Evaluación de la cobertura de la merienda escolar en 4 departamentos de Paraguay. Años 2016-2018

RESUMEN Introducción: La merienda escolar contribuye con la nutrición y rendimiento escolar, es importante conocer su alcance. Objetivo: Evaluar la merienda escolar en Concepción, Cordillera, Paraguarí y Central, en cuanto implementación y cobertura. Materiales y Métodos: Estudio observacional descriptivo retrospectivo de licitaciones para merienda escolar entre 2016-2018 en Concepción, Cordillera, Paraguarí y Central. Fueron caracterizadas las instituciones incluidas, días cubiertos del calendario escolar (180 días) y cantidad de beneficiarios. Resultados: Fueron incluidas 15 licitaciones. En Concepción 90% fueron instituciones públicas, 6% privadas, 3% sin datos; Cordillera 88% fueron públicas, 8% privadas, 4% sin datos; Paraguarí 91% fueron públicas, 3% privadas, resto sin datos; Central 12% fueron privadas 11% sin datos, resto públicas. En Concepción fueron 30.112 beneficiarios en 2016/2017 y 27.514 en 2018, en Cordillera aumentó de 37.167 (2017) a 44.375 (2018); en Paraguarí varió de 30.339 (2016) a 29.761 (2018), en Central fueron 180.535 beneficiarios en 2017-2018. En Concepción en 2016/2017 se planificó merienda para 80 días, 133 días en 2018, en Cordillera 160 días en 2017, 117 días en 2018; en Paraguarí en 2016 fueron 122 días, 110 en 2017 y 117 días en 2018; en Central fueron 216 días en 2017-2018.Los beneficiarios cubiertos según Registro Único de Estudiantes al 2018 fue 78,5% en Concepción, 87% en Cordillera, 90% en Paraguarí, 75% en Central. Conclusiones: En provisión de merienda escolar, la mayoría fueron instituciones públicas, hubo descenso de beneficiarios en el 2018 excepto Cordillera. 2/3 de los beneficiarios registrados fueron incluidos y se proveyó durante poco más de la mitad del año escolar.

ABSTRAC Introduction: The school meal contributes to nutrition and school performance, it is important to know its reach. Objective: To evaluate school meals in Concepción, Cordillera, Paraguarí and Central, in terms of implementation and reach. Materials and Methods: This was a retrospective, descriptive, observational study of awarded contracts for school meals between 2016-2018 in Concepción, Cordillera, Paraguarí and Central. We characterized the included institutions, covered days of the school calendar (180 days) and number of beneficiaries. Results: 15 contracts were included. In Concepción, 90% of schools were public institutions, 6% private, 3% without data; in Cordillera 88% were public, 8% private, 4% without data; in Paraguarí 91% were public, 3% private, the rest without data; in Central 12% were private, 11% without data, the rest public. In Concepción there were 30,112 beneficiaries in 2016/2017 and 27,514 in 2018, in Cordillera it increased from 37,167 (2017) to 44,375 (2018); in Paraguarí it varied from 30,339 (2016) to 29,761 (2018), in Central there were 180,535 beneficiaries in 2017-2018. In Concepción in 2016/2017 meals were planned for 80 days, 133 days in 2018, in Cordillera 160 days in 2017, 117 days in 2018; in Paraguarí in 2016 there were 122 days, 110 in 2017 and 117 days in 2018; In Central there were 216 days in 2017-2018. The beneficiaries covered according to the Single Student Registry in 2018 were 78.5% in Concepción, 87% in Cordillera, 90% in Paraguarí, 75% in Central. Conclusions: In the provision of school meals, the majority of schools were public institutions, there was a decrease in beneficiaries in 2018 except in Cordillera. 2/3 of the registered beneficiaries were included and meals were provided for just over half the school year.

Composición de los alimentos incorporados en la merienda escolar en niños preescolares / Composition of Food Incorporated to the School Snack of Preschool Children

RESUMEN Introducción: Según la alta incidencia de desnutrición en el país, se realizan estudios que evidencian un bajo rendimiento físico y mental en el niño, relacionado a una inadecuada merienda escolar. Objetivo: Evaluar la composición de la merienda escolar y los factores determinantes. Métodos: Estudio descriptivo de corte transversal correlacional, realizado en preescolares de 10 centros de educación inicial de la provincia de Santa Elena, en 2017. El universo quedó constituido por 785 niños, con una muestra de 150 binomios padres/preescolares. Se utilizó el método observacional y la encuesta aplicada, las variables estudiadas fueron: edad de los padres, sexo, nivel de instrucción, peso y talla (evaluadas según las Tablas de Valoración Nutricional de la Organización Mundial de la Salud), alimentos incluidos en la merienda y capacitación sobre alimentación saludable. En el análisis de los datos se utilizó el software SPSSS versión 21 y las medidas de tendencia central, de dispersión e intervalos de confianza. Resultados: El 84,44 por ciento de los padres incorporan alimentos saludables, 81,14 por ciento entre 21 a 25 años de edad. En la escuela "Carmen Montenegro" suministran en la merienda escolar alimentos saludables a diferencia del centro de educación "Luz Esmeralda Valdivia" en la cual añaden alimentos de bajo nivel proteico y donde 58,73 por ciento manifestó no haber recibido capacitación sobre alimentación saludable. Conclusión: Los alimentos más incorporados en la merienda escolar fueron: frutas, lácteos, legumbres y jugos naturales; y los menos añadidos fueron: dulces, jugos envasados, gaseosas y snacks(AU)

ABSTRACT Introduction: With respect to the high incidence of malnutrition in the country, studies are being carried out that show a low physical and mental performance in the child, associated with inadequate school snack. Objective: To evaluate the composition of the school snack and the determining factors. Methods: A descriptive, correlation, cross-sectional study was carried out in preschools children from 10 education centers in Santa Elena Province, in 2017. The study population was made up of 785 children, with a sample of 150 parent/ preschool binomials. The observational method and the applied survey were used, the variables studied were age of the parents, sex, level of instruction, weight and height (evaluated according to the Nutritional Assessment Tables of the World Health Organization), foods included in the snack, and training on healthy eating. The software SPSS v. 21 and the measures of central tendency, dispersion and confidence intervals were used in the data analysis. Results: 84.44 percent of the parents incorporate healthy foods, 81.14 percent between 21 and 25 years of age. At Carmen Montenegro School, they provide healthy food in the school snack, unlike Luz Esmeralda Valdivia Education Center, in which they add low-protein foods and where 58.73 percent said that they had not received training on healthy eating. Conclusion: The most incorporated foods in the school snack were fruits, dairy products, legumes, and natural juices; while the least added were sweets, packaged juices, soda, and snacks(AU)

Contribución de la merienda al patrón alimentario de escolares con exceso de peso y estado nutricional normal, en Cartago, Costa Rica

Con el fin de identificar el aporte nutricional de las meriendas al patrón alimentario de los escolares con estado nutricional normal y con exceso de peso, se estudiaron 80 escolares (40 casos con sobrepeso/obesidad y 40 controles con estado nutricional normal) costarricenses de primer a tercer grado. Se tomó peso, talla y pliegue tricipital para la valoración antropométrica y se utilizó un registro dietético de tres días para la información de consumo. Las meriendas fueron analizadas de acuerdo al tipo (lugar de preparación y consumo) y horario. Se obtuvo que las meriendas de la tarde y la “preparada y consumida en casa” son las realizadas con la mayor frecuencia por ambos grupos. En la merienda “preparada y consumida en casa” y la “merienda de la tarde” se observó un consumo significativamente mayor de energía y carbohidratos en las niñas caso. En la merienda “preparada y consumida en casa”, se reportó un consumo significativamente mayor de grasa saturada en los niños caso comparado con los niños control. Las meriendas de la tarde y las meriendas “preparadas y consumidas en casa”, podrían estar relacionadas con el desarrollo de sobrepeso/obesidad en la muestra estudiada, por lo que la educación nutricional brindada a padres y escolares, resultan claves en la prevención de ésta.

Nutritional contribution of snacks to food patterns in school children who are overweight or obese compared to school children who are of normal weight in Cartago,Costa Rica. In order to assess the nutritional contribution of snacks to food patterns in school children, a sample of 80 Costa Rican elementary schoolchildren: 40 children who were overweight or obese (the case group) and 40 children with normal weight (the control group) were evaluated. The anthropometric evaluation included weight, height, and triceps skinfold thickness. Food patterns were determined using a 3-day food diary.Snacks consumed throughout the day were classified and analyzed according to their place of preparation and location of consumption and to the time of the day in which they were consumed. The results of this study revealed that “afternoon snacks” and “snacks prepared and eaten at home” were the most frequently consumed snacks by both case and control groups.The girls in the case group had a significantly larger intake of energy and carbohydrates in their “afternoon snacks” and the “snacks prepared and eaten at home” as compared to girls in the control group. Boys in the case group showed a significantly greater consumption of saturated fat in the “snacks prepared and eaten at home” as compared to boys in the control group. It was concluded that the intake of “afternoon snacks” and of those “prepared and eaten at home” could be related with the incidence of overweight/obesity in the sample of study and therefore nutrition education aimed at parents and children is crucial and could play an important role in its prevention.

Merenda escolar na promoção da saúde bucal: o potencial cariogênico dos alimentos / School meal in promotion of oral health: the cariogenic potential of food

Studies on school meals have increased in recent years in pursuit of strategies to offer food that serves not only to feed students, but also provide adequate physical and mental development, as well as promote general and oral health, emphasizing the prevention of caries. This article is a bibliographical review concerning works about foods and meals offered in schools, considering their cariogenic potential, as well as its role in the promotion of oral health. Carbohydrates, mainly the simple ones, are the nutrients of bigger impact on caries. However, an active bacterial flora is necessary to metabolize such nutrients in the mouth, which depends on the individual's oral hygiene. The variation in the cariogenic potential of different foods must also be considered, and this depends on the consistency, the way they are prepared and the period of time the food is adhered to the dental surface. Few studies on the cariogenic potential of meals served in schools were found in the literature. However, many foods offered present a great cariogenic potential. Some examples are cheese, bovine milk, rapadura (a Brazilian preparation of raw brown sugar in bars), some fruits, yoghurt and sugar. A lack of con cern about the damage of these foods to the dental health is observed. Some authors alert about the importance of making adjustments in school meals to preserve oral health and recognize that feeding programs must be joined to education about oral hygiene, control of the dental plaque, application of fluorides and permanent reinforcement of the educative task

Estudios sobre la merienda escolar han aumentado en los últimos años procurando estrategias para ofrecer una alimentación que sirva no apenas para saciar el apetito de los alumnos sino también para garantizar unadecuado desarrollo físico y mental, promoverla salud en general y en particular la prevención de la carie dentaria. Este trabajo es una revisión bibliográfica de los trabajos sobre alimentos y comidas ofrecidas en la merienda escolar em relación a su potencial cariogénico y su papelen la promoción de la salud bucal. Los carbohidratos, principalmente los de bajo peso molecular son los nutrientes de mayor impacto sobre la carie. Sin embargo, es necesario que haya una flora bacteriana activa para metabolizar tales nutrientes en la cavidad oral,lo cual está determinado por la higiene bucal.Es necesario considerar también la variación enel potencial cariogénico de los alimentos, que depende de la consistencia, modo de preparación y tiempo que el alimento permanece adherido ala superficie dental. La literatura presenta pocos estudios sobre la cariogenicidad de refeccionesservidas en la merienda escolar, pero muchos delos alimentos ofrecidos presentan gran potencial cariogénico: queso, leche bovino, algunas frutas, yogur y azúcar, sin observar alguna preocupación en relación a los daños de esta alimentación a la salud de los dientes. Algunos autores alertan para la importancia de realizar ajustes en la merienda escolar para contribuir apreservar la salud bucal, advirtiendo también que programas de alimentación deben estar unidos a la enseñaza de higiene bucal, control de la placa bacteriana, aplicación de fluoreto, con refuerzo permanente de la tarea educativa

Estudos sobre a merenda escolar vêm aumentando nos últimos anos com a busca de estratégias para oferecer uma alimentação que não sirva apenas para saciar a fome dos alunos, mas também para proporcionar um adequado desenvolvimento físico e mental, além de promovera saúde geral e bucal, com ênfase na prevenção da cárie. Este artigo refere-se a uma revisão bibliográfica realizada acerca de trabalhos referentes a alimentos e refeições oferecidos na merenda escolar quanto ao seu potencial cariogênico, bem como seu papel na promoção da saúde bucal. Os carboidratos, principalmente os simples, são os nutrientes de maior impacto sobre a cárie. No entanto, é necessário que haja uma flora bacteriana ativa para metabolizar tais nutrientes na cavidade oral, o que depende da higiene bucal do indivíduo. Deve-se considerar também a variação no potencial cariogênico dos alimentos, que depende da consistência, do modo de preparação e do tempo que o alimento fica aderido à superfície dentária. Foram encontrados na literatura poucos estudos sobre a cariogenicidade de refeições servidas na merenda escolar, porém, muitos alimentos oferecidos apresentam grande potencial cariogênico, a exemplo do queijo, leite bovino, rapadura, algumas frutas, iogurte e açúcar, e o que se observa é a inexistência de preocupação quanto aos prejuízos desta alimentação à saúde dos dentes. Alguns autores alertam para a importância de se realizarem ajustes na merenda escolar de forma a preservar a saúde bucal, e reconhecem que programas de alimentação devem estar unidos ao ensino de higiene bucal, controle da placa bacteriana, aplicação de fluoretos e reforço permanente da tarefa educativa

Programa de Alimentação Escolar no Brasil: limitações e evolução nas décadas de 80 e 90 / The brazilian program of school meals: limitations and evaluation in 80s and 90s

This work describes the trajectory of the National Program of School Meals ­ PNAE ­ implemented in Brazil for about 50 years. The main and decisive changes made by the Federal Government in the last two decades are examined. Among them, the decentralization of the program deserves a highlight, which affects the consumption of the meals distributed and the nutritional status of the beneficiaries. The analysis shows that during this period, the decentralization of the program was definitively implemented, with the Federal Government transferring the money to buy food directly to the school administrators. It was also verified that at the end of the eighties, the PNAE, benefited students with a greater per capita income and enrolled in the schools of the southern and southeastern region (more economicall y developed). In the nineties, there was a modification in this tendency and the PNAE reveals itself better focused in relation to the students in elementary education. Nourishment consumption analysis shows that the meal contribution to the group recommendation is low, mainly in energy, vitamins, and minerals, particularly calcium and iron. It shows also, low presence of fruits and vegetables in the school meals. With regard to the nutritional status, the coexistence of two problems ­ growth deficits and overweight ­reveals a complex nutritional situation of superposition that demands differentiated intervention to these very different realities

El objetivo de este trabajo fue describir la trayectoria del Programa Nacional de Merienda Escolar (PNAE) vigente en Brasil aproximada-mente 50 años. Se examinaron las principales modificaciones implementadas por el Gobierno Federal en las últimas décadas. Entre estas, hayque destacar la descentralización del programa y su repercusión en el consumo de las merendas distribuidas y en el estado nutricional de los beneficiarios del programa. El estudio revela que durante este período se consolidó definitivamente el proceso de descentralización, principalmente a mediados de la década del 90, cuando los recursos destinados a la compra de alimento comenzaran a ser repasados directamente a los administradores de las escuelas. Fue comprobado también que al final de la década del 80,el PNAE, beneficiaba indebidamente a alunos con mayor renta per cápita matriculados en las regiones Sur y Sudeste (que son economicamente más desarrolladas). En los años 90, esa tendencia fue modificada y el PNAE se mostró mejoren focado en relación a la población que frecuenta la enseñanza básica. El análisis del consumo alimenticio muestra que la contribución de la merienda no atiende las recomendaciones para ese grupo y es deficiente principalmente enenergía, vitaminas y minerales, principalmente calcio y hierro, siendo bastante escasa la presencia de frutas y hortalizas en la minuta de los escolares. Con relación al estado nutricional, la coexistencia de 2 problemas, el retardo del crecimiento y el sobrepeso, revela un panorama complejo que requiere intervención diferenciada para cada realidad

Este trabalho visa descrever a trajetória do Programa Nacional de Merenda Escolar (PNAE), que vigora no Brasil há cerca de 50 anos. São examinadas as principais e decisivas mudanças implementadas pelo governo federal, durante as últimas décadas. Entre essas, merece destaque a descentralização do Programa, as repercussões desta no consumo das refeições distribuídas e no estado nutricional dos beneficiários da merenda escolar. As análises revelam que durante o período concretizou-se, de forma definitiva, o processo de descentralização, coma inovação (especialmente em meados da década dos 90) do repasse das verbas federais, destinadas à compra de alimentos, diretamente para os administradores das escolas. Verificou-se, também, que no final da década dos 80, o PNAE, beneficiava, indevidamente, os alunos com maior renda per capita e matriculados nas escolas das regiões Sul e Sudeste (economicamente mais desenvolvidas). Nos anos 90, há modificação nessa tendência e o PNAE se revela melhor focalizado em relação à população que frequenta o ensino fundamental. Análises do consumo alimentar permitem inferir que a contribuição das refeições para o atendimento das recomendações do grupo é baixa, principalmente para a energia, vitaminas e minerais, com destaque para o cálcio e o ferro, sendo, bastante reduzida, também, a presença de frutas e hortaliças na pauta alimentar dos escolares. Quanto ao estado nutricional, a coexistência de duas problemáticas - déficits de crescimento e sobrepeso revela um quadro nutricional complexo de superposição, o que demanda intervenções diferenciadas para essas realidades muito distintas