20 anos da PNAN: perspectiva das coordenadoras de alimentação e nutrição do Ministério da Saúde

As coordenadoras de Alimentação e Nutrição do Ministério da Saúde falam sobre os 20 anos de história da PNAN

Política nacional de alimentação e nutrição no Brasil: 20 anos de história

Ciclo de Debates da Política Nacional de Alimentação e Nutrição (PNAN) 09 de setembro, 05 e 21 de outubro, 18 de novembro e 09 de dezembro de 2021

A demanda por novas práticas de atenção nutricional do SUS

Ciclo de debates da Política Nacional de Alimentação e Nutrição. A demanda por novas práticas de atenção nutricional do SUS.

History of nutrition policy in Japan.

Why has Japan become the longest-lived country in the world? The longevity is often attributed to Japan's economic growth, but Japan experienced an extended life expectancy prior to achieving such economic growth. During and after the Second World War when the General Headquarters of the Supreme Commander for the Allied Powers was occupying Japan, the welfare administration system was drastically reformed, resulting in dramatic improvements in the hygiene status, which led to an increase in the average life expectancy in Japan. Here, this background is reviewed, along with an explanation of how Japan has become the world's longest-lived country.

[Nutriome as the direction of the "main blow": determination of physiological needs in macro- and micronutrients, minor biologically active substances].

One of the essential parts of fundamental research in Nutrition Science is the determination of the physiological requirements of humans for energy and food substances. Research that has been carried out in this area over the past 90 years, consistently develops and improves the norms of physiological requirements for energy and nutrients for various groups of the population of the Russian Federation. In the 50 years of the last century in this research field, determining the values of daily intake for macronutrients (proteins, lipids and carbohydrates), was in the first place. Then the Era of micronutrients (vitamins, minerals, trace elements) was started, and, finally, now there is the Era of minor food biologically active substances. More and more facts are accumulating about their leading role in regulating metabolism. They can be recognized as endogenous regulators, the primary vital components involved in the formation of human health. In recent years, the new definition of Nutriome is introduced into Nutrition Science. It is considered as a set of essential nutritional factors to maintain a dynamic equilibrium between human being and the environment, aimed to ensure viability, the preservation and reproduction of the species, keeping the adaptive capacity, the system of antioxidant defence, apoptosis, metabolism, and immune system function. The Nutriome is a formula for optimal nutrition, which is continually being improved and supplemented. Knowledge of this formula is the key to forming an optimal diet for a person, and, therefore, to save their health. It is evident that at the population level, the Nutriome has its characteristics, its structure for each age period of human life. The need to develop a formula for optimal nutrition and, consequently, updating nutrient-based dietary guidelines is induced by socio-economic and demographic changes in population, changes in anthropometric characteristics of children and adults, increasing prevalence of socially significant non-communicable diseases, developing studies of the significance of particular food substances and establishing the relationship between nutrition and health.

Policy Progress in Reducing Sodium in the American Diet, 2010-2019.

Most Americans consume dietary sodium exceeding age-specific government-recommended targets of 1,500-2,300 mg/day per person. The majority (71%) of US dietary sodium comes from restaurant and packaged foods. Excess sodium intake contributes to hypertension and cardiovascular disease, which is the leading cause of death in the United States. This review summarizes evidence for policy progress to reduce sodium in the US food supply and the American diet. We provide a historical overview of US sodium-reduction policy (1969-2010), then examine progress toward implementing the 2010 National Academy of Medicine (NAM) sodium report's recommendations (2010-2019). Results suggest that the US Food and Drug Administration made no progress in setting mandatory sodium-reduction standards, industry made some progress in meeting voluntary targets, and other stakeholders made some progress on sodium-reduction actions. Insights from countries that have significantly reduced population sodium intake offer strategies to accelerate US progress toward implementing the NAM sodium-reduction recommendations in the future.

Impacts and Echoes: The Lasting Influence of the White House Conference on Food, Nutrition, and Health.

The 1969 White House Conference on Food, Nutrition, and Health had a significant influence on the direction of food and nutrition policy in the United States. The conference produced recommendations leading to federal legislation and programs to alleviate hunger and malnutrition, improve consumers' nutrition knowledge through education and labeling, and monitor the nutritional status of the population. Fifty years later, its legacy was revisited at a conference convened by Harvard University and Tufts University. This article reviews the literature contributing to the first author's keynote speech at the conference, its influencers, and its influences. We focus on the highlights of five domains that set the stage for the conference: the social environment, the food environment, nutrition science, public health data, and policy events. We briefly describe the conference, its proposed directions, and its lasting legacy in these five domains.

Dietary saturated fat and heart disease: a narrative review.

The American Heart Association (AHA) recently published a meta-analysis that confirmed their 60-year-old recommendation to limit saturated fat (SFA, saturated fatty acid) and replace it with polyunsaturated fat to reduce the risk of heart disease based on the strength of 4 Core Trials. To assess the evidence for this recommendation, meta-analyses on the effect of SFA consumption on heart disease outcomes were reviewed. Nineteen meta-analyses addressing this topic were identified: 9 observational studies and 10 randomized controlled trials. Meta-analyses of observational studies found no association between SFA intake and heart disease, while meta-analyses of randomized controlled trials were inconsistent but tended to show a lack of an association. The inconsistency seems to have been mediated by the differing clinical trials included. For example, the AHA meta-analysis only included 4 trials (the Core Trials), and those trials contained design and methodological flaws and did not meet all the predefined inclusion criteria. The AHA stance regarding the strength of the evidence for the recommendation to limit SFAs for heart disease prevention may be overstated and in need of reevaluation.

La alimentación en la España contemporánea a través del NO-DO / Food in contemporary Spain through NO-DO newsreel

El NO-DO, programa semanal creado como un servicio de difusión de obligatoria exhibición en los cines españoles durante la dictadura franquista, constituye el mayor fondo histórico audiovisual para la historia contemporánea de España durante el siglo XX. El análisis y el estudio de estos noticiarios y documentales ilustran, de forma paralela a la evolución política y socioeconómica de aquel momento, cómo tuvo lugar el proceso de transición alimentaria y nutricional. El presente trabajo tuvo como objetivo principal analizar y reflexionar acerca de la imagen que el NO-DO ofrecía a la población española sobre el ámbito de la nutrición y el desarrollo de las distintas tendencias en la alimentación de esta época. Para la elaboración de este estudio, se elaboró una amplia lista de descriptores propios de la disciplina de la nutrición y la alimentación de modo que sirviera como herramienta para la búsqueda de referencias recogidas tanto en los noticiarios como en los documentales, a través del buscador de la web del archivo online del NO-DO que se incluye en los fondos de la Filmoteca Española. Realizada la búsqueda y aplicados los criterios de exclusión, atendiendo a la temática de estudio, se analizaron un total de 169 noticiarios y 5 documentales. El análisis de los resultados obtenidos permitió una revisión general de esta época a través del proceso de transición nutricional que vivió el país en estas décadas (1943-1981)

The NO-DO, a weekly projection of the Franco regime, created as a diffusion service of obligatory exhibition in Spanish cinemas, constitutes the greatest audiovisual historical background for the contemporary history of Spain in the 20th century. The analysis and study of these newsreels and documentaries illustrate parallel to the political and socioeconomic evolution of that time, how the process of food and nutritional transition took place. The main objective of this work was to analyse and reflect on the image that these newsreels and documentaries offered to the Spanish population on the field of nutrition and the development of the different tendencies in the diet of this period. In order to carry out this study, an extensive list of descriptors specific to the discipline of nutrition and food was drawn up so that it could serve as a tool for searching for references collected both in newsreels and in documentaries, through the web search engine of the NO-DO on-line archive that is included in the Spanish Film Library's collection. Once the search was carried out and the exclusion criteria were applied, according to the subject of the study, there were analysed a total of 169 newsreels and 5 documentaries. The analysis of the results obtained allowed a general review of this era through the process of nutritional transition that the country experienced in these decades (1943-1981)

History and challenges of Brazilian social movements for the achievement of the right to adequate food.

The historical struggles that Brazil faced to overcome malnutrition coincided with the empowerment of civil society and social movements which played a crucial role in the affirmation of health and food as social rights. After two decades under military dictatorship, Brazil went through a redemocratization process in the 1980s when activism emerged to demand spaces to participate in policy-making regarding the social agenda, including food and nutrition security (FNS). From 1988 onward institutional structures were established: the National Council of FNS (CONSEA) convenes government and civil society sectors to develop and monitor the implementation of policies, systems and actions. Social participation has been at the heart of structural changes achieved since then. Nevertheless, the country faces multiple challenges regarding FNS such as the double burden of disease, increasing use of pesticides and genetically modified seeds, weak regulation of ultra-processed products, and marketing practices that affect the environment, population health, and food sovereignty. This article aims at examining the development of the participatory political system and the role played by Brazilian social movements in the country's policies on FNS, in addition to outlining challenges faced by those policies.

Perspective: Challenges and Controversial Issues in the Dietary Guidelines for Americans, 1980-2015.

Since 1980, every edition of the Dietary Guidelines for Americans (DGAs) has recommended increased consumption of fruits, vegetables, and whole grains, but reduced consumption of saturated fat, sugars, and sodium and, therefore, their primary food sources. Every edition has generated controversy, mainly from producers of foods affected by "eat less" recommendations, particularly meat. Objections to the 2015 DGAs focused on environmental as well as scientific issues, but also on purported conflicts of interest among members of the Dietary Guidelines Advisory Committee. On this basis, critics induced Congress to authorize the National Academy of Medicine (NAM) to review the process of drawing up the guidelines. The NAM's 2017 reports should strengthen the process, but as long as science continues to support advice to reduce consumption of targeted foods, the guidelines will continue to elicit political controversy.

The History and Future of Dietary Guidance in America.

Evidence-based dietary guidance in the United States has progressed substantially since its inception >100 y ago. This review describes the historical development and significance of dietary guidance in the United States, including the Dietary Guidelines for Americans (DGAs), and emphasizes the foundations upon which they were developed, the process in the formation of past and current guidelines, and present and future applications. Dietary guidance during the first half of the 20th century was focused primarily on food groups in a healthy diet, food safety, safe food storage, and the role of some minerals and vitamins in the prevention of disease. This was punctuated by World War II messaging to reduce food waste and increase food storage. In 1980, the first DGA report was released, and later, the USDA and the Department of Health and Human Services (HHS) were given a mandate for reissuance and reassessment every 5 y. An ad hoc advisory committee made up of nongovernmental experts was established for each edition to review the scientific evidence and provide content recommendations to the Secretaries of the USDA and the HHS. Wording was changed from negative (avoid) to positive (choose) and emphasis was increasingly placed on reducing the prevalence of overweight and obesity and prevention of chronic diseases. Today, the DGAs guide all federally funded feeding and educational programs, including food policies, food assistance programs, and consumer education programs, as well as these programs at the regional, state, and local levels. Additional users include dietitians and other health professionals, food service personnel, food and beverage manufacturers, schools, and day care facilities. Currently, the DGAs are intended for individuals aged ≥2 y. Future editions of the DGAs will include guidance for infants and children <2 y, as well as pregnant women.

A socio-historical approach to policy analysis: the case of the Brazilian Workers' Food Policy.

Policy analyses based on traditional or structuralist definitions of the state are important, but they have some limitations for explaining processes related to policymaking, implementation, and results. Bourdieusian sociology links the analysis to objective and subjective dimensions of social practices and can help elucidate these phenomena. This article provides such empirical evidence by analyzing the social genesis of a Brazilian policy that currently serves 18 million workers and was established by the state in 1976 through the Fiscal Incentives Program for Workers' Nutrition (PIFAT/PAT). The study linked the analysis of the trajectory of social agents involved in the policy's formulation to the historical conditions that allowed the policy to exist in the first place. Although the literature treats the policy as a workers' food program (PAT), the current study showed that it actually represented a new model for paying financial subsidies to companies that provided food to their employees, meanwhile upgrading the commercial market for collective meals. The study further showed that the program emerged as an administrative policy, but linked to economic agents. The program became a specific social space in which issues related to workers' nutrition became secondary, but useful for disguising what had been an explicit side of its genesis, namely its essentially fiscal nature.

[The fight against malnutrition of the medical community between 1860 and 1940]. / La comunidad médica y su lucha en contra de la desnutrición en Chile (1860-1940).

The aim of this manuscript is to highlight the contribution of the first two generations of physicians who faced malnutrition in Chile, between the end of nineteenth century and the first decades of the twentieth century. In the history of Chilean medicine, there is a paucity of research about the role of these physicians in the fight against malnutrition. The main interest was centered in the forties of the twentieth century and the first policies and actions for the working class feeding have been overlooked. The existence of two pioneering groups that have common elements and differences to face the problem of under nutrition is established.

La comunidad médica y su lucha en contra de la desnutrición en Chile (1860-1940) / The fight against malnutrition of the medical community between 1860 and 1940

The aim of this manuscript is to highlight the contribution of the first two generations of physicians who faced malnutrition in Chile, between the end of nineteenth century and the first decades of the twentieth century. In the history of Chilean medicine, there is a paucity of research about the role of these physicians in the fight against malnutrition. The main interest was centered in the forties of the twentieth century and the first policies and actions for the working class feeding have been overlooked. The existence of two pioneering groups that have common elements and differences to face the problem of under nutrition is established.

Interweaving Ideas and Patchwork Programmes: Nutrition Projects in Colonial Fiji, 1945-60.

The influence of a range of actors is discernible in nutrition projects during the period after the Second World War in the South Pacific. Influences include: international trends in nutritional science, changing ideas within the British establishment about state responsibility for the welfare of its citizens and the responsibility of the British Empire for its subjects; the mixture of outside scrutiny and support for projects from post-war international and multi-governmental organisations, such as the South Pacific Commission. Nutrition research and projects conducted in Fiji for the colonial South Pacific Health Service and the colonial government also sought to address territory-specific socio-political issues, especially Fiji's complex ethnic poli,tics. This study examines the subtle ways in which nutrition studies and policies reflected and reinforced these wider socio-political trends. It suggests that historians should approach health research and policy as a patchwork of territorial, international, and regional ideas and priorities, rather than looking for a single causality.