioantropologia da alimentação serve de embasamento para sustentar as reflexões. Para a produção dos dados foram selecionados 20 artigos científicos sobre EAN publicados entre 2010 e 2018 em diferentes bases de dados. Para o processo de análise dos dados foram utilizadas técnicas da análise do discurso. Concluiu-se que a cultura alimentar, apesar de mencionada de forma repetida nos textos, não se consolida como uma dimensão legítima no campo da EAN. Ainda que na maior parte das vezes esteja reivindicada nos textos, nem sempre é referenciada de forma explícita e concreta. Por isso, acaba perdendo a relevância e o peso que, paradoxalmente, já tem.

Abstract The scope of this paper is to conduct a critical analysis on how perceptions of the notion of food culture have been presented in scientific papers on food and nutrition education in Brazilian Elementary schools. To achieve this, the use and application of this concept in the texts were recorded and the forms of the proposed relationship between the inclusion of food culture in the theoretical-methodological planning and the practice of the actions were critically read and analyzed. The paper is based on qualitative document research. The theoretical scope of the socio-anthropology of food is used as the focal point to support the reflections. Twenty scientific papers were selected on food and nutrition education published in various databases between 2010 and 2018. For data production and analysis, discourse analysis techniques were used. The conclusion drawn is that, despite being mentioned repeatedly in the texts, food culture is not consolidated as a legitimate dimension in the field of food and nutrition education. Although it is almost always claimed in the texts, it is not always explicitly and concretely mentioned. Therefore, it ends up losing the relevance and weight that, paradoxically, it already has.

Ambiente alimentar do entorno de escolas públicas e privadas: oportunidade ou desafio para alimentação saudável? / Food environment surrounding public and private schools: an opportunity or challenge for healthy eating?

Resumo O estudo analisou e comparou os tipos de alimentos comercializados no entorno de 30 escolas privadas e 26 públicas de Ensino Fundamental do município de Niterói, Rio de Janeiro. A coleta de dados foi realizada por auditoria utilizando um instrumento tipo checklist para caracterização dos estabelecimentos (formal ou informal) e identificação dos tipos de alimentos e bebidas comercializados. Estes foram classificados segundo o grau de processamento (in natura, processados e ultraprocessados). Para análise dos dados foram utilizados os testes estatísticos de Mann-Whitney para verificar diferença do tipo de comércio e das categorias de alimentos comercializados entre as escolas e o de Kruskal-Wallis para verificar diferença na quantidade de alimentos comercializada entre as categorias. A quantidade de ultraprocessados no entorno das escolas foi estatisticamente maior (p=0,0001) do que as outras categorias. Algumas preparações culinárias apresentaram alto percentual de contribuição energética de ultraprocessados. Não houve diferença estatisticamente significativa (p=0,478) nas categorias de alimentos comercializados entre escolas públicas e privadas. No entorno das escolas predomina a comercialização de ultraprocessados, favorecendo a exposição de crianças a um ambiente que estimula o consumo destes produtos.

Abstract The study analyzed and compared the types of food sold in the surroundings of 30 private and 26 public elementary schools in the city of Niterói, Rio de Janeiro. Data were collected by audit using a checklist instrument to characterize establishments (formal or informal) and identify the types of food and beverages sold, which were classified by processing level (fresh, processed, and ultraprocessed). Mann-Whitney statistical tests were used to verify the difference in the type of trade outlets d the categories of food sold between schools. The Kruskal-Wallis test was used to verify the difference in the amount of food traded between the categories. The amount of ultraprocessed food in the surroundings of public and private schools was statistically higher (p=0.0001) than the other categories. Some culinary preparations had a high rate of energy contribution from ultraprocessed foods (above 15%). There was no statistically significant difference (p = 0.478) in the categories of food sold between public and private schools. The sale of ultraprocessed products predominates around public and private schools, favoring the exposure of children to an environment that encourages the consumption of these products.

Adesão à alimentação escolar por adolescentes brasileiros: determinantes individuais e do contexto escolar / Acceptance of school food by Brazilian adolescents: individual and school context determinants

Resumo Objetivou-se avaliar a adesão à alimentação escolar por adolescentes brasileiros considerando determinantes individuais e do contexto escolar. Foram avaliados 10.262 adolescentes de escolas públicas da Pesquisa Nacional de Saúde do Escolar de 2015. Regressão multinível foi utilizada para estimar o efeito de variáveis do contexto individual e do ambiente escolar na ocorrência da baixa adesão à alimentação escolar por adolescentes. A prevalência dessa baixa adesão (consumo da alimentação escolar ≤2dias/semana) foi 64,2% nesse grupo. O modelo explicativo evidenciou menor adesão a essa prática entre adolescentes do sexo feminino (RP=1,09; IC: 1,03-1,14), entre aqueles com 15 anos ou mais de idade (RP=1,08; IC: 1,02-1,14), que tinham consumo regular de refrigerantes (RP=1,09; IC: 1,03-1,15), que não realizavam regularmente almoço e jantar com pais e responsáveis (RP=1,08; IC: 1,02-1,14), e que moravam em domicílios com menos de 4 pessoas (RP=1,07; IC: 1,02-1,13). Em relação ao ambiente escolar, estudar em escolas com mais de 1.000 alunos (RP=1,22; IC: 1,12-1,33) e com presença de cantina (RP=1,15; IC: 1,08-1,22) determinaram a baixa adesão. Os resultados demonstram importante efeito do contexto escolar na determinação do consumo da alimentação escolar por adolescentes.

Abstract The scope of this study was to evaluate the acceptance of school food by Brazilian adolescents, taking individual and school context determinants into consideration. A total of 10,262 adolescents in public schools of the 2015 Brazilian National Survey of School Health (PeNSE 2015) were assessed. Multilevel regression was used to estimate the effect of variables of the individual context and the school environment on low acceptance of school food by adolescents. The prevalence of low acceptance (consumption of school meals ≤ 2 days/week) was 64.2% in this group. The explanatory model showed less acceptance of this practice among female adolescents (PR=1.09; CI: 1.03-1.14), among those aged 15 years or older (PR=1.08; CI: 1.02-1.14), those who regularly consumed soft drinks (PR=1.09; CI: 1.03-1.15), those who did not regularly have lunch and dinner with parents and guardians (PR=1.08; CI: 1.02-1.14), and those who lived in households with less than 4 people (PR=1.07; CI: 1.02-1.13). Concerning the school environment, studying in schools with more than 1,000 students (PR=1.22; CI: 1.12-1.33) and the presence of a cafeteria (PR=1.15; CI: 1.08-1.22) led to low acceptance. The results revealed the importance of the school context in determining the consumption of school meals by adolescents.

Desarrollo e implementación de una propuesta educativa en el comedor escolar para la promoción de alimentación saludable en la escuela Cristóbal Colón en Santo Domingo de Heredia, Costa Rica / Development and implementation of a nutrition education approach using the school dining for promoting healthy eating in Cristóbal Colón school in Santo Domingo, Heredia, Costa Rica

RESUMEN Introducción: El sobrepeso y la obesidad infantil han alzado proporciones alarmantes a nivel mundial. El entorno escolar ha demostrado ser un espacio óptimo para la implementación de estrategias educativas con el fin de atacar esta problemática. El objetivo fue diseñar y aplicar una propuesta educativa para usar el comedor escolar como un espacio para la promoción de alimentación saludable. Metodología: Su población meta fueron los niños y las niñas de primero a sexto grado y el personal del centro educativo. Se desarrolló en cuatro etapas: diagnóstico, propuesta, implementación y evaluación. Se preguntó al estudiantado por preferencias y prácticas alimentarias, así como opiniones sobre el comedor; se realizaron grupos focales con el personal y se evaluó el comedor en infraestructura y servicio. La propuesta incluyó temas como desayuno en casa, autorregulación de tiempos de comida y consumo de frutas y vegetales. Se crearon mensajes educativos, se degustaron preparaciones nuevas y se redecoró el espacio del comedor durante un período de tres meses. Resultados: No se logró modificar preferencias alimentarias, ni el agrado por el comedor. Se vieron cambios en prácticas alimentarias. Disminuyó en un 12 % la cantidad de escolares que reportó almorzar doble, es decir en el comedor y en la casa, disminuyó 3 % quienes reportaron nunca desayunar y disminuyó un 4 % quienes reportaron traer merienda de la casa. Concusiones: El comedor escolar mostró el potencial de generar cambios en hábitos y conocimientos nutricionales de las niñas y los niños. Es necesario fomentar iniciativas educativas por períodos mayores de tiempo y con procesos de evaluación que valoren la adherencia de la población meta a hábitos y prácticas saludables a largo plazo.

ABSTRACT Introduction: Childhood obesity and overweight have reached alarming numbers world wise. The school environment has proven to be an optimal area to develop strategies against this situation. Methods: This project had the main objective of creating and implementing an educational approach to use the school canteen as a nutrition educational space. Its target population were the students from first to sixth grade and the school staff. It was developed in four phases: diagnosis, proposal, implementation and evaluation. A guided questionnaire was applied to students inquiring about food preferences and practices, and their opinions on the school canteen. In addition, there were focus groups with the staff and an evaluation of the consuming area in structure and service. The proposal included the importance of breakfast, self-regulation of meals and fruit and vegetable consumption. Education messages were created, tastings for new preparations were implemented and the redecoration of the dining area developed for a three-month period. Results: After the implementation, there were no changes in food preferences or opinion on the canteen. The main changes were found in students who reported eating double lunch, which decreased by 12%, the ones that said they never ate breakfast decreased 3% and the ones who bring snacks, decreased 4% Conclusion: the school canteen demonstrated to be useful to make changes in nutritional habits and knowledge of the students. However, it is necessary to encourage other nutritional education projects for longer periods and better long-term adherence evaluation of the healthy eating practices in the students.

Consumption of school meals provided by PNAE among brazilian public school adolescents / Consumo de comidas escolares proporcionadas por PNAE entre adolescentes de escuelas públicas brasileñas

ABSTRACT Objective: Assess adherence to school food offered by the School Food Program (Programa Nacional de Alimentação Escolar - PNAE) and the associated factors among Brazilian adolescents. Methods: Cross-sectional study with data from the Study of Cardiovascular Risks in Adolescents conducted in 2013-2014, with 58,707 adolescents aged 12 to 17 years-old who attended public schools. Logistic regression models were stratified by sex and the significance level of 5% was adopted for all analyses. Results: There was low adherence to school meals (17.2%). The chance of regular consumption of school meals was higher among male adolescents belonging to the medium (p<0.05) and the low (p<0.05) socioeconomic score categories. For females, the chance of regular consumption of food offered at school was higher among black-skinned, brown-skinned, indigenous-skinned or yellow-skinned adolescents (p<0.05), aged 16 and 17 (p<0.05), who worked (p<0.001) and belonged to the medium (p<0.05) and low (p<0.05) socioeconomic score categories. The regular purchase of food in school cafeterias reduced the chance of regular consumption of school meals for males (p<0.001) and females (p<0.001). Conclusions: Adherence to the food offered by the PNAE is far from ideal, and it is important to create public policies that encourage the consumption of school meals and improve adherence. In addition, the strengthening and drafting of regulations aimed at the sale of food in the interior and surrounding schools' areas is necessary.

RESUMEN Objetivo: Evaluar la adherencia a la comida escolar ofrecida por el Programa Nacional de Alimentación Escolar y los factores asociados entre los adolescentes brasileños. Métodos: Estudio transversal con datos del Estudio de Riesgos Cardiovasculares en Adolescentes realizado en 2013-2014, con 58.707 adolescentes de 12 a 17 años que asistieron a escuelas públicas. Los modelos de regresión logística se realizaron estratificados por sexo, y se aplicó el nivel de significancia del 5% para todos los análisis. Resultados: Hubo baja adherencia a las comidas escolares (17,2%). La posibilidad de consumo regular de comidas escolares fue mayor entre los adolescentes varones pertenecientes a las categorías de puntaje socioeconómico medio (p<0,05) y bajo (p<0,05). Para las mujeres, la probabilidad de consumo regular de alimentos ofrecidos en la escuela fue mayor entre las adolescentes de piel negra, marrón, indígena o amarilla (p<0,05), de 16 y 17 años (p<0,05), quién trabaja (p<0,001) y pertenece a las categorías de puntaje socioeconómico medio (p<0,05) y bajo (p<0,05). La compra regular de alimentos en las cafeterías escolares redujo la posibilidad de consumo regular de comidas escolares para hombres (p<0,001) y mujeres (p<0,001). Conclusiones: La adhesión a los alimentos ofrecidos por el PNAE está lejos de ser ideal, y es importante crear políticas públicas que fomenten el consumo de comidas escolares, mejoren su adherencia, además de ayudar en el fortalecimiento y la redacción de regulaciones dirigidas a la venta de alimentos en el interior y las áreas de las escuelas circundantes.

Adesão à alimentação escolar e fatores associados em adolescentes de escolas públicas na região Sul do Brasil / Adherence to school food and associated factors among adolescents in public schools in the Southern region of Brazil

Resumo Objetivou-se analisar o índice de adesão à alimentação escolar e os fatores associados entre adolescentes matriculados em escolas públicas estaduais do município da Lapa, Paraná, sul do Brasil. De caráter transversal e analítico, incluiu 492 adolescentes de 10 a 19 anos de cinco escolas urbanas e cinco rurais do município. Foi aplicado um questionário sobre o consumo da alimentação escolar e de alimentos competitivos (aqueles comprados ou trazidos de casa) e realizada a avaliação antropométrica nos adolescentes. Os seus pais/responsáveis responderam um questionário demográfico e socioeconômico. Foi utilizado modelo de regressão de "odds" proporcionais ajustado para verificar as associações. O índice de adesão efetiva à alimentação escolar foi de 30,1% nas escolas rurais e de 23,7% nas urbanas. Não gostar das preparações servidas foi o principal motivo apontado para a não adesão. Observou-se menor adesão entre os adolescentes que possuíam maior renda familiar per capita e entre os que consumiam alimentos competitivos de 4 a 5x/semana. A adesão foi maior entre aqueles que consideravam a alimentação escolar saudável. Diante do baixo índice de adesão à alimentação escolar, a universalidade do atendimento não está sendo atingida. Os fatores apontados podem auxiliar em melhoras na execução do programa.

Abstract The scope of this study was to analyze adherence to school food and associated factors among adolescents from public state schools in the municipality of Lapa, Paraná, in the Southern region of Brazil. The study uses a cross-sectional and analytical design and includes 492 male and female adolescents aged 10 to 19 years from five urban and five rural schools in the municipality. The students underwent anthropometric assessment and answered a questionnaire about school food and alternative food intakes (purchased or home-cooked). Their parents/guardians answered a questionnaire about their demographic and socioeconomic characteristics. An adjusted proportional odds regression model investigated the associations. The effective adherence to school food was 30.1% in rural schools and 23.7% in urban schools. Dislike of the food preparation was the main reason for non-adherence. The results showed lesser adherence among adolescents with higher per capita family income who consumed alternative food products four to five times per week. Adolescents who considered school food healthy showed higher adherence. Low adherence to school food indicates the inadequate universality of the program. The factors revealed may help to improve program planning and execution.

Changes In Emotional Distress And Cognitive Performance Following Aerobic Exercise And Low Fat Milk Consumption In Sedentary Female Adolescents

@#Introduction: Regular aerobic exercise and low-fat milk consumption can improve certain cognitive functions and reducing emotional distress. However, the impacts of combining these modalities are less explored. Thus, the present study examined the effects of combining aerobic exercise and low-fat milk intake among sedentary female students. Methods: Using a nonrandomized pretest – posttest with a control group research design, 85 sedentary females aged 16 years old were assigned into either milk (n = 21), exercise (n = 22), combined low fat milk and exercise (n = 23), or control (n = 19) groups. One serving of low-fat milk was provided to the students during each school day, and a 1-hour supervised step aerobics exercise was conducted twice per week for 3 months. Emotional distress and sustained attention were measured at baseline, 6th and 12th weeks after the intervention. A mixed factorial ANOVA was used to analyse the data. Results: The results revealed significantly less emotional distress in the combined (p < 0.01) and exercise groups (p < 0.05) compared with the control group after 12 weeks. Additionally, significant reductions were observed in the total time taken and errors of omission for both digits 6 and 9 of the Digit Vigilance Test in the combined group (p < 0.05, p < 0.001) compared with the control group. Conclusions: The results showed that low fat milk alone did not provide any additional benefits related to distress regulation, but the combination of exercise and low-fat milk contributed to improving sustained attention.

Cantinas de escolas estaduais de Curitiba/PR, Brasil: adequação à lei de regulamentação de oferta de alimentos / Canteens of State Schools in Curitiba in the State of Paraná, Brazil: adaptation to the food supply regulation law

Resumo Objetivou-se caracterizar a oferta de alimentos nas cantinas de escolas públicas estaduais de Curitiba, Paraná, e investigar associação da oferta de alimentos permitidos/não permitidos pela Lei das Cantinas, com variáveis da escola e da cantina. Foi realizado estudo transversal com entrevista aos administradores de cantinas em 27 escolas estaduais e foi utilizado o teste de Mann Whitney para investigar associações. Verificou-se maior frequência de administração das cantinas por autogestão (n = 25; 92,6%); local adequado na escola para realização das refeições (n = 20; 74,1%); tempo na administração do local superior a 10 anos (n = 13; 48,2%) e de administradores que referiram conhecer a Lei (n = 22; 81,5%). Mais de 2/3 das cantinas comercializava alimentos não permitidos, tais como bebidas açucaradas (n = 22; 81,5%) e doces, pipocas e salgadinhos industrializados (n = 13; 48,2%). Apenas uma (3,7%) ofertava salgados fritos. Somente a oferta de ensino técnico associou-se à maior disponibilidade de alimentos permitidos pela legislação (p = 0,033). As cantinas avaliadas podem ser caracterizadas como locais de oferta de alimentos não permitidos pela Lei da Cantina Saudável. Destaca-se a importância da regulação e da fiscalização da comercialização de alimentos nas cantinas para promoção de saúde nas escolas.

Abstract The scope of this study was to determine the food on offer in state public school canteens of Curitiba, Paraná, and to investigate the association between the permitted/prohibited food supplied under the Canteen Law, with school and canteen variables. A cross-sectional study was conducted with interviews with canteen administrators in 27 state schools. The Mann Whitney test was used to investigate associations. There was a higher frequency of administration of the canteens under the self-management regime (n = 25, 92.6%); appropriate location in the school for serving meals (n = 20, 74.1%); length of time in administration of over 10 years (n = 13, 48.2%) and administrators who reported knowing the Canteen Law (n = 22, 81.5%). More than 2/3 of canteens sold prohibited food, such as sweetened beverages (n = 22, 81.5%) and candies, industrialized popcorn and salty snacks (n = 13, 48.2%). Only one school provided fried snacks (n = 1, 3.7%). The offer of technical education alone was associated with greater availability of food allowed by the legislation (p = 0.033). The school canteens evaluated can be described as places of commercialization of food not permitted by the Healthy Canteen Law. It is important to highlight the regulation and inspection of food sales in canteens for the promotion of health in schools.

Percepción de satisfacción entre beneficiarios del programa de alimentación escolar en Bucaramanga-Colombia / Perception of satisfaction among beneficiaries of the school food program of Bucaramanga-Colombia

Resumen Introducción: El Programa de Alimentación Escolar PAE en Colombia es uno de los más antiguos orientado a la protección de la población infantil para potenciar su desarrollo y disminuir la deserción escolar; sin embargo, no hay investigación suficiente que permita evidenciar avances y logros del programa. Objetivo: Determinar la prevalencia en la percepción de satisfacción de los beneficiarios del Programa de Alimentación Escolar - PAE en Bucaramanga, Colombia y sus factores asociados. Metodología: Se realizó en 2017 un estudio cuantitativo de corte transversal analítico. La población correspondió al universo de escolares beneficiarios del PAE en la ciudad (N= 31.230) y la muestra a 401 escolares la cual se dividió en dos grupos según edad: grupo 1 (de 5 a 8 años) y grupo 2 (de 9 a 17 años). Las encuestas para evaluar los componentes sensorial, organizacional y social, fueron sometidas a prueba piloto para validación aparente o facial y ajustadas según resultados. Una vez recogidos los datos se hizo análisis descriptivo a características de interés; para corroborar diferencias estadísticamente significativas se usó la prueba de chi2 y T de Student y se realizaron análisis bivariados y multivariados entre las características de interés y la percepción de satisfacción usando regresión lineal simple y múltiple. Resultados: Los estudiantes mostraron un nivel alto de percepción de satisfacción frente a las raciones recibidas, siendo los más satisfechos los de nivel socioeconómico bajo y medio bajo (Coef B 2,43; IC 95%: 1,61-3,25) y los que recibieron ración preparada en sitio (niños de 5 a 8 años), (Coef B 8,36; IC 95%: 7,08-9,64). Se encontró que el 25% de los estudiantes de nivel socioeconómico medio-medio y medio-alto botaba los alimentos a la basura. Conclusiones: Estos hallazgos mostraron la necesidad prioritaria de ser más rigurosos en la focalización de los beneficiarios del programa, así como llevar a cabo otros ajustes planteados en el estudio, para incrementar la calidad del programa PAE de Bucaramanga.

Abstract Introduction: The PAE School Feeding Program in Colombia is one of the oldest oriented to the protection of the child population to enhance their development and decrease school dropouts; however, there is not enough research to show progress and achievements of the program. Objective: To determine the prevalence of perception of satisfaction of the beneficiaries of the School Feeding Program, in Bucaramanga, Colombia and its associated factors. Methodology: An analytical cross-sectional study was carried out in 2017 with an empirical non-experimental analytical approach. The population corresponded to the universe of PAE schoolchildren in the city (N = 31,230) and the sample to 401 students which was divided into two groups according to age: group 1 (from 5 to 8 years) and group 2 (from 9 to 17 years). The surveys to evaluate the sensory, organizational and social components were submitted to a pilot test for apparent or facial validation and adjusted according to results. Once the data was collected, a descriptive analysis was made to the characteristics of interest; To corroborate statistically significant differences, the chi2 and Student's T test were used and bivariate and multivariate analyzes were performed between the characteristics of interest and the perception of satisfaction using simple and multiple linear regression. Results: The students showed a high level of satisfaction perception compared to the rations received, being the most satisfied those low and medium low socioeconomic status (Coef B 2.43; 95%CI: 1.61-3.25) and those who received ration prepared on site (children 5 to 8 years old), (Coef B 8.36; 95%CI: 7.08-9.64). Conclusions: These findings showed the priority need to be more rigorous in the targeting of the beneficiaries of the program, as well as carry out other adjustments proposed in the study, to increase the quality of the PAE program in Bucaramanga.

Fatores associados ao consumo alimentar na escola e ao sobrepeso/obesidade de escolares de 7-10 anos de Santa Catarina, Brasil / Factors associated with food consumption in schools and overweight/obesity in 7 to 10-year-old schoolchildren in the state of Santa Catarina, Brazil

Resumo O objetivo deste artigo é investigar associação entre a proveniência de lanches consumidos na escola, seu valor nutricional e o sobrepeso/obesidade. Estudo transversal com 3.930 escolares de 7-10 anos de idade, de Santa Catarina. O consumo alimentar na escola foi avaliado com R-24 horas ilustrado, e a origem dos lanches por entrevista estruturada. Refrigerantes e sucos artificiais, frituras, salgadinhos industrializados, lanches prontos, doces, guloseimas e biscoitos recheados foram classificados como "lanches de baixo valor nutricional", enquanto frutas, sucos naturais, legumes, verduras e sopa de verduras foram os "lanches de alto valor nutricional". Realizou-se regressão logística univariada e múltipla. O sobrepeso/obesidade se associou significativamente ao consumo de alimentos provenientes da cantina (OR = 1,34; IC = 1,07-1,68), na rede particular. Trazer alimentos de casa foi significativamente associado ao maior consumo de lanches de baixo valor nutricional, nas escolas públicas (OR = 1,56; IC = 1,32-1,83) e nas particulares (OR = 2,64; IC = 1,76-3,97). Os resultados apontam a necessidade de expansão de normativas que minimizem a disponibilidade de alimentos de baixo valor nutricional nas cantinas e que promovam educação nutricional envolvendo a comunidade escolar.

Abstract The scope of this article is to investigate the association between the source of snacks consumed in schools, their nutritional value and overweight/obesity. It involved a cross-sectional study with 3,930 schoolchildren aged between 7 and10 in the state of Santa Catarina. Food consumption in the school was assessed with an illustrated 24-hour dietary recall and the source of snacks was investigated by structured interview. Soft drinks and artificial fruit juices, fried and processed snacks, ready-to-eat or sweetened snacks, delicacies and stuffed biscuits were classified as "low nutritional value foods," while fruit, natural fruit juices, vegetables, and vegetable soup were the "high nutritional value foods." Univariate and multiple logistic regression was conducted. Overweight/obesity was significantly associated with higher food consumption from the school canteen (OR = 1.34; CI = 1.07-1.68) in private schools. Bringing food from home was significantly associated with increased consumption of low nutritional foods, both in public (OR = 1.56; CI = 1.32-1.83) and private (OR = 2.64; CI = 1.76-3.97) schools. The results highlight the need for tightening of norms to reduce the availability of low nutritional value food in canteens, and actions to promote nutritional education involving the school community.

Food Choices and Diet Quality in the School Food Environment: A Qualitative Insight from the Perspective of Adolescents

@#Introduction: Overweight and obesity among adolescents are not caused by a single factor, and evidence indicates that the food environment is one of the driving forces behind the current escalating obesity epidemic. Therefore, it is imperative to explore any perceived factors related to food choices and quality of food in the school food environment among adolescents. Methods: A qualitative study based on the Socio-Ecological Model (SEM) was conducted on a purposive, multi-ethnic sample of 51 adolescents from different localities. The semi-structured and in-depth interviews were fully transcribed and analyzed qualitatively using Atlas.Ti. The transcribed texts were coded into similar and related themes such as food choices, quality of food, social-peers’ influence, cost of food and self-awareness. Results: The findings revealed that there is a clustering of barriers to practising a healthy dietary intake within the school food environment. Accessibility to low cost snacks and fried foods, influence by parents and peers, as well as the autonomous character of informants in making their own purchases are the contributing factors to healthy eating practice among adolescents. Conclusions: The study highlights that the barriers to practicing healthy eating considerably outweighs the enabling factors. Therefore, the findings will help facilitate the construction of policy-driven environmental changes as well as strategies in designing effective and multilevel interventions that raise awareness in helping adolescents navigate healthy food in their school’s compound

Compra de alimentos da agricultura familiar pelo Programa Nacional de Alimentação Escolar (PNAE): estudo transversal com o universo de municípios brasileiros / Purchase of products directly from family farms for the National School Feeding Program (PNAE): cross-sectional study with the universe of brazilian municipalities

Resumo A integração entre a agricultura familiar e a alimentação escolar têm o potencial de melhorar a variedade dos cardápios escolares aproximando produção e consumo de alimentos. Este estudo caracterizou os municípios brasileiros quanto à compra de alimentos da agricultura familiar pelo Programa Nacional de Alimentação Escolar. Trata-se de estudo transversal realizado por meio de questionário eletrônico enviado aos 5.565 municípios do país. Participaram da pesquisa 93,2% dos municípios (n = 5.184). Destes, 78,5% adquiriram alimentos da agricultura familiar, destacando-se a região Sul, com a maior frequência de municípios realizando a compra (95,5%), e a região Centro-Oeste com a menor (67,9%). Os municípios de grande porte, com gestão da alimentação escolar do tipo mista, descentralizada ou terceirizada e sem nutricionista como responsável técnico, apresentaram menor frequência de compra de alimentos da agricultura familiar. Conclui-se que, apesar da ampla efetivação da aquisição de alimentos da agricultura familiar pelo programa em todo país, 50% dos municípios não investiram o mínimo exigido em lei, demandando ações educativas e de assistência técnica direcionadas para o cumprimento da legislação, em especial nos estados e regiões que apresentaram maiores dificuldades.

Abstract The integration of family farming with school meals has the potential to improve the variety of school menus thereby bringing the production and consumption of food into closer alignment. This study researched the Brazilian municipalities with respect to the purchase of food from family farms for the National School Food Program. It involved a cross-sectional study conducted via an electronic questionnaire sent to 5,565 municipalities in the country. The research included 93.2% of the municipalities (n = 5,184), 78.5% of which acquired food from family farms, with the highest frequency (95.5%) of the municipalities making the purchase in the southern region, and the lowest (67.9%) in the Central West region. The large-scale municipalities, with mixed, decentralized or outsourced school food management, and without a nutritionist as technical manager, purchased food less frequently from family farms. The conclusion reached is that, despite the widespread acquisition of food from family farms in the program throughout the country, 50% of municipalities did not invest the minimum required by law, requiring actions aimed at compliance with legislation and greater investment, especially in states and regions which revealed the greatest difficulties.

Adequação nutricional e desperdício de alimentos em Centros de Educação Infantil / Nutritional adequacy and food waste in Early Childhood Education Centers

Resumo Analisar aspectos quantitativos e qualitativos da alimentação escolar constitui-se de etapa primordial para fazer do Programa Nacional de Alimentação Escolar (PNAE) um espaço efetivo para a promoção da alimentação saudável e formação de sujeitos de direitos. O objetivo deste estudo foi avaliar a adequação nutricional das refeições servidas e consumidas e quantificar o desperdício de alimentos em Centros de Educação Infantil de Maceió/AL. Foram analisadas por três dias não consecutivos, pelo método de pesagem direta, as refeições de 359 crianças (17 e 63 meses). O desperdício de alimentos foi determinado pelo índice de resto-ingestão e o valor nutricional das refeições servidas e consumidas foram comparadas com os valores de referência do PNAE para energia, carboidrato, proteína, lipídio, vitaminas A e C, ferro, cálcio, zinco, magnésio e fibra. Dos 85 alimentos/preparações presentes no cardápio, 58 (68%) apresentaram percentual de resto-ingestão, superior a 10%. As refeições servidas e consumidas atenderam aproximadamente 50% do recomendado para energia e macronutrientes. A diferença entre as médias dos nutrientes ofertados e consumidos foi estatisticamente significante (p < 0,05) para fibra, vitamina A, vitamina C, cálcio, ferro e zinco.

Abstract Analyzing quantitative and qualitative aspects of school meals represents the initial stage to ensure that the National School Food Program (PNAE) is an effective space for the promotion of healthy eating habits and establishing individual rights. The objective of this study was to evaluate the nutritional adequacy of meals served and consumed, as well as quantifying food waste in Child Daycare Centers in Maceió, in the state of Alagoas. All meals served and consumed by 359 children (aged 17 to 63 months) were analyzed by the direct weighing method for three non-consecutive days in all institutions. Food waste was determined by the leftover factor and the nutritional value of meals served and consumed was compared to the PNAE reference values regarding energy, carbohydrates, protein, lipids, vitamins A and C, iron, calcium, zinc, magnesium and fiber. Of the 85 meals/preparations featured on the menu, 58 (68%) revealed a high leftover percentage; in excess of 10%. The meals served and consumed met approximately 50% of the recommended energy and macronutrient values. The difference between the averages of the nutrients offered and consumed was statistically significant (p < 0.05) for fiber, vitamin A, vitamin C, calcium, iron and zinc.

Consumo alimentar conforme o tipo de alimentação consumida em escolas de zona rural no Sul do Brasil / Food intake according to the type of food consumed in schools in a rural area in southern Brazil

Resumo Objetivou-se avaliar o consumo alimentar de escolares conforme o tipo de alimentação consumida em escolas de zona rural. Trata-se de um estudo transversal realizado com adolescentes de 12 escolas públicas rurais de Canguçu/RS. A investigação está vinculada à intervenção "Educação Física +: Praticando Saúde na Escola". O consumo alimentar foi avaliado pelos marcadores do Sistema de Vigilância Alimentar e Nutricional. A variável independente principal foi o tipo de alimentação consumida (trazida de casa, fornecida gratuitamente e/ou comprada na escola). Foi utilizada a estatística descritiva e o teste de Qui-quadrado com nível de significância de p < 0,05. Participaram do estudo 526 escolares, 51,3% do sexo feminino e 88,0% que consumiram a alimentação gratuita. Entre 15-31% dos adolescentes consumiram mais de três dias na semana anterior alimentos considerados não saudáveis. Os escolares que relataram levar lanche de casa para a escola consumiram com maior frequência salada crua, frutas frescas ou salada de frutas, bolachas/biscoitos salgados e salgadinhos de pacote e refrigerante. Concluiu-se que o consumo de alimentos saudáveis entre os escolares da zona rural foi baixo e intervenções são necessárias a fim de melhorar o quadro atual de práticas inadequadas de alimentação.

Abstract The scope of the article was to evaluate food consumption according to the type of food consumed in rural schools. A cross-sectional descriptive study was conducted among adolescents enrolled in 12 rural public schools in Canguçu in the state of Rio Grande do Sul, Brazil. The research was linked to the intervention named "Physical Education +: Practicing Health in School." Dietary intake was evaluated using consumption markers from the Brazilian Food and Nutrition Surveillance System. The main independent variable was the type of food consumed at school (brought from home, provided by the school free of charge and/or purchased at school). Descriptive statistics and the Chi-square test were used and the significance level was p<0.05. The study enlisted 526 students, 51.3% female and 88.0% consuming food free of charge. From 15% to 31% of adolescents consumed foods considered unhealthy for more than three days in the preceding week. Students who reported taking a snack to school consumed raw salad, fresh fruit or fruit salad, biscuits/crackers and packet snacks and soft drinks more frequently. It was concluded that the consumption of healthy foods among schoolchildren in rural areas was low and interventions are needed to improve the current situation of inadequate feeding practices.

As ações de educação alimentar e nutricional e o nutricionista no âmbito do Programa Nacional de Alimentação Escolar / Food and nutrition education actions and the nutritionist within the scope of the National School Food Program

Resumo O Programa Nacional de Alimentação Escolar (PNAE) preconiza a promoção de práticas alimentares saudáveis por meio da oferta de refeições juntamente com ações de educação alimentar e nutricional (EAN). O objetivo deste trabalho foi identificar as ações de EAN no PNAE e sua relação com o perfil do nutricionista. Estudo transversal analítico, realizado em municípios de Goiás, Brasil. Dados coletados por telefone, sendo a associação entre a variável desfecho (realização de EAN) e as de exposição (população escolar e atuação do nutricionista) feita por teste qui-quadrado de Pearson, nível de significância de 5,0%. Foram incluídos 214 (87%) municípios, dos quais 91,1% promovem EAN, com frequência predominantemente semestral (25,3% nas escolas e 23,2% nas creches). A presença do nutricionista mostrou-se associada à EAN (p = 0,001). Ações de EAN são executadas na maioria dos municípios, entretanto com baixa frequência. A associação encontrada indica a relevância da presença do nutricionista, em condições que atendam à legislação, possibilitando o cumprimento de suas atribuições, conforme definido pelo Marco Legal do PNAE e do Conselho Federal de Nutricionistas.

Abstract The National School Food Program (NSFP) recommends the promotion of healthy eating habits by offering meals along with food and nutrition education (FNE) actions. The objective of this study was to identify the FNE in the NSFP and its relationship with the nutritionist's profile. It involved an analytical, cross-sectional study conducted in cities in the state of of Goiás, Brazil. Data was collected by telephone, and the association between the outcome variable (achievement of FNE actions) and exposure (school population and nutritionist performance) was done by Pearson's chi-square test of with a 5% significance level. In this study, 214 (87%) municipalities were included, among which, 91.1% promote FNE actions with predominantly biannual frequency (25.3% in schools and 23.2% in day care centers). The nutritionist presence was associated to the FNE (p = 0.001). FNE actions are performed in most municipalities, however with low frequency. The association indicates the relevance of a nutritionist present in conditions that heed the legislation, enabling the performance of their duties, as defined by the Legal Framework of the NSFP and the Federal Council of Nutritionists.

Avaliação do Programa Nacional de Alimentação Escolar: revisão da literatura / Evaluation of the National School Food Program: review of the literature

Resumo O Programa Nacional de Alimentação Escolar (PNAE) representa uma estratégia importante de promoção da alimentação saudável. Objetivou-se realizar uma análise sumária das pesquisas avaliativas sobre o PNAE. Pesquisa bibliografica do período de 2010 a 2015 nas bases de dados Bireme e SciELO. Foram selecionados 12 artigos vinculados à área, dos quais oito analisaram a inserção do nutricionista no PNAE; sete, a aquisição de alimentos da agricultura familiar; cinco, a implantação dos Conselhos de Alimentação Escolar; cinco, a execução dos cardápios; e quatro, os recursos financeiros destinados ao PNAE. Apontam-se problemas na atuação do nutricionista e dos Conselhos de Alimentação Escolar, na aquisição de alimentos da agricultura familiar e na composição dos cardápios (baixo conteúdo de frutas e hortaliças). Destaca-se a necessidade de maior atenção relacionada à execução do PNAE, de maneira a garantir uma alimentação escolar dentro de princípios que promovam a segurança alimentar e nutricional. Novos estudos avaliativos sobre o Programa são fundamentais para o fornecimento de subsídios aos gestores públicos com fins de aprimorar a sua execução.

Abstract The National School Food Program (PNAE) constitutes an important strategy for the promotion of healthy eating. The objective was to perform a brief analysis of evaluative research on the PNAE. It involved a search of the literature from 2010 to 2015 in the Bireme and Scielo databases. Twelve articles were selected linked to the area, eight of which analyzed the insertion of the nutritionist in the PNAE; seven, to buy food from family farms; five, the implementation of School Food Councils; five, the compilation of menus; and four, funding destined for the PNAE. Problems in the performance of the nutritionist and the School Food Councils, on buying food from family farms and in the compilation of the menus (low fruit and vegetable content) were detected. The need for greater attention to execution of the PNAE was highlighted in order to ensure school food within guidelines that promote food and nutrition security. Further evaluation studies about the program are fundamental for the provision of subsidies to public managers for purposes of enhancing its implementation.