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

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.

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.

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.

Aspects of the built environment associated with obesity in children and adolescents: A narrative review / Aspectos do ambiente construído associados à obesidade em crianças e adolescentes: revisão narrativa

OBJECTIVE: To perform a narrative literature review to describe the availability of food retailers (groceries and eateries) and their association with obesity in schoolchildren and adolescents. METHODS: The review included studies published from 2003 to 2013 listed in three databases with data on the child's school and/or home surroundings. RESULTS: There was a higher concentration of fast foods near the schools, especially high schools, public schools, or schools located in low-income regions. Moreover, children and adolescents living in areas further from convenience stores had better diets. CONCLUSION: Acknowledging the relationship between built environment and obesity by establishing scientific evidence is necessary for developing specific strategies that help to control the spread of obesity in this age group, aiming to construct healthier spaces. .

OBJETIVO: Realizar revisão narrativa da literatura, procurando descrever as características da disponibilidade de locais de comercialização de alimentos (pontos de venda de alimentos e pontos de alimentação) e sua associação com obesidade entre crianças em idade escolar e adolescentes. MÉTODOS: Foram identificados os estudos publicados entre 2003 e 2013 em três diferentes bases de dados que apresentaram resultados relacionados ao ambiente no entorno escolar e/ou residencial de crianças e adolescentes. RESULTADOS: No entorno das escolas, encontrou-se maior concentração de estabelecimentos do tipo fast food, em especial nas escolas de ensino médio, públicas ou localizadas em regiões de menor poder aquisitivo. Também foi identificado que crianças e adolescentes que residem em áreas mais distantes de lojas de conveniências apresentam dieta de melhor qualidade. CONCLUSÃO: O reconhecimento da relação entre ambiente construído e obesidade, por meio do estabelecimento de evidências científicas, é necessário para a elaboração de estratégias diferenciadas que contribuam para o controle do crescimento da obesidade nesse grupo etário, com um novo olhar para a construção de espaços mais saudáveis. .

Conselhos de Alimentação Escolar em Santa Catarina, Brasil: uma análise do Discurso do Sujeito Coletivo / School Nutrition Councils in Santa Catarina, Brazil: Collective Subject Discourse analysis

OBJETIVO: Identificar no discurso dos conselheiros de alimentação escolar a compreensão sobre as funções, os limites e os avanços da atuação dos Conselhos de Alimentação Escolar. MÉTODOS: Trata-se de um estudo qualitativo que utilizou entrevistas com roteiro semiestruturado baseadas na técnica de Grupos Focais em nove Conselhos de Alimentação Escolar do estado de Santa Catarina, sendo oito conselhos municipais e um estadual. As falas dos conselheiros foram gravadas, posteriormente transcritas e analisadas a partir do método do Discurso do Sujeito Coletivo. RESULTADOS: Foram construídos cinco discursos, agrupados segundo as ideias centrais emergentes. Destacam-se os avanços conquistados pela atuação dos Conselhos de Alimentação Escolar e a capacidade limitada de intervenção na gestão da alimentação escolar. Os achados corroboram a literatura no que se refere ao excesso de burocracia para atuação dos conselhos, à compreensão dos conselheiros sobre os espaços democráticos institucionalizados como de controle social e à falta de comprometimento e representatividade dos membros envolvidos. CONCLUSÃO: Entre os temas analisados, ressaltam-se a compreensão do papel de fiscalização do Conselho de Alimentação Escolar, o conceito de controle social que envolve a participação no Programa Nacional de Alimentação Escolar, e a compreensão desse programa como uma política de Segurança Alimentar e Nutricional. Verifica-se a necessidade de continuidade da formação e qualificação de conselheiros e de estímulo à participação democrática que vise a uma maior representação social. Dessa forma, contribui-se para o resgate da capacidade dos conselhos de intervirem na execução da política pública. .

OBJECTIVE: Identify in the committee members' discourse the understanding of the School Nutrition Councils' functions and the actions taken by their members. METHODS: This is a qualitative study, and data were collected using a questionnaire with semi-structured interviews based on the Focus Groups technique in School Nutrition Councils' in the state of Santa Catarina. A total of nine councils were analyzed (eight municipal councils and one state council). The council members' discourse was recorded, transcribed, and analyzed according to the Collective Subject Discourse method. RESULTS: Five Collective Subject Discourses' were built and grouped according to the Central Ideas. The advances made by the actions of the School Nutrition Councils' members and their limited ability to intervene in the school nutrition management were observed. The findings corroborate those in the literature with regard to: excessive bureaucracy hindering or preventing council member actions, the understanding the councilors of democratic institutionalized spaces such as social control, and the lack of commitment and representativeness of the members involved. CONCLUSION: Among the topics analyzed, the following should be highlighted: the understanding the role of the School Nutrition Councils in supervising activities; the social control concept, which involves participation in the National School Nutrition Program; and the understanding of this program as a Food and Nutrition Security policy. There is a need for further training and of councilors and the encouragement of democratic participation aiming at greater social representation thus contributing to improve their ability to intervene in the implementation of public policies. .

[Evaluation of municipal management of the Brazilian National School Nutrition Program in the largest cities of Santa Catarina State, Brazil]. / Avaliação da gestão municipal do Programa Nacional de Alimentação Escolar nos maiores municípios de Santa Catarina, Brasil.

This article reports on an evaluative study of municipal management of the Brazilian National School Nutrition Program in the largest cities in Santa Catarina State, Brazil. The matrix of indicators included two dimensions: political-organizational, with the sub-dimensions resources, inter-sector action, and social control, and operational-technical, organized in nutritional and feeding efficacy, nutritional monitoring, and educational activities for a healthy diet. A total of 22 indicators were determined, and data were collected through interviews with nutritionists. The political-organizational dimension showed 60% of fair cases and 40% of poor cases, while the operational-technical dimension showed 90% of poor cases, resulting from low performance in monitoring and educational activities. Although the cases showed unsatisfactory results, the evaluation provides important data on the management of the Brazilian National School Nutrition Program. The study emphasizes the importance of evaluation for alerting managers to the relevance of reviewing and upgrading activities.

Factors associated with the feeding practices of the adult population of Goiânia, Goiás, Brazil.

This cross-sectional study identified the factors associated with adult feeding practices in Goiânia, the capital of the state of Goiás, in the Midwestern region of Brazil, by means of telephone interviews with 2,002 adults (> 18 years old). Information about demographic aspects, lifestyle, nutritional status, and food consumption was collected, leading to a sum of healthy food choices. It was observed that men and women have an average of two healthy food choices and low frequency of fruit intake (5.4% of men; 8.5% of women), as well as the consumption of legumes and vegetables (18.1% of men; 22.6% of women). The hierarchical multiple regression analysis revealed that the mean healthy food choice among men increases with age and physical practice, and among women, with paid work. The prevalence of unhealthy food choices associated with other risk behaviors favors the development of chronic diseases. Multi-strategy and intersectorial actions are necessary to overcome this situation.

School Gardens in the Distrito Federal, Brazil / Hortas escolares no Distrito Federal, Brasil

OBJECTIVE: The aim of the present study was to identify experiences with gardens in public schools in the Distrito Federal, Brazil, and to analyze factors involved in their use to promote healthy eating habits. METHODS: This is an analytical cross-sectional study with data collection in two phases: (1) telephone contact with all public schools in the Distrito Federal; (2) interviews conducted with a sample of schools with a garden (n=105). RESULTS: Of the 582 schools in the Distrito Federal, 453 (77.8%) participated in phase 1 and 37.7% of these had a garden. Rural schools had a higher prevalence of gardens (p=0.003). Among the schools which had no garden, 75.2% (n=212) had interest in creating one. The main reason for the deactivation of gardens was a lack of manpower to maintain them. The main reason for creating a garden was to supplement school food (56.2%). The garden was used as an educational space to promote healthy eating habits by 60.8% of the schools. CONCLUSION: An expressive percentage of schools with gardens (37.7%) was identified in the Distrito Federal. A number of factors were associated with the presence of a garden, including the location and size of the school, as well as the level of education. A significant percentage of schools reported using the garden as a space to promote healthy eating habits. This result must be refined by assessing the use and impact of gardens as a tool to promote healthy eating habits in the school community. .

OBJETIVO: Identificar experiências com hortas em escolas públicas do Distrito Federal, Brasil, analisando determinantes no seu uso voltado à promoção da alimentação saudável. MÉTODOS: Estudo transversal analítico, com coleta de dados em duas fases: (1) por telefone com todas as escolas públicas do Distrito Federal; (2) entrevista presencial com amostra das escolas que possuíam horta (n=105). RESULTADOS: Das 582 escolas do Distrito Federal, 453 (77,8%) participaram da fase 1 e dessas, 37,7% possuíam horta. Escolas rurais apresentaram maior prevalência de horta (p=0,003). Das escolas sem horta, 75,2% tinham interesse na sua implantação. O principal motivo para desativação da horta foi falta de mão-de-obra para manutenção. Quanto às escolas com horta, a intenção de complementar a alimentação escolar foi o principal motivo de sua implantação (56,2%). A horta era utilizada como espaço educativo para promoção da alimentação saudável por 60,8% das escolas. CONCLUSÃO: Foi identificado no Distrito Federal um percentual expressivo de escolas com horta (37,7%). Alguns fatores relacionados à localização, porte e nível de ensino da escola associaram-se à presença da horta. Verificou-se inicialmente, um elevado percentual de escolas que relataram utilizar a horta como espaço de promoção da alimentação saudável. Faz-se necessário aprofundar este resultado por meio de avaliação do uso e impacto da horta como instrumento de promoção da alimentação saudável na comunidade escolar. .

Factors associated with the feeding practices of the adult population of Goiânia, Goiás, Brazil / Fatores associados às práticas alimentares da população adulta de Goiânia, Goiás, Brasil

This cross-sectional study identified the factors associated with adult feeding practices in Goiânia, the capital of the state of Goiás, in the Midwestern region of Brazil, by means of telephone interviews with 2,002 adults (> 18 years old). Information about demographic aspects, lifestyle, nutritional status, and food consumption was collected, leading to a sum of healthy food choices. It was observed that men and women have an average of two healthy food choices and low frequency of fruit intake (5.4% of men; 8.5% of women), as well as the consumption of legumes and vegetables (18.1% of men; 22.6% of women). The hierarchical multiple regression analysis revealed that the mean healthy food choice among men increases with age and physical practice, and among women, with paid work. The prevalence of unhealthy food choices associated with other risk behaviors favors the development of chronic diseases. Multi-strategy and intersectorial actions are necessary to overcome this situation.

Os fatores associados à prática alimentar da população adulta de Goiânia foram identificados por meio de estudo transversal realizado através de entrevistas telefônicas com 2.002 adultos (> 18 anos). Foram coletadas informações sociodemográficas, de estilo de vida, estado nutricional e consumo alimentar. Construiu-se um somatório de escolhas alimentares saudáveis. Foi observado que homens e mulheres realizam, em média, duas escolhas alimentares saudáveis, sendo baixa a frequência de consumo de frutas (5,4% homens; 8,5% mulheres) e legumes e verduras (18,1% homens; 22,6% mulheres). A análise de regressão múltipla hierarquizada revelou que a média de escolhas alimentares saudáveis entre os homens aumenta com a idade e com a prática de atividade física e, entre as mulheres, com o relato de trabalho remunerado. O predomínio de escolhas alimentares não saudáveis, associado a outros comportamentos de risco, favorece o desenvolvimento de doenças crônicas. Ações multiestratégicas e intersetoriais são necessárias para a superação deste cenário.

Caracterização do Programa Nacional de Alimentação Escolar no Estado de Santa Catarina / Characterization of the National School Food Program in Santa Catarina State, Brazil

OBJETIVO: Caracterizar o Programa Nacional de Alimentação Escolar no Estado de Santa Catarina. MÉTODOS: Pesquisa quantitativa exploratória e transversal. A coleta de dados foi realizada de fevereiro a maio de 2010 por meio de questionário online com 293 municípios catarinenses. As variáveis descritivas foram analisadas conforme distribuição absoluta e relativa. Na análise estatística foi realizado o teste de Qui-quadrado (p<0,05) utilizando software Stata 11.0. RESULTADOS: A taxa de adesão foi de 74,4%. A maioria dos municípios possuía: gestão do Programa Nacional de Alimentação Escolar centralizada (97,7%); até 10 escolas (58,7%); até mil alunos matriculados (55,1%), apenas um nutricionista (91,7%); e até 10 merendeiras no município (49,5%); fornecendo até 2 mil refeições ao dia (61,9%). Destaca-se que 2,8% dos municípios não possuíam responsável técnico e dois terços afirmaram que o custo médio por refeição servida variava entre R$0,31 e R$0,90, enquanto 21,6% informaram que o custo médio da refeição foi ≤R$0,30. Não foi detectada diferença estatística significante em relação ao número de refeições por merendeira ao dia e ao custo médio da refeição entre os diferentes portes dos municípios ou índice de desenvolvimento humano (p=0,584). Detectou-se adequação no número de nutricionistas por aluno matriculado estatisticamente maior nos municípios de pequeno porte (p<0,001), assim com nos municípios de médio índice de desenvolvimento humano (p<0,001). CONCLUSÃO: Verifica-se inadequação da maioria dos municípios quanto ao número de nutricionistas. Percebeu-se a necessidade do estabelecimento de parâmetros mínimos de adequação entre número de merendeiras e refeições servidas, da necessidade de incentivos financeiros relacionados à mão de obra e custo das refeições...

OBJECTIVE: To characterize the National School Food Program in Santa Catarina State. METHODS: This quantitative, exploratory, cross-sectional study used an online questionnaire to collect data from 293 municipalities in Santa Catarina from February to May 2010. The descriptive variables were analyzed according to their absolute and relative distributions. The software Stata 11.0 used the Chi-square test for comparing groups with a significance level of 5% (p<0.05). RESULTS: The questionnaire response rate was 74.4%. Some municipalities had: centralized management of the National School Food Program (97.7%); up to 10 schools (58.7%); up to one thousand students enrolled in public schools (55.1%); one dietician (91.7%); up to ten cooks (49.5%); and up to two thousand meals served per day (61.9%). A few (2.8%) municipalities did not have a technician in charge of the school food. The mean cost of each meal was ≤R$0.30 in 21.6% of the municipalities and varied from R$0.31 to R$0.90 in two-thirds of the municipalities. Municipalities of different sizes or Human Development Indices had similar mean meal cost and number of meals prepared per cook per day (p=0.584). Small municipalities (p<0.001) and those with medium Human Development Indices (p<0.001) were more likely to have a proper dietician-to-student ratio. CONCLUSION: There is an inadequacy in most municipalities regarding the number of nutritionists. To establish minimum standards of adequacy between the number of cooks and meals served is necessary, beyond the need for financial incentives regarding workforce and meals costs...

Percepção dos cozinheiros escolares sobre o processo de utilização de produtos orgânicos na alimentação escolar em municípios catarinenses / School lunch cooks' perception of the use of organic foods in the school meals served in Santa Catarina state, Southern Brazil

OBJETIVO: Identificar o perfil dos cozinheiros escolares e avaliar a utilização, os benefícios e os possíveis fatores limitantes da introdução de alimentos orgânicos na alimentação escolar. MÉTODOS: Estudo transversal e exploratório incluindo os cozinheiros chefes de 242 escolas públicas municipais dos 52 municípios do estado de Santa Catarina que compraram alimentos orgânicos para a alimentação escolar em 2010. Os entrevistados foram questionados sobre a utilização de alimentos orgânicos, seus benefícios, as dificuldades e a capacitação recebida sobre esse tema. As prevalências e os IC95% foram calculados no software Stata 11.0. RESULTADOS: Dos 242 cozinheiros entrevistados, 97,4% eram do sexo feminino, 86,6% apresentavam 30 ou mais anos de idade e 47,9% não cursaram o ensino médio ou superior. Entre esses, 9,4% (IC95% 6,1-13,9) desconheciam que a escola estava recebendo alimentos orgânicos. Entre aqueles que referiram usar alimentos orgânicos (n=219), 42,7% (IC95% 34,3-51,5) referiram presença diária desses alimentos no cardápio escolar. A qualidade dos alimentos no momento da entrega na escola foi considerada ótima/boa em 93,7% dos casos. Quase 10,0% relataram dificuldades no uso desses alimentos, especialmente por problemas no recebimento/ armazenamento e baixa aceitação pelos alunos. A maioria percebeu benefícios no uso de orgânicos na alimentação escolar, tanto para os alunos (99,8%) quanto para a comunidade (100,0%). CONCLUSÃO: O percentual de dificuldades encontrado pelos cozinheiros no uso dos alimentos orgânicos foi baixo, sendo positiva a avaliação quanto ao rendimento, a durabilidade, a quantidade de trabalho e a qualidade desses produtos em comparação aos não orgânicos. Os possíveis fatores limitantes poderiam ser corrigidos mediante melhoria na estrutura física das escolas, na logística de recebimento/estocagem desses alimentos, na capacitação direcionada dos cozinheiros e na sua maior integração nas políticas de alimentação escolar.

OBJECTIVE: This study investigated the profile of school cooks and assessed the use, benefits, and possible limitations associated with the introduction of organic foods in school meals. METHODS: This cross-sectional, exploratory study included the head cooks of 242 public municipal schools of 52 municipalities from the state of Santa Catarina that bought organic foods in 2010. The interviewees were asked about the use of organic foods, their benefits, the associated difficulties, and the training they were given on this subject. The software Stata 11.0 calculated the prevalences and 95% confidence intervals. RESULTS: Of the 242 interviewed cooks, 97.4% were females, 86.6% were aged 30 or more years, and 47.9% had not completed high school or higher education. Of these, 9.4% (95%CI=6.1-13.9) were not aware that the school was buying organic foods. Of the 219 cooks who used organic foods, 42.7% (95%CI=34.3-51.5) reported that these foods were present every day in the school meals. The quality of these foods upon arrival at the school was considered great/good 93.7% of the time. Almost 10.0% of the interviewees reported difficulties associated with these foods, especially regarding delivery, storage, and low student acceptance. Most interviewees believed that these foods benefited the students (99.8%) and the community (100.0%). CONCLUSION: Few cooks had difficulties using organic foods. The cooks found that their yield, shelf life, required work, and quality exceeded those of non-organic foods. The limitations could be eliminated by improving the layout of the schools, food delivery, food storage, cook training, and integration in school food policies.

[Municipal School Nutrition Councils in Santa Catarina, Brazil: characterization and performance profile]. / Conselhos Municipais de Alimentação Escolar em Santa Catarina: caracterização e perfil de atuação.

The aim of this study is to assess Municipal School Nutrition Councils (CAEs) of the Brazilian School Nutrition Program (PNAE) in the state of Santa Catarina, Brazil. A cross-sectional study was conducted with a sample of municipalities in the state (n = 152; 52%). CAE presidents were interviewed and asked about the counselor profile, attributions performed and the relation of CAEs with other local councils. Poisson regression analysis was conducted to obtain unadjusted and adjusted prevalence ratios and the adjusted model adopted a hierarchic approach. The majority of councils analyzed their accounting reports, monitored resources and strived for quality of the CAEs at all levels. They coordinated the storage of food, participated in establishing the menu, monitored the purchasing of food and had an internal control system. However, only 22.4% carried out all their attributions once or more per year. A positive association was found between an adequate performance of the CAE and relations with other local councils. The awareness of the CAEs, as well as a stimulus to acting jointly with other councils and actors involved with food and nutrition security, are essential to ensure the right to healthy and adequate nutrition at school.

Promotion of healthy eating at schools in the Federal District of Brazil / Promoção da alimentação saudável: cenário das escolas da capital do Brasil

OBJECTIVE: The aim of the present study was to describe strategies for the Promotion of Healthy Eating at Public and Private Schools in the Federal District of Brazil. METHODS: A descriptive, analytical, cross-sectional study was carried out involving 122 Private Schools and 173 Public Schools. The components of health promotion in the school setting were adapted to the context of the promotion of healthy eating, with interviews conducted for the administration of a semi-structured questionnaire. The Student's t test, Spearman's correlation coefficients and likelihood ratios were used for the statistical analysis (5% level of significance; p<0.05). RESULTS: Only one private elementary school fulfilled the criteria for 20 of the 24 items studied. At the other extreme, two public high schools only fulfilled the criteria for three items. A positive correlation was found between number of meetings held with the school community to address healthy eating and presence of healthy environments as well as between presence of healthy environments and monitoring of nutritional status of schoolchildren (p<0.01). Schools that held an above-average number of meetings to address healthy eating had a smaller proportion of street vendors and local stores in the surrounding area (p=0.01). The majority of schools that had a partnership with healthcare professionals included the topic of healthy eating in the curriculum (p=0.04). CONCLUSION: The different associations found demonstrate the importance and interdependence of the components of the promotion of healthy eating. Preschools have developed more strategies for the Promotion of Healthy Eating and health in general in comparison to other teaching modalities. Schools in the Federal District of Brazil need support and training to be developed as a "Health Promoting School", specifically with regard to actions directed toward healthy eating.

OBJETIVO: Caracterizar as estratégias de Promoção da Alimentação Saudável em escolas públicas e privadas do Distrito Federal. MÉTODOS: Estudo transversal descritivo-analítico realizado com 122 escolas particulares e 173 públicas. Adaptaram-se os componentes de promoção da saúde no ambiente escolar para o contexto da Promoção da Alimentação Saudável, sendo realizadas entrevistas para a aplicação do instrumento. Os testes utilizados foram: t de Student, coeficiente de correlação de Spearman e teste da razão de verossimilhança (nível de significância p<0,05). RESULTADOS: Apenas uma escola privada de ensino infantil contemplava positivamente 20 dos 24 itens pesquisados. No outro extremo, duas escolas públicas de ensino médio contemplavam apenas três itens. Observou-se correlação positiva entre o número de reuniões com a comunidade escolar para abordar a temática alimentação saudável e a presença de ambientes saudáveis e; entre a presença de ambientes saudáveis e o monitoramento do estado nutricional dos escolares (p<0,01). As escolas que realizavam reuniões acima da média para abordar alimentação saudável possuíam em menor proporção ambulantes e/ou comércios locais próximos (p=0,01). A maioria das escolas que possuíam parceria com profissional de saúde incluía a temática Alimentação Saudável no currículo (p=0,04). CONCLUSÃO: As diversas associações encontradas demonstram a importância e a interdependência dos componentes de Promoção da Alimentação Saudável estudados. As escolas de educação infantil desenvolveram mais estratégias de Promoção da Alimentação Saudável e da saúde em relação às demais modalidades. A maioria das escolas do Distrito Federal precisa de apoio e capacitação para desenvolver-se como Escola Promotora da Saúde, no recorte específico de ações voltadas para a alimentação saudável.

Conselhos Municipais de Alimentação Escolar em Santa Catarina: caracterização e perfil de atuação / Municipal School Nutrition Councils in Santa Catarina, Brazil: characterization and performance profile

O objetivo deste estudo é avaliar os Conselhos Municipais de Alimentação Escolar (CAE) no Estado de Santa Catarina. Investigação transversal em amostra de municípios catarinenses (n = 152; 52%). Entrevistaram-se preferencialmente os presidentes dos CAE, pesquisando-se o perfil dos conselheiros, as atribuições realizadas e a relação do CAE com outras instâncias de controle social. Utilizou-se Regressão de Poisson para obter razões de prevalências bruta e ajustada. No modelo ajustado seguiu-se uma abordagem hierárquica. A maioria dos conselhos analisava a prestação de contas, fiscalizava os recursos, zelava pela qualidade do PNAE em todos os níveis, orientava o armazenamento dos alimentos, participava da elaboração do cardápio, acompanhava a compra de gêneros e tinha regimento interno. Entretanto, apenas 22,4% realizavam todas as atribuições com frequência maior ou igual à anual. Verificou-se associação positiva entre uma boa atuação do CAE e existência de relação com outros conselhos locais. A sensibilização dos CAE e o estímulo à atua­ção articulada com outros conselhos e atores envolvidos com a segurança alimentar e nutricional, são essenciais para a garantia do direito à alimentação saudável e adequada nas escolas.

The aim of this study is to assess Municipal School Nutrition Councils (CAEs) of the Brazilian School Nutrition Program (PNAE) in the state of Santa Catarina, Brazil. A cross-sectional study was conducted with a sample of municipalities in the state (n = 152; 52%). CAE presidents were interviewed and asked about the counselor profile, attributions performed and the relation of CAEs with other local councils. Poisson regression analysis was conducted to obtain unadjusted and adjusted prevalence ratios and the adjusted model adopted a hierarchic approach. The majority of councils analyzed their accounting reports, monitored resources and strived for quality of the CAEs at all levels. They coordinated the storage of food, participated in establishing the menu, monitored the purchasing of food and had an internal control system. However, only 22.4% carried out all their attributions once or more per year. A positive association was found between an adequate performance of the CAE and relations with other local councils. The awareness of the CAEs, as well as a stimulus to acting jointly with other councils and actors involved with food and nutrition security, are essential to ensure the right to healthy and adequate nutrition at school.

Fatores comportamentais associados ao sobrepeso e à obesidade em escolares do Estado de Santa Catarina / Behavioral factors associated with overweight and with obesity in students in the State of Santa Catarina / /Factores de comportamiento asociados al sobrepeso y a la obesidad en escolares del Estado de Santa Catarina

Foi realizado estudo transversal com 4.964 escolares do ensino fundamental do Estado de Santa Catarina para verificar associação entre as variáveis socioeconômicas e de atividade física com o sobrepeso e a obesidade, estes últimos diagnosticados a partir do índice de massa Corporal (ImC). Foram estimadas, por ponto e por intervalo com 95% de confiança, as prevalências de sobrepeso e obesidade, variáveis de desfecho. As razões de prevalência foram obtidas pelo modelo de Poisson e ajustadas à renda familiar per capita, escolaridade dos pais, sexo e idade da criança. As prevalências de sobrepeso e obesidade foram 15,4% e 6,1%, respectivamente, semelhantes entre sexo e categorias de idade. Após ajuste, as variáveis associadas com sobrepeso e obesidade foram: frequência semanal de esportes; número de horas sono/noite; e horas/dia no computador (fim de semana). Reduzida prática de esportes, menor duração de sono/noite e mais tempo no computador associam-se com sobrepeso e obesidade nestes escolares.

A cross-sectional study with 4,964 elementary school students of the State of Santa Catarina was performed to check for the association of socioeconomic variables and exercise with overweight or obesity, the two latter diagnosed by the Body Mass Index (BMI). The outcome variables, overweight and obesity, were estimated by point prevalence and 95% confidence intervals. Prevalence ratios were obtained by the Poisson model and adjusted to per capita family income, parents ´ schooling, child´s gender and age. The prevalence of overweight and obesity were 15.4% and 6.1%, respectively, similar between gender and age categories. After adjustments, variables associated with overweight and obesity were: weekly frequency of practicing sports; number of hours of sleep/night; and hours/day on the computer (weekends). Less sports practice, less hours of sleep/night and more time on the computer were associated with overweight or obesity in the students studied.

Se realizó un estudio transversal con 4.964 escolares de enseñanza fundamental del Estado de Santa Catarina para verificar la asociación entre las variables socioeconómicas y de actividad física, con el sobrepeso y la obesidad, estos últimos diagnosticados a partir del Índice de Masa Corporal (IMC). Se estimaron como variables de resultados, por punto y por intervalo con un 95% de confianza, las prevalencias de sobrepeso y obesidad. Las razones de prevalencia se obtuvieron por el modelo de Poisson y se ajustaron a la renta familiar per capita, escolaridad de los padres, sexo y edad del niño. Las prevalencias de sobrepeso y obesidad fueron 15,4% y 6,1%, respectivamente, semejantes entre sexo y categorías de edad. Tras el ajuste, las variables asociadas con el sobrepeso y obesidad fueron: frecuencia semanal de deportes; número de horas de sueño/noche; y horas/día en el ordenador (fin de semana). Reducida práctica de deportes, menor duración de sueño/noche y más tiempo frente al ordenador se asocian con el sobrepeso y obesidad en estos escolares.

Overweight and obesity related factors in schoolchildren in Santa Catarina State, Brazil / Fatores associados ao sobrepeso e a obesidade em escolares do Estado de Santa Catarina

The purpose of this study is to determine the correlation of socioeconomic, dietary, and anthropometric-nutritional variables of parents and their children to overweight (including obesity) in schoolchildren in Santa Catarina State, Brazil. This is a transversal study conducted on 4,964, 6 to 10-year-old schoolchildren registered in 345 Santa Catarina elementary schools. The following data were acquired: the children’s current weight and height, birth weight and length, duration of breastfeeding, age at which water, herbal tea and other foods were introduced to their diet; parental income, education level, age, weight and height were also obtained. The prevalence of overweight and obese children were estimated by point and by interval with a 95% confidence; prevalence rates were obtained based on the Poisson model. An hierarchical approach was used, in which variables were adjusted within blocks and included in the model when they presented p<0.05 at the outcome (overweight including obesity). The results indicate that 47.8% of the subjects were male. The prevalence of overweight and obese students was 15.4% (CI95%: 14.4%-16.5%) and 6.1% (CI95%: 5.4%-6.7%) respectively and were statistically similar among sexes and age ranges. BMI values were higher in males and among older children (p<0.05). After adjustment within and among blocks, the variables per capita household income and parents’ BMI values remained associated with overweight (including obesity). Overweight (including obesity) in schoolchildren is associated with a higher per capita household income and parental overweight and obesity.

Este estudo objetivou verificar a associação entre variáveis socioeconômicas, dietéticas, antropométrico-nutricionais dos pais e da criança e a presença de sobrepeso incluindo obesidade, em escolares do Estado de Santa Catarina. Trata-se de um estudo transversal com 4.964 escolares entre 6 a 10 anos matriculados em 345 escolas do ensino fundamental de Santa Catarina. Foram obtidos dados de peso e estatura dos escolares, peso e comprimento ao nascer, tempo de aleitamento materno, idade da introdução de água ou chá e de outros alimentos, renda, escolaridade e idade, peso e estatura dos pais. As prevalências de sobrepeso e obesidade foram estimadas por ponto e por intervalo com 95% de confiança e as razões de prevalência foram obtidas a partir do modelo de Poisson. Foi utilizada a abordagem hierárquica, onde as variáveis foram ajustadas dentro dos blocos e incluídas no modelo quando apresentaram p<0,05 com o desfecho (sobrepeso incluindo obesidade). Os resultados indicam que 47,8% dos participantes pertenciam ao sexo masculino. As prevalências de sobrepeso e obesidade foram, respectivamente, 15,4% (IC95%: 14,4%-16,5%) e 6,1% (IC95%: 5,4%-6,7%), sendo estatisticamente semelhantes entre sexos e categorias de idade. Os valores do IMC foram maiores no sexo masculino e entre as crianças mais velhas (p<0,05). Após ajuste dentro e entre os blocos permaneceram associadas com a presença de sobrepeso incluindo obesidade, as variáveis renda familiar per capita e IMC dos pais. O sobrepeso incluindo obesidade dos escolares está associado à renda familiar per capita mais elevada e ao fato dos pais apresentarem sobrepeso e obesidade.

Fatores associados ao aleitamento materno exclusivo em Guarapuava, Paraná / Factors associated with exclusive breastfeeding in Guarapuava, Paraná, Brazil

OBJETIVO: Esta pesquisa investigou a prevalência do aleitamento materno exclusivo aos seis meses de idade e sua associação com características socioeconômicas, demográficas, ambientais, de morbidade e biológicas. MÉTODOS: Foi realizado um estudo transversal e a amostra foi composta por 426 crianças entre zero e 23,9 meses, assistidas pelo Programa Saúde da Família e residentes na área urbana da cidade de Guarapuava (PR). Foram realizadas entrevistas domiciliares com a aplicação de questionários pré-codificados para investigar fatores relacionados ao aleitamento materno RESULTADOS: A mediana de aleitamento materno exclusivo aos seis meses foi de sessenta dias e a prevalência foi de 12,9 por cento. Verificou-se associação estatisticamente significante (p<0,05) do aleitamento materno exclusivo aos seis meses de idade com o trabalho materno fora do lar e com a continuidade do aleitamento materno até o momento da entrevista. CONCLUSÃO: Os resultados indicam baixas prevalências de aleitamento materno exclusivo, além da necessidade de ações mais efetivas de amparo à mãe trabalhadora, que possui maiores dificuldades para a manutenção desta prática.

OBJECTIVE: This research investigated the prevalence of exclusive breastfeeding at the age of six months and its association with socioeconomic, demographic, environmental, biological and morbidity characteristics. METHODS: A cross-sectional study was done with a sample of 426 children from Guarapuava, PR, aged 0 to 23.9 months seen by the Family Health Program. Pre-coded questionnaires were administered during home interviews to investigate breastfeeding-associated factors. RESULTS: The median of exclusive breastfeeding at six months was 60 days and the prevalence was 12.9 percent. Exclusive breastfeeding at six months was significantly associated (p<0.05) with the mother's employment status and with breastfeeding continuing until the occasion of the interview. CONCLUSION: The results indicate low prevalences of exclusive breastfeeding and the need of more effective actions to support working mothers, since it is harder for them to continue exclusive breastfeeding once they go back to work.

Projeto a escola promovendo hábitos alimentares saudáveis: comparação de duas estratégias de educação nutricional no Distrito Federal, Brasil / Promotion of healthy eating habits by schools study: comparison of two nutrition education strategies in the Federal District of Brazil

OBJETIVO: Analisar e comparar o conhecimento sobre nutrição de professores e alunos do Projeto "a escola promovendo hábitos alimentares saudáveis", submetidos a duas estratégias de educação nutricional em escolas do Distrito Federal. MÉTODOS: O Projeto Escola utilizou duas estratégias de intervenção em educação nutricional: intervenção nutricional (A) ações educativas realizadas na comunidade escolar pela equipe; e intervenção nutricional (B) ações educativas desenvolvidas por professores que frequentaram oficinas de capacitação. O conhecimento das crianças foi avaliado por meio de um instrumento sobre pirâmide dos alimentos e um sobre higiene pessoal; sendo aplicado com os professores um questionário do tipo verdadeiro ou falso. RESULTADOS: Foram avaliadas 4 escolas com intervenção A (180 alunos e 19 professores) e 4 com intervenção B (129 alunos e 16 professores). A média de acertos no instrumento de pirâmide dos alimentos foi de 3,2 e 2,9 (p=0,37), respectivamente pelas crianças que receberam as intervenções nutricionais A e B. Na atividade sobre higiene pessoal, para estes mesmos alunos, observaram-se percentuais de acerto de 61,1 por cento e 73,6 por cento (p=0,10). Os professores que receberam as intervenções nutricionais A e B obtiveram percentuais de acertos semelhantes nos questionários, em torno de 90,0 por cento (p=0,06). CONCLUSÃO: Observou-se que os dois tipos de intervenção de educação nutricional foram igualmente úteis para promover o conhecimento de alunos e professores. Portanto, faz-se necessário incentivar a realização de processos de educação nutricional no ambiente escolar, de acordo com a diretriz da Política Nacional de Alimentação e Nutrição que diz respeito à promoção da saúde.

OBJECTIVE: The objective of this study was to analyze and compare the nutrition knowledge of teachers and students who participated in the study "Promotion of healthy eating habits by schools" and were submitted to two different strategies of nutrition education in schools of the Federal District, Brazil. METHODS: The study administered two strategies of nutrition education intervention: nutrition intervention (A) administration of educational activities in the school community by the research team; and nutrition intervention (B) educational activities were administered by teachers who participated in the training workshops..The knowledge of the students was assessed by an instrument based on the food pyramid and another one based on personal hygiene. The teachers were assessed by means of a true-or-false questionnaire. RESULTS: Four schools submitted to nutrition intervention A (180 students and 19 teachers) and four schools submitted to nutrition intervention B (129 students and 16 teachers) were assessed. The average number of correct answers given by the students on the instrument based on the food pyramid was 3.2 for students in intervention A and 2.9 for students in intervention B (p=0.37). On the instrument about personal hygiene for the same students, 61.1 percent and 73.6 percent, respectively, answered it correctly (p=0.10). The teachers submitted to interventions A and B answered a similar number of questions correctly, around 90.0 percent (p=0.06). CONCLUSION: This study showed that two different types of nutrition education intervention were equally useful to promote nutrition knowledge among teachers and students. Therefore, it is necessary to promote nutrition education programs in schools, in accordance with the National Food and Nutrition Policies, which regard health promotion strategies.

[Dietary assessment of pre-school children from Federal District Brazil]. / Avaliação do consumo alimentar de pré-escolares do distrito Federal, Brasil.

The objective was to assess food consumption among children attending non-profit nurseries in the Federal District, Brazil.A representative sample was obtained and stratified by income. Food intake among 678 children, between 4 and 82 months old, was analyzed in nine nurseries using the 24-h dietary recall and direct food weighing methods. In children under 13 months old mean intake was above AI between 93.6 to 100% for carbohydrates, proteins, vitamins B1, B2, B12, B6, and zinc. In children from 7-12 months 56.5% presented iron consumption below EAR. Calcium intake was above AI for 35.4% of children over 1 year old. For vitamins with EAR values, the prevalence of inadequate consumption was 53.2% for vitamin E, and 90% for folate for children over 12 months old. Iron and zinc intake was above UL for 6.4% and 32.5% of children under 1 year old, and 1.5% and 5.3% for the remaining children, respectively. Lipid percentage distribution range among children between 13 and 47 months old was within the acceptable range for only 16.2%. Nonetheless, children between 36 and 82 months of both genders presented mean intake below energy requirements. Inadequate consumption observed for some nutrients points to the need for improvements in the standard of meals and nutritional assistance offered to children enrolled in charitably run nurseries in the Federal District.

Overweight and obesity related factors in schoolchildren in Santa Catarina State, Brazil.

The purpose of this study is to determine the correlation of socioeconomic, dietary, and anthropometric-nutritional variables of parents and their children to overweight (including obesity) in schoolchildren in Santa Catarina State, Brazil. This is a transversal study conducted on 4,964, 6 to 10-year-old schoolchildren registered in 345 Santa Catarina elementary schools. The following data were acquired: the children's current weight and height, birth weight and length, duration of breastfeeding, age at which water, herbal tea and other foods were introduced to their diet; parental income, education level, age, weight and height were also obtained. The prevalence of overweight and obese children were estimated by point and by interval with a 95% confidence; prevalence rates were obtained based on the Poisson model. An hierarchical approach was used, in which variables were adjusted within blocks and included in the model when they presented p < 0.05 at the outcome (overweight including obesity). The results indicate that 47.8% of the subjects were male. The prevalence of overweight and obese students was 15.4% (C195%: 14.4%-16.5%) and 6.1% (C195%: 5.4%-6.7%) respectively and were statistically similar among sexes and age ranges. BMI values were higher in males and among older children (p < 0.05). After adjustment within and among blocks, the variables per capita household income and parents' BMI values remained associated with overweight (including obesity). Overweight (including obesity) in schoolchildren is associated with a higher per capita household income and parental overweight and obesity.

First law regulating school canteens in Brazil: evaluation after seven years of implementation / Primera ley de regulación de las cantinas escolares en Brasil: evaluación después de siete años de aplicación

The high prevalence of overweight and obesity among schoolchildren in Brazil and worldwide has shown that strategies to promote healthy eating habits are needed. Santa Catarina was the first Brazilian State to promulgate specific legislation to regulate the food commercialized in schools (Law nº 12.061/2001). The objective was to assess the functioning of school canteens in eight key municipalities of Santa Catarina, investigating whether the foods sold were in accordance with the Law. A questionnaire was completed by the principals and those responsible for the canteens. Item Response Theory was used to examine the levels of compliance with the Law. In all 345 schools took part. Of these, 156 (45 percent) had a canteen. The presence of a canteen was significantly higher in the private sector (p<0.001) The majority of the canteens (n=105; 68.2 percent) did not sell fried snacks, soft drinks, industrialised popcorn, hard candies, lollipops and chewing gum and industrialised packaged snacks. The items which were least likely to comply with the Law were juices and the daily availability of fruits. The notice board on diet was present in only 7.1 percent of the establishments. Many canteens offered items of low nutritional value. The inspection of these establishments is necessary, together with educational actions targeting the proprietors of the canteens as well as the schools themselves. Training for the canteen’s proprietors may constitute a strategy that will guarantee the economic viability of these establishments and the possibility of them being transforming into places of health promotion.

Las elevadas tasas de sobrepeso y obesidad en los escolares han planteado la necesidad de aplicar estrategias para promover la alimentación saludable en esta población. Santa Catarina fue el primer estado brasileño a crear legislación para regular los alimentos vendidos en las cantinas escolares (Ley nº 12.061/2001). El objetivo fue realizar un diagnóstico sobre el funcionamiento de las cantinas en ocho municipios polos de Santa Catarina, comprobando si los alimentos vendidos están de conformidad con la Ley. Se aplicó un cuestionario a los directores y responsables de las cantinas. Se usó la Teoría de la Respuesta al Ítem para comprobar los niveles de adecuación a la Ley. Los participantes del estudio fueron 345 escuelas. De éstas, 156 (45 por ciento) tienen cantina. La presencia de la cantina fue estatísticamente mayor en la red privada (p<0.001) La mayoría de las cantinas (n=105; 68,2 por ciento) no vende snacks fritos, refrescos, palomitas de maíz industrializadas, caramelos, chicles o bocadillos industrializados. Los puntos con mayor dificultad de adecuación a la Ley fueron los jugos no naturales y la disponibilidad diaria de frutas. Sólo 7,1 por ciento de las cantinas tenían mural sobre alimentación. Muchas cantinas venden alimentos de bajo valor nutricional. La vigilancia de estos establecimientos es necesaria, junto con acciones educativas destinadas a los propietarios de las cantinas y a los estudiantes. La formación de los propietarios de las cantinas será la estrategia para garantizar la viabilidad económica y la posibilidad concreta de la cantina convertirse a su vez en una zona de promoción de la salud.