Food and nutritional education in rural quilombola communities in Rio Grande do Sul, Brazil: methodological aspects / Educação alimentar e nutricional em comunidades quilombolas rurais do Rio Grande do Sul, Brasil: aspectos metodológicos

Background: The construction of programs to promote healthy eating should be guided by the culture and living conditions of people. Objective: To describe the methodology for a community intervention in food and nutritional education (FNE) carried out in rural quilombola communities (QC) in Rio Grande do Sul. Methods: Two communities were included. The FNE actions consisted of six workshops with a focus on the concepts of food culture, adequate and healthy food, and health promotion, focusing on food rather than nutrients. The actions were planned from the production of strategies that could be replicated by the participants to the other residents. Results: The workshops were attended by people of various ages and the participation of women was more expressive. Each workshop had specific objectives and different dynamics employed. Conclusion: This approach sought to emphasize the experiences, culture, and opinions of the people residing in the QC included in the study. It is hoped that this FNE community intervention can guide and subsidize the planning and execution of similar initiatives in other QCs in Rio Grande do Sul or even the country.

Introdução: A construção de programas de promoção da alimentação saudável deve ser pautada sobre a cultura e as condições de vida das pessoas. Objetivo: Descrever a metodologia para uma intervenção comunitária de educação alimentar e nutricional (EAN) realizada em comunidades quilombolas (CQ) rurais do Rio Grande do Sul. Métodos: Foram incluídas duas comunidades. As ações de EAN consistiram na realização de seis oficinas com abordagem pautada nos conceitos de cultura alimentar, alimentação adequada e saudável e promoção da saúde, com foco em alimentos e comida ao invés de nutrientes. As ações foram planejadas a partir da produção de estratégias que pudessem ser replicadas pelos participantes aos outros moradores. Resultados: Participaram das oficinas pessoas de várias idades e a participação das mulheres foi mais expressiva. Cada oficina teve objetivos específicos e diferentes dinâmicas empregadas. Conclusão: Essa abordagem buscou enfatizar as experiências, a cultura e as opiniões das pessoas que residem nas CQ incluídas no estudo. Espera-se que essa intervenção comunitária de EAN possa nortear e subsidiar o planejamento e execução de iniciativas similares em outras CQ do estado ou até mesmo do país.

Healthy eating markers among adolescents from the municipal school system in Pelotas, Rio Grande do Sul, Brazil, 2019: a cross-sectional study.

MAIN RESULTS: Around 3% of the students regularly consumed the five healthy eating markers, with beans being the most frequently consumed; strong association was found between healthy eating markers and behavioral variables. Implications for services: The results obtained can contribute for interventions, programs and actions, particularly in the school environment, aimed at promoting an adequate and healthy diet. PERSPECTIVES: Better targeting of interventions, programs and actions developed in the school environment, seeking to increase consumption of fresh and minimally processed food, along with the adoption of healthy behaviors. OBJECTIVE: to analyze the consumption of healthy eating markers among adolescent students in Pelotas, Rio Grande do Sul, Brazil, in 2019. METHODS: this was a cross-sectional study carried out in schools taking part in the Health at School Program. Consumption of the five markers (beans, milk, fruit, cooked vegetables and raw salads) within five days prior to the study, obtained through a self-administered questionnaire, was defined as regular. Association between demographic, socioeconomic and behavioral variables and the outcomes was analyzed using Poisson regression. RESULTS: among the 797 respondents, 2.8% (95%CI 1.8;4.1) reported regular consumption. Beans were the most regularly consumed food (48.3%); fruit, cooked vegetables and raw salads were consumed regularly by less than 30% of the students. Doing physical activities, having breakfast and having meals with the family were associated with regular consumption of the foods assessed. CONCLUSION: regular consumption of healthy foods was low in this population, and was associated with behavioral factors.

Nova diet quality scores and risk of weight gain in the NutriNet-Brasil cohort study.

OBJECTIVE: To assess the prospective association of two diet quality scores based on the Nova food classification with BMI gain. DESIGN: The NutriNet-Brasil cohort is an ongoing web-based prospective study with continuous recruitment of participants aged ≥ 18 years since January 2020. A short 24-h dietary recall screener including 'yes/no' questions about the consumption of whole plant foods (WPF) and ultra-processed foods (UPF) was completed by participants at baseline. The Nova-WPF and the Nova-UPF scores were computed by adding up positive responses regarding the consumption of thirty-three varieties of WPF and twenty-three varieties of UPF, respectively. Participants reported their height at baseline and their weight at both baseline and after approximately 15 months of follow-up. A 15-month BMI (kg/m2) increase of ≥5 % was coded as BMI gain. SETTING: Brazil. PARTICIPANTS: 9551 participants from the NutriNet-Brasil cohort. RESULTS: Increasing quintiles of the Nova-UPF score were linearly associated with higher risk of BMI gain (relative risk Q5/Q1 = 1·34; 95 % CI 1·15, 1·56), whereas increasing quintiles of the Nova-WPF score were linearly associated with lower risk (relative risk Q5/Q1 = 0·80; 95 % CI 0·69, 0·94). We identified a moderate inverse correlation between the two scores (-0·33) and a partial mediating effect of the alternative score: 15 % for the total effect of the Nova-UPF score and 25 % for the total effect of the Nova-WPF score. CONCLUSIONS: The Nova-UPF and Nova-WPF scores are independently associated with mid-term BMI gain further justifying their use in diet quality monitoring systems.

Marcadores de alimentação saudável entre adolescentes da rede municipal de ensino de Pelotas, Rio Grande do Sul, 2019: estudo transversal / Healthy eating markers among adolescents from the municipal school system in Pelotas, Rio Grande do Sul, Brazil, 2019: a cross-sectional study / Marcadores de alimentación saludable entre adolescentes del sistema escolar municipal de Pelotas, Rio Grande do Sul, Brasil, 2019: estudio transversal

Objetivo: analisar o consumo de marcadores de alimentação saudável entre adolescentes escolares de Pelotas, Rio Grande do Sul, Brasil, em 2019. Métodos: estudo transversal, realizado nas escolas vinculadas ao Programa Saúde na Escola; o consumo dos cinco marcadores (feijão, leite, frutas, vegetais cozidos, saladas cruas) em até cinco dias antecedentes ao estudo, obtido mediante questionário autoaplicado, foi definido como regular; a associação de variáveis demográficas, socioeconômicas e comportamentais com os desfechos foi analisada por regressão de Poisson. Resultados: entre os 797 entrevistados, 2,8% (IC95% 1,8;4,1) referiram consumo regular; o feijão foi o alimento mais consumido regularmente (48,3%); frutas, vegetais cozidos e saladas cruas foram consumidos regularmente por menos de 30% dos escolares; praticar atividade física, tomar café da manhã e realizar refeições com a família estiveram associados ao consumo regular dos alimentos avaliados. Conclusão: o consumo regular de alimentos saudáveis, encontrado baixo nessa população, associou-se com fatores comportamentais.

Objective: to analyze the consumption of healthy eating markers among adolescent students in Pelotas, Rio Grande do Sul, Brazil, in 2019. Methods: this was a cross-sectional study carried out in schools taking part in the Health at School Program. Consumption of the five markers (beans, milk, fruit, cooked vegetables and raw salads) within five days prior to the study, obtained through a self-administered questionnaire, was defined as regular. Association between demographic, socioeconomic and behavioral variables and the outcomes was analyzed using Poisson regression. Results: among the 797 respondents, 2.8% (95%CI 1.8;4.1) reported regular consumption. Beans were the most regularly consumed food (48.3%); fruit, cooked vegetables and raw salads were consumed regularly by less than 30% of the students. Doing physical activities, having breakfast and having meals with the family were associated with regular consumption of the foods assessed. Conclusion: regular consumption of healthy foods was low in this population, and was associated with behavioral factors.

Objetivo: analizar el consumo de marcadores de alimentación saludable entre estudiantes adolescentes de Pelotas, Rio Grande do Sul, Brasil, en 2019. Métodos: estudio transversal realizado en escuelas vinculadas al Programa Salud en la Escuela. Se definió como regular el consumo de los cinco marcadores (porotos, leche, frutas, vegetales cocidos y ensaladas crudas) dentro de los cinco días previos al estudio, obtenidos a través de un cuestionario autoadministrado. La asociación entre variables demográficas, socioeconómicas y conductuales con los resultados se analizó mediante la regresión de Poisson. Resultados: entre los 797 encuestados, el 2,8% (IC95% 1,8; 4,1) informó un consumo regular. Los porotos fueron el alimento más consumido (48,3%). Frutas, verduras cocidas y ensaladas crudas fueron consumidas regularmente por menos del 30% de los estudiantes. La práctica de actividad física, el desayuno y las comidas en familia se asociaron con mayor consumo de los alimentos evaluados. Conclusión: el consumo regular de alimentos saludables fue bajo en esta población y se asoció con factores conductuales.

Physical activity and serum interleukin-6 in relation to bone density in young adults / Atividade física e interleucina-6 sérica em relação à densidade óssea em adultos jovens

Physical activity (PA) and inflammation influence bone density through multiple physiological mechanisms, but current evidence is not robust on the structure mediating these relationships. There-fore, the aim of this study was to investigate the associations of PA, and serum interleukin-6 (IL-6) on bone density. Cross-sectional analysis in the Pelotas (Brazil) 1982 Birth Cohort with participants aged 30-years old. PA was objectively measured by accelerometry. Bone mineral density (g/cm2) was evaluated for the lumbar spine and femoral neck using dual-energy X-ray absorptiometry. Crude and adjusted linear regressions and mediation analyses were performed. In both sexes, the overall PA was positively associated with femoral neck bone density, but not lumbar spine. For men, the mean of femoral neck were 0.027, 0.042, and 0.032 higher in the second, third, and fourth quartiles, respectively, compared to the first quartile (reference). Among women, higher bone density values were found in the third (0.021) and fourth (0.027) quartiles of overall PA compared to the lowest quartile. Among females, moderate-to-vigorous intensity physical activity presented a positive rela-tionship with all sites of bone density. The indirect effect through IL-6 was not significant. Physical activity was associated with gains in bone density. The findings reinforce recommendations for PA in adulthood to promote bone health

A atividade física (AF) e a inflamação influenciam a densidade óssea através de múltiplos mecanismos fisiológicos, mas a atual evidência não é robusta sobre a estrutura de mediação dessas relações. Portanto, o objetivo deste estudo foi investigar as associações de AF e interleucina-6 sérica (IL-6) na densidade óssea. Análise transversal na Coorte de Nascimentos de 1982 Pelotas (Brasil) em participantes com 30 anos de idade. AF foi medida objetivamente por acelerometria. Densidade mineral óssea (g/cm2) foi avaliada para a coluna lombar e colo do fêmur usando absorciometria de raios-X de dupla energia. Foram realizadas regressões lineares brutas e ajustadas e análises de mediação. Em ambos os sexos, a AF total foi positivamente associada à densidade óssea do colo do fêmur, mas não à coluna lombar. Para os homens, as médias do colo do fêmur foram 0,027, 0,042 e 0,032 maiores no segundo, terceiro e quarto quartis, respectivamente, em relação ao primeiro quartil (referência). Entre as mulheres, os maiores valores de densidade óssea foram encontrados no terceiro (0,021) e quarto (0,027) quartis de AF total em comparação ao quartil mais baixo. No sexo feminino, a atividade física de intensidade moderada a vigorosa apresentou relação positiva com todos os locais de densidade óssea. O efeito indireto através da IL-6 não foi significativo. A atividade física foi associada a ganhos de densidade óssea. Os achados reforçam recomendações de AF na idade adulta para promover a saúde óssea

Epidemiology of interleukin-6: the 30-year follow-up of the 1982 Pelotas (Brazil) birth cohort study.

BACKGROUND: Cardiovascular diseases are the main cause of death globally. Interleukin-6 (IL-6) is a biomarker of cardiovascular risk. AIM: To investigate factors associated with IL-6 concentration in serum, from early life up to 30 years of age. SUBJECTS AND METHODS: In the 2012-2013 follow-up, IL-6 was measured in 2809 participants of the 1982 Pelotas Birth Cohort (1369 males). Multivariable linear regressions, stratified by sex, were performed to evaluate the associations of African ancestry, family income and maternal education at birth, monthly income and education at 30 years, smoking status, harmful alcohol intake, physical activity, and body composition with IL-6, considering a conceptual hierarchical framework. RESULTS: Males with low educational levels and current smokers had the highest mean IL-6. Among females, African ancestry and low monthly income were associated with the highest mean values for the outcome. Physical activity had an inverse association with IL-6 concentration among females. A direct relationship was observed between the measures of adiposity on IL-6, in both sexes. CONCLUSION: Body composition was the main predictor for the outcome evaluated in males and females. Thus, the avoidance of overweight remains an important strategy for the prevention and control of cardiovascular risk and biomarkers associated with these diseases.

Short and long sleep duration and associated factors in pre-adolescence and early adulthood: evidence from the 1993 Pelotas birth cohort study.

OBJECTIVE: The objective of the present study was to investigate the associated factors with short and long sleep duration at ages 11 (pre-adolescence) and 22 years old (early adulthood). METHODS: Participants of the 1993 Pelotas birth cohort with self-reported sleep records at 11 (n = 4442) and 22 (n = 3800) years were included. The total sleep time duration was categorised as short (<9 h for 11 years and <7 h for 22 years), long (>11 for 11 years and >9 for 22 years) and recommended according to the National Sleep Foundation criteria. Multinomial regression analyses were applied according to a hierarchical approach in order to investigate the associated factors with sleep duration patterns. All analyses were stratified by sex. RESULTS: Higher income was associated with higher odds of short sleep duration in 11-year-old boys [OR = 1.54 (CI95%: 1.08; 2.19)] and girls [OR = 1.45 (CI95%: 1.03; 2.06)] and also with lower odds of long sleep duration in both ages. At 22 years, common mental health disorders were associated with higher odds of short sleep duration in both men [OR = 1.56 (CI95%: 1.18; 2.06)] and women [OR = 1.48 (CI95%: 1.11; 1.99)]. Sleep duration was also related to screen time and physical activity showing different association patterns according to sex and age. CONCLUSIONS: Different factors may be associated with sleep duration patterns in pre-adolescence and early adulthood. Our results emphasise the importance of considering stratification analyses to identify associated factors with sleep duration since they may vary according to age and sex.

Food processing and cardiometabolic risk factors: a systematic review.

OBJECTIVE To systematically review the evidence for the association between food consumption according to processing and cardiometabolic factors in adults and/or the elderly. METHOD Two independent evaluators analyzed the electronic databases PubMed, Web of Science and Lilacs until December 2018. We used the following terms: (convenience foods OR food processing OR highly-processed OR industrialized foods OR minimally-processed OR prepared foods OR processed foods OR ultra-processed OR ultraprocessed OR ultra processed OR unprocessed) AND (metabolic syndrome OR hypertension OR blood pressure OR diabetes mellitus OR glucose OR glycaemia OR insulin OR cholesterol OR triglycerides OR blood lipids OR overweight OR obesity) AND (adult OR adults OR adulthood OR aged OR elderly OR old). We assessed methodological and evidence qualities, and also extracted information for the qualitative synthesis from the selected studies. RESULTS Of the 6,423 studies identified after removing duplicates, eleven met the eligibility criteria. The main food classification we used was Nova. The consumption of ultra-processed foods was positively associated with overweight and obesity, high blood pressure and metabolic syndrome. All articles included met more than 50% of the methodological quality criteria. The quality of evidence was considered moderate for the outcome overweight and obesity and weak for hypertension and metabolic syndrome. CONCLUSIONS The Nova food classification stands out in the area of nutritional epidemiology when assessing the effects of food processing on health outcomes. Although caution is required in the interpretation, the results indicated that the consumption of ultra-processed foods can have an unfavorable impact in the health of individuals.

Food processing and cardiometabolic risk factors: a systematic review / Processamento de alimentos e fatores de risco cardiometabólicos: revisão sistemática

ABSTRACT OBJECTIVE To systematically review the evidence for the association between food consumption according to processing and cardiometabolic factors in adults and/or the elderly. METHOD Two independent evaluators analyzed the electronic databases PubMed, Web of Science and Lilacs until December 2018. We used the following terms: (convenience foods OR food processing OR highly-processed OR industrialized foods OR minimally-processed OR prepared foods OR processed foods OR ultra-processed OR ultraprocessed OR ultra processed OR unprocessed) AND (metabolic syndrome OR hypertension OR blood pressure OR diabetes mellitus OR glucose OR glycaemia OR insulin OR cholesterol OR triglycerides OR blood lipids OR overweight OR obesity) AND (adult OR adults OR adulthood OR aged OR elderly OR old). We assessed methodological and evidence qualities, and also extracted information for the qualitative synthesis from the selected studies. RESULTS Of the 6,423 studies identified after removing duplicates, eleven met the eligibility criteria. The main food classification we used was Nova. The consumption of ultra-processed foods was positively associated with overweight and obesity, high blood pressure and metabolic syndrome. All articles included met more than 50% of the methodological quality criteria. The quality of evidence was considered moderate for the outcome overweight and obesity and weak for hypertension and metabolic syndrome. CONCLUSIONS The Nova food classification stands out in the area of nutritional epidemiology when assessing the effects of food processing on health outcomes. Although caution is required in the interpretation, the results indicated that the consumption of ultra-processed foods can have an unfavorable impact in the health of individuals.

RESUMO OBJETIVO Revisar sistematicamente as evidências da associação entre consumo de alimentos de acordo com o processamento e fatores cardiometabólicos em adultos e idosos. MÉTODOS Dois avaliadores independentes analisaram as bases de dados eletrônicas PubMed, Web of Science e Lilacs até dezembro de 2018. Os seguintes termos foram utilizados: (convenience foods OR food processing OR highly-processed OR industrialized foods OR minimally-processed OR prepared foods OR processed foods OR ultra-processed OR ultraprocessed OR ultra processed OR unprocessed) AND (metabolic syndrome OR hypertension OR blood pressure OR diabetes mellitus OR glucose OR glycaemia OR insulin OR cholesterol OR triglycerides OR blood lipids OR overweight OR obesity) AND (adult OR adults OR adulthood OR aged OR elderly OR old). Nos estudos incluídos foram avaliadas as qualidades metodológica e de evidência, além de extraídas informações para a síntese qualitativa. RESULTADOS Dos 6.423 estudos identificados após a remoção das duplicatas, onze preencheram os critérios de elegibilidade. A principal classificação de alimentos utilizada foi a Nova. O consumo de alimentos ultraprocessados foi positivamente associado com excesso de peso e obesidade, hipertensão arterial e síndrome metabólica. Todos os artigos incluídos preencheram mais de 50% dos critérios de qualidade metodológica. A qualidade de evidência foi considerada moderada para o desfecho excesso de peso e obesidade e fraca para hipertensão arterial e síndrome metabólica. CONCLUSÕES A classificação de alimentos Nova se destaca na área da epidemiologia nutricional ao avaliar os efeitos do processamento de alimentos sobre desfechos em saúde. Embora seja necessária prudência na interpretação, os resultados indicam que o consumo de alimentos ultraprocessados pode ter impacto desfavorável sobre a saúde dos indivíduos.

The community health worker as interlocutor in complementary feeding in Pelotas, Rio Grande do Sul, Brazil. / O agente comunitário de saúde como interlocutor da alimentação complementar em Pelotas, RS, Brasil.

This paper evaluates the knowledge of community health workers in complementary feeding and their association with sociodemographic characteristics, work routines and describes the resources available in primary care facilities to master this topic. We applied questionnaires to the responsible for health services and to community health workers, the latter consisting of a knowledge test that allowed the calculation of scores according to the number of correct answers in multiple-choice questions. There was a positive association with age, length of service, home visits to children under 24 months, providing guidance or seeking information about complementary feeding with the knowledge in feeding in the first 24 months of life. There were discrepant responses by health services and the community health workers regarding training, government materials and child growth monitoring. Greater mastery was noted in breastfeeding in relation to complementary feeding. Therefore, primary care facilities should provide support and resources to increase knowledge in complementary feeding through training and access to government materials.

Este artigo avalia o conhecimento dos agentes comunitários de saúde em alimentação complementar e sua associação com características sociodemográficas, rotinas de trabalho e descreve os recursos disponíveis nas unidades básicas de saúde para que tenham domínio neste tema. Foi aplicado um questionário ao responsável do serviço de saúde e outro aos agentes comunitários de saúde, este último composto pelo teste de conhecimento que permitiu o cálculo de escores conforme o número de acertos em questões de múltipla escolha. Houve associação positiva com idade, tempo de profissão, visitas domiciliares a crianças com até 24 meses, realizar orientações e buscar informações sobre alimentação complementar com o conhecimento em alimentação nos primeiros 24 meses de vida. Evidenciou-se desacordo entre as respostas do serviço de saúde e dos agentes comunitários de saúde quanto a treinamentos, materiais governamentais e acompanhamento do crescimento infantil. Verificou-se maior domínio em aleitamento materno em relação à alimentação complementar, portanto, a unidade básica de saúde deve oferecer respaldo e recursos que ampliem o conhecimento em alimentação complementar, mediante treinamentos e acesso facilitado aos materiais governamentais.

O agente comunitário de saúde como interlocutor da alimentação complementar em Pelotas, RS, Brasil / The community health worker as interlocutor in complementary feeding in Pelotas, Rio Grande do Sul, Brazil

Resumo Este artigo avalia o conhecimento dos agentes comunitários de saúde em alimentação complementar e sua associação com características sociodemográficas, rotinas de trabalho e descreve os recursos disponíveis nas unidades básicas de saúde para que tenham domínio neste tema. Foi aplicado um questionário ao responsável do serviço de saúde e outro aos agentes comunitários de saúde, este último composto pelo teste de conhecimento que permitiu o cálculo de escores conforme o número de acertos em questões de múltipla escolha. Houve associação positiva com idade, tempo de profissão, visitas domiciliares a crianças com até 24 meses, realizar orientações e buscar informações sobre alimentação complementar com o conhecimento em alimentação nos primeiros 24 meses de vida. Evidenciou-se desacordo entre as respostas do serviço de saúde e dos agentes comunitários de saúde quanto a treinamentos, materiais governamentais e acompanhamento do crescimento infantil. Verificou-se maior domínio em aleitamento materno em relação à alimentação complementar, portanto, a unidade básica de saúde deve oferecer respaldo e recursos que ampliem o conhecimento em alimentação complementar, mediante treinamentos e acesso facilitado aos materiais governamentais.

Abstract This paper evaluates the knowledge of community health workers in complementary feeding and their association with sociodemographic characteristics, work routines and describes the resources available in primary care facilities to master this topic. We applied questionnaires to the responsible for health services and to community health workers, the latter consisting of a knowledge test that allowed the calculation of scores according to the number of correct answers in multiple-choice questions. There was a positive association with age, length of service, home visits to children under 24 months, providing guidance or seeking information about complementary feeding with the knowledge in feeding in the first 24 months of life. There were discrepant responses by health services and the community health workers regarding training, government materials and child growth monitoring. Greater mastery was noted in breastfeeding in relation to complementary feeding. Therefore, primary care facilities should provide support and resources to increase knowledge in complementary feeding through training and access to government materials.