How Do Brazilian Consumers Understand Food Groups in the Food-based Dietary Guidelines?

In the Food-based Dietary Guidelines (FBDGs), food classification is based on food groups and nutrient sources. Much research has already investigated multiple aspects of consumer understanding of the information described in these documents. However, no study has evaluated consumer understanding of all food items contained in the groups described in the FBDGs. This study aimed to assess Brazilian consumers' understanding of food classification according to food groups in the concepts of the FBDGs. Therefore, an instrument, Consumer Understanding of Food Groups (UFG), was constructed and validated to assess consumer understanding of food groups. The instrument comprised 44 items approved by experts (agreement > 80%). A total of 894 Brazilians from all regions participated in this study. The results suggest that 48.9% of the participants believe it is easier to classify food according to food groups. The classification of food groups is based on the origin of the food (animal and vegetable). Although consumers easily recognize foods according to their origin, we still identify asymmetries regarding including food items from the animal kingdom and species from the plant kingdom. This exploratory study highlights important information that can contribute to improving the FBDGs. It is essential to consider consumers' understanding and guide them regarding choices from a technical point of view.

Is There a Convergence between the Food Classification Adopted by Food-Based Dietary Guidelines and Food Science and Technology?

The World Health Organization (WHO) proposed the dietary guidelines presented as the Food-based Dietary Guidelines (FBDG). The FBDG classify foods according to their origin, nature, nutrient source, food group, and processing level. Food science and technology (FST) ranks food according to its origin, perishability, nutrient source, processing, food group, and formulation. This paper aimed to compare the convergence points for food classification according to the FBDG and FST. This study was carried out in two phases. The first step was identifying the Food-Based Dietary Guidelines (FBDG). For each of the FBDG, food items were grouped as fruits, vegetables, cereals, sugars, fat and oils, legumes, foods from animals, dairy products, and others. The second step aimed to identify and describe the different food classification systems. The search was performed on PubMed®, Science Direct, and Web of Science and websites of international organizations such as the Food and Agriculture Organization of the United Nations (FAO), the World Health Organization (WHO), and the Codex Alimentarius. Our results show that the points of convergence between the classifications were the classification in terms of origin (animal and vegetable), nutrient sources, and food groups. However, inconsistencies were observed for the distribution of food items in each group in the 98 surveyed FBDG. As for nature, there was a convergence for in natura, minimally processed, and processed foods. However, the criteria adopted for minimally processed and processed foods described in the FBDG differ from those considered by the FST. FST also does not recognize the classification of foods concerning the level of processing.

How Do Consumers Understand Food Processing? A Study on the Brazilian Population.

Food guides are official documents that guide consumers' food choices. They inform the qualitative classification of food groups and messages on how to adopt a healthy diet. The classifications and nomenclatures adopted in these documents vary according to cultural, nutritional, and scientific criteria. This study aimed to evaluate the understanding of Brazilian consumers regarding food classification according to the Food Guide for the Brazilian Population (FGBP) concepts. An instrument was constructed to assess consumer understanding. It was named "Understanding of the Level of Processing of Food" (ULPF) and validated according to the concepts of constructs presented by psychometrics such as the Delphi methodology. The instrument was composed of 36 items approved by experts (concordance > 80% and with good internal consistency). A total of 2333 Brazilians from all regions participated in the study. The results suggest that food classification according to the level of processing was difficult for participants to understand. About 85% of them did not understand or did not know the definitions and classification of food and preparations according to food and science technology (FST) and the FGBP. More than 50% of the participants believed that it was easier to classify food according to food groups.

Risk behaviors among persons civilly committed for opioid use.

Despite the growth in civil commitment for persons who use opioids, we know little about the kinds of risk behaviors among those committed. This study examined the behaviors that a judge might use to determine if there is sufficient evidence that an individual's opioid use poses a risk for serious harm. The study recruited participants (n = 121) from three Massachusetts Department of Public Health civil commitment facilities in 2018. We used a list of risk behaviors that courts consider supportive of opioid-related civil commitment. Participants averaged 28 years of age, 56% were male, and 91% met criteria for severe opioid use disorder. Participants endorsed an average of 9 of the 27 risk behaviors. On average, participants endorsed three of the six drug use behaviors representing a danger to themselves, four of eleven behaviors representing an inability to care for or protect themselves (home safety, weight loss), and two of ten behaviors representing a danger to others (driving high or drunk). Participants who reported they were "not at all pleased" to have been civilly committed endorsed significantly (p = .009) fewer behaviors representing a danger to themselves than those who said they were at least "a little pleased." We conclude that the majority of individuals civilly committed for opioid use are engaging in multiple high-risk behaviors that pose a serious risk of harm to themselves.

A Systematic Review on Gluten-Free Bread Formulations Using Specific Volume as a Quality Indicator.

This study aimed to perform a systematic review on gluten-free bread formulations using specific volumes as a quality indicator. In this systematic review, we identified 259 studies that met inclusion criteria. From these studies, 43 met the requirements of having gluten-free bread with a specific volume greater than or equal to 3.5 cm3/g. Other parameters such as the texture profile, color (crumb and crust), and sensory analysis examined in these studies were presented. The formulations that best compensated the lack of the gluten-network were based on the combination of rice flour, rice flour with low amylose content, maize flour, rice starch, corn starch, potato starch, starch with proteins and added with transglutaminase (TGase), and hydrocolloids like hydroxypropylmethylcellulose (HPMC). Of the 43 studies, three did not present risk of bias, and the only parameter evaluated in common in the studies was the specific volume. However, it is necessary to jointly analyze other parameters that contribute to the quality, such as texture profile, external and internal characteristics, acceptability, and useful life of the bread, especially since it is a product obtained through raw materials and unconventional ingredients.

Gluten contamination in food services and industry: A systematic review.

Gluten-related disorders (GRD) affects approximately 10% of the general population. The only treatment for GRD is still so far is the lifelong complete exclusion of gluten from the daily diet. The correct information about the presence/absence of gluten in food is very important to this group. The present study aimed to evaluate the prevalence of gluten contamination in gluten-free industrial and non-industrial products. In this systematic review, 24 cross-sectional studies were analyzed. The authors developed specific search strategies for Science Direct, Scopus, Web of Science, Google Scholar and ProQuest Dissertations & Theses Global. The authors evaluated the methodological quality of the included studies using criteria from Meta-analysis of Statistics Assessment and Review Instrument (MASTARI). We performed the statistical meta-analysis by metafor package of R program. 95.83% (n = 23) of the studies presented positive results for contamination (over 20 ppm). In industrial food products, studies showed a contamination prevalence of 13.2% (95% CI: 10.8%-15.7%). In non-industrial food products, studies showed a contamination prevalence of 41.5% (95% CI: 16.6%-66.4%). Despite the non-industrial products presented higher contamination prevalence than the industrial products, the difference was not significant (p = 0.072). The findings indicate cross-contamination in industrialized and non-industrialized products. As expected, industrial products labeled as gluten-free showed a lower percentage of gluten-contamination than non-industrialized. Despite that, any contaminated sample found in this group present greater relevance than non-labeled foods. It indicates that foods labeled as "gluten-free" should not be considered safe for patients with GRD since information on the label regarding the presence/absence of gluten is unreliable. Therefore, any gluten-contamination in products labeled as gluten-free is a serious problem to whom present GRD. Further studies are needed to estimate gluten cross-contamination in food service meals and industry better.

Self-treatment of skin infections by people who inject drugs.

BACKGROUND AND AIMS: Persons who inject drugs (PWID) experience high rates of skin and soft tissue infections (SSTI) and often access emergency or inpatient treatment. However, many PWID do not seek care and self-treat some or all of their infections. The goal of the current study was to examine predictors of self-treatment of SSTI in a sample of hospitalized PWID, and describe methods of and reasons for self-treatment. METHODS: PWID (N = 252) were recruited from inpatient medical units at an urban safety-net hospital to join a behavioral intervention trial. The baseline interview focused on past-year SSTI incidence and related treatment, including reasons for not accessing medical care and methods of self-treatment. RESULTS: Of study participants, 162 (64%) reported having at least one SSTI in the past year. This subset was 59.9% White/Caucasian with a mean age of 38.0 (SD + 10.5). One-third of these participants (32.3%) reported ever self-treating SSTI in the past year. In a logistic regression model, number of past-year infections (OR = 1.81, p < .001) and positive outlook (OR = 2.46, p < .001) were associated with self-treatment of SSTI. Common methods of self-treatment included mechanically draining sores, applying heat/warm compress, and cleaning affected areas. Continued drug use and belief that infections were not serious and could be self-treated were two main reasons for not seeking professional medical care. CONCLUSIONS: Interventions targeting SSTI among PWID should include education on when to seek medical care and the risks of serious infection, and could be implemented at local clinics or harm reduction programs to increase access.

Homelessness, Personal Hygiene, and MRSA Nasal Colonization among Persons Who Inject Drugs.

Methicillin-resistant Staphylococcus aureus (MRSA) infection is a leading cause of hospitalization and medical visits among individuals experiencing homelessness and also among persons who inject drugs (PWID), populations with significant overlap in urban centers in the USA. While injection drug use is a risk factor for MRSA skin infections, MRSA is also known to transmit easily in crowded, public locations in which individuals have reduced personal hygiene. Individuals in urban centers who experience homelessness or drug addiction may spend significant amounts of time in environments where MRSA can be easily transmitted, and may also experience reduced access to facilities to maintain personal hygiene. We assessed the relationship between homelessness, personal hygiene, and MRSA nasal colonization, a proxy for MRSA infection risk, in a study of PWID in Boston, MA (n = 78). Sleeping in a homeless shelter for at least one night in the last 3 months was significantly associated with MRSA nasal colonization (OR 3.0; p = 0.02; 95% CI 1.2, 7.6). Sleeping at more than one place during the last week (considered a metric of elevated housing instability) was also associated with a threefold increase in odds of MRSA nasal colonization (OR 3.1; p = 0.01; 95% CI 1.3, 7.6). MRSA nasal colonization was strongly associated with use of public showers (OR 13.7; p = 0.02; 95% CI 1.4, 132.8), although few people in this study (4 of 78) reported using these public facilities. Sharing bedding with other people was also associated with increased risk of MRSA colonization (OR 2.2; p = 0.05; 95% CI 1.0-4.7). No associations between hand hygiene, frequency of bathing or clothes laundering, or street sleeping were observed. Use of public facilities supporting persons experiencing homelessness and housing instability, including shelters and public showers, is associated with an increased risk of MRSA nasal colonization in this study. Personal hygiene behaviors appear less associated with MRSA nasal colonization. Environmental assessments of MRSA contamination in homeless shelters and public sanitation facilities are warranted so as to inform appropriate intervention activities.

Dietary Patterns of Children and Adolescents from High, Medium and Low Human Development Countries and Associated Socioeconomic Factors: A Systematic Review.

The purpose of this systematic review is to assess the associations among education, income and dietary pattern (DP) in children and adolescents from high, medium and low human development countries (HHDC, MHDC and LHDC, respectively). Observational studies that evaluated the association between family income or education with the DP are obtained through electronic database searches. Forty articles are selected for review. In HHDC, education is inversely associated with "unhealthy" DP and positively associated with "healthy" DP. In cross-sectional studies from HHDC, higher income is negatively associated with "unhealthy" DP. In MHDC, there is no association between the socioeconomic variables (SE) and the DPs, although, in some studies, the unhealthy diet is positively associated with SE. Only one study conducted in LHDC showed an inverse association between income/education with "unhealthy" DP and there is no association between the SE and "healthy" DP. In conclusion, children and adolescents living in HHDC with high parental education tend to have a healthier diet. In MHDC, although an unhealthy diet is found among the high-income and educated population, the associations are not clear. Additional research is needed to clarify the associations between income and education with "unhealthy" and "healthy" DPs in MHDC and LHDC.

Educational training of nutritionists in Public Health Nutrition: A systematic review / Formação do nutricionista em Saúde Pública. uma revisão sistemática

ABSTRACT The present systematic review aimed to synthesize the findings of studies in the literature on the educational training of nutritionists in Public Health. The study was conducted by searching international databases (PubMed, Science Direct, Lilacs, PsycINFO, Scopus, and Web of Science), as well as in the gray literature. The steps of systematic search followed the recommendations of the Preferred Reporing Itens for Systematic Reviews and Meta-Analysis. Eligibility criteria included studies on the Public Health training in Nutrition Undergraduate courses, whose subjects were students, educators, and professionals who practice in the field of Nutrition. A total of 633 articles were identified, of which, 66 were eligible for reading and analysis of the full text and 12 were included in the systematic review. Of these, five of these 12 articles used quantitative methods, 3 used mixed methods, and 4 used exclusively qualitative methods. There was high heterogeneity among the studies, such as different samples, subjects, and evaluation methods. The studies included were carried out from 2008 to 2017 in 28 different countries, including Brazil, Canada, Vietnam, and some European countries. In most of these articles, Public Health was one of the main areas in the formal education of nutritionists, with predominant traditional teaching approach, with a biological focus and a fragmented curricular structure. The included studies were evaluated with low risk of bias. In spite of the limitations identified in the professional training of nutritionists, there was a clear emphasis on the importance of the relationship between theory and practice, teaching-research-extension approaches, and practical activities or internships in Public Health, which can promote the development of skills and competencies that can exert an impact on their professional performance.

RESUMO A presente revisão sistemática objetivou sintetizar os achados disponíveis na literatura sobre a formação profissional do nutricionista em Saúde Pública. A pesquisa foi realizada em bases de dados internacionais (PubMed, Science Direct, Lilacs, PsycINFO, Scopus e Web of Science), bem como uma busca adicional na literatura cinzenta. As etapas da pesquisa seguiram as recomendações do Preferred Reporing Itens for Systematic Reviews and Meta--Analysis. Como critérios de elegibilidade incluiu-se os estudos sobre a formação em Saúde Pública nos cursos de Graduação em Nutrição, cujos sujeitos respondentes eram estudantes, docentes e profissionais do campo da Nutrição. Foram identificados incialmente 633 artigos, dos quais 66 foram elegíveis para leitura completa e 12 incluídos na revisão sistemática. Destes, cinco utilizaram a abordagem quantitativa, três se serviram da metodologia mista, e quatro são estudos qualitativos. A heterogeneidade dos estudos foi alta, com amostras, público-alvo e métodos de avaliação distintos. As pesquisas incluídas foram realizadas em 28 países, entre eles Brasil, Canadá, Vietnã e países da Europa, nos anos de 2008 a 2017. Na maioria dos estudos, a Saúde Pública está entre as principais áreas na formação profissional do nutricionista, num processo de ensino que se mostrou tradicional, biologicista e com estrutura curricular fragmentada. A qualidade dos estudos indicou baixo risco de vieses. Houve um destaque para a importância da articulação teoria-prática, ensino-pesquisa-extensão e atividades práticas-estágios na formação em Saúde Pública, o que favorece o desenvolvimento de competências e habilidades que podem se refletir na atuação profissional.