Educação Alimentar e Nutricional na Atenção Primária à Saúde na perspectiva do profissional não nutricionista

Introdução: O Direito Humano a Alimentação Adequada (DHAA), na perspectiva da Segurança Alimentar e Nutricional (SAN), destacou-se devido à compreensão dos determinantes para a Promoção da Saúde (PS). A Educação Alimentar e Nutricional (EAN) é uma ferramenta capaz de promover a reflexão dos cidadãos sobre como realizar esse direito. No Brasil, o quadro de insegurança alimentar entre crianças e adolescentes torna os profissionais de saúde da Atenção Primária à Saúde (APS) atores promissores para a reversão desse quadro, já que esses trabalham com os principais influenciadores desse público: a família. Objetivo: Analisar a atuação de profissionais de saúde não nutricionistas coordenadores de grupos educativos com conteúdo de alimentação e nutrição, desenvolvidos na APS do município de São Paulo. Métodos: Estudo qualitativo, com aplicação de entrevistas semiestruturadas e análise por meio do Discurso do Sujeito Coletivo. Foram levantados os dados a respeito da formação desses profissionais e identificadas suas percepções sobre seus papéis nos grupos que coordenam e a importância atribuída a eles. Resultados: A profissão dos 21 entrevistados reflete a atual configuração da Estratégia Saúde da Família. Há predominância de profissionais do sexo feminino com pós-graduação em temas de saúde coletiva. Foram identificadas 13 Ideias Centrais dividas em 2 Eixos Temáticos. Levantaram-se percepções contrárias e outras a favor aos referenciais teóricos trabalhados. Como favoráveis, identificou-se a valorização dos grupos como espaços de participação, troca de experiências e criação de vínculo entre seus membros, sendo o coordenador do grupo responsável pela condução desses. A importância na atuação interprofissional para o atendimento integral à saúde e atualização entre os profissionais também foi destacada. Já as desfavoráveis trouxeram a desvalorização das atividades em grupo, ou a atribuição de sua importância como forma de acesso a serviços, medicamentos ou informação, a identificação dos coordenadores como responsáveis por mudanças de comportamentos nos participantes, modelos a serem seguidos, e sendo considerados detentores do conhecimento, o que parece sobrecarregá-los, desmotivá-los e frustrá-los. Assim, alguns buscam seu reconhecimento trazendo atividades que agradam os usuários, independentemente da constatação das necessidades do território. Conclusões: A percepção dos profissionais parece refletir a forma em que atuam, evidenciando um momento heterogêneo sobre as formas de se abordar os aspectos relacionados à alimentação, além do despreparo para a coordenação de grupos. Dessa forma, recomenda-se a aproximação entre os campos da saúde e da educação, visando práticas mais significativas e libertadoras, bem como a reflexão sobre a formação desses profissionais, já que suas atuações parecem refletir a educação na qual foram moldados. Os princípios da PS, do DHAA, da SAN, da EAN e das características essenciais a um coordenador de grupos, devem ser trabalhados com esses atores, e, para tanto, como produto dessa pesquisa, sugeriu-se um curso de atualização.

A manual for improving fish production in Northern Zambia through integrated farming systems

This manual was written as part of the Integrated Research in Development for Improved Livelihoods Programme in Northern Province, Zambia (IRDLP) and is primarily intended for extension agents to use with smallholder farmers engaged in semi-intensive fish farming in Northern Zambia. The IRDLP is an Irish Aid-funded project implemented by WorldFish, Harvest Plus and the Center for International Forestry Research (CIFOR). The goal of the IRDLP is to help improve the livelihoods, health status, and food and nutrition security of resource-poor households in the Mbala and Luwingu districts in Northern Zambia, especially women and vulnerable groups. This is achieved through generating and providing evidence-based information, scientific technologies and livelihood solutions to trigger community and farmer innovations for positive change. This manual provides information on how smallholder fish farmers can improve fish production in Northern Zambia, particularly in the Luwingu and Mbala districts, through integrated farming practices.

Poverty, hunger and food security in Central America and Panama

Includes bibliography

Nutrition and health: the issue is not food, nor nutrients, so much as processing [Invited commentary]

Orthodox teaching and practice on nutrition and health almost always focuses on nutrients, or else on foods and drinks. Thus, diets that are high in folate and in green leafy vegetables are recommended, whereas diets high in saturated fat and in full-fat milk and other dairy products are not recommended. Food guides such as the US Food Guide Pyramid are designed to encourage consumption of healthier foods, by which is usually meant those higher in vitamins, minerals and other nutrients seen as desirable.What is generally overlooked in such approaches, which currently dominate official and other authoritative information and education programmes, and also food and nutrition public health policies, is food processing. It is now generally acknowledged that the current pandemic of obesity and related chronic diseases has as one of its important causes increased consumption of convenience including pre-prepared foods(1,2). However, the issue of food processing is largely ignored or minimised in education and information about food, nutrition and health, and also in public health policies.A short commentary cannot be comprehensive, and a general proposal such as that made here is bound to have some problems and exceptions. Also, the social, cultural, economic and environmental consequences of food processing are not discussed here. Readers comments and queries are invited

Meat consumption and mortality - results from the European Prospective Investigation into Cancer and Nutrition.

BACKGROUND Recently, some US cohorts have shown a moderate association between red and processed meat consumption and mortality supporting the results of previous studies among vegetarians. The aim of this study was to examine the association of red meat, processed meat, and poultry consumption with the risk of early death in the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS Included in the analysis were 448,568 men and women without prevalent cancer, stroke, or myocardial infarction, and with complete information on diet, smoking, physical activity and body mass index, who were between 35 and 69 years old at baseline. Cox proportional hazards regression was used to examine the association of meat consumption with all-cause and cause-specific mortality. RESULTS As of June 2009, 26,344 deaths were observed. After multivariate adjustment, a high consumption of red meat was related to higher all-cause mortality (hazard ratio (HR) = 1.14, 95% confidence interval (CI) 1.01 to 1.28, 160+ versus 10 to 19.9 g/day), and the association was stronger for processed meat (HR = 1.44, 95% CI 1.24 to 1.66, 160+ versus 10 to 19.9 g/day). After correction for measurement error, higher all-cause mortality remained significant only for processed meat (HR = 1.18, 95% CI 1.11 to 1.25, per 50 g/d). We estimated that 3.3% (95% CI 1.5% to 5.0%) of deaths could be prevented if all participants had a processed meat consumption of less than 20 g/day. Significant associations with processed meat intake were observed for cardiovascular diseases, cancer, and 'other causes of death'. The consumption of poultry was not related to all-cause mortality. CONCLUSIONS The results of our analysis support a moderate positive association between processed meat consumption and mortality, in particular due to cardiovascular diseases, but also to cancer.

5th Food Safety and Security Symposium: food and health

Abstract The 5º Simpósio de Segurança Alimentar (5th Food Safety and Security Symposium) was held in May, 2015, in Bento Gonçalves, RS, Brazil with the objective of discussing the interrelation between food and health, in various perspectives. This paper reviews the state of the art regarding all the issues discussed during the Symposium, connecting them with the lectures presented at the conference. As final remarks, it was perceived that the interrelation between food and health is growing stronger and cannot be discussed without involving the different areas involved.

Dietary intakes and food sources of phytoestrogens in the European Prospective Investigation into Cancer and Nutrition (EPIC) 24-hour dietary recall cohort

BACKGROUND/OBJECTIVES: Phytoestrogens are estradiol-like natural compounds found in plants that have been associated with protective effects against chronic diseases, including some cancers, cardiovascular diseases and osteoporosis. The purpose of this study was to estimate the dietary intake of phytoestrogens, identify their food sources and their association with lifestyle factors in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. SUBJECTS/METHODS: Single 24-hour dietary recalls were collected from 36 037 individuals from 10 European countries, aged 35–74 years using a standardized computerized interview programe (EPIC-Soft). An ad hoc food composition database on phytoestrogens (isoflavones, lignans, coumestans, enterolignans and equol) was compiled using data from available databases, in order to obtain and describe phytoestrogen intakes and their food sources across 27 redefined EPIC centres. RESULTS: Mean total phytoestrogen intake was the highest in the UK health-conscious group (24.9 mg/day in men and 21.1 mg/day in women) whereas lowest in Greece (1.3 mg/day) in men and Spain-Granada (1.0 mg/day) in women. Northern European countries had higher intakes than southern countries. The main phytoestrogen contributors were isoflavones in both UK centres and lignans in the other EPIC cohorts. Age, body mass index, educational level, smoking status and physical activity were related to increased intakes of lignans, enterolignans and equol, but not to total phytoestrogen, isoflavone or coumestan intakes. In the UK cohorts, the major food sources of phytoestrogens were soy products. In the other EPIC cohorts the dietary sources were more distributed, among fruits, vegetables, soy products, cereal products, non-alcoholic and alcoholic beverages. CONCLUSIONS: There was a high variability in the dietary intake of total and phytoestrogen subclasses and their food sources across European regions.

Intakes and sources of isoflavones, lignans, enterolignans, coumestrol and soya-containing foods in the Norfolk arm of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk), from 7-day food diaries, using a newly updated database

Objective: A phytoestrogen-rich diet has been suggested to protect against a variety of common diseases but UK intake data on phytoestrogens or their food sources is sparse. This study aims to estimate the average intake of isoflavones, lignans, enterolignans and coumestrol from 7-day food diaries (7dFD), and to provide data on total isoflavone, lignan and phytoestrogen consumption by food group. Design: Development of a food composition database for twelve phytoestrogens and analysis of soya food and phytoestrogen consumption in a population-based study. Setting: Men and women, aged 40-79 years from the general population participating in EPIC-Norfolk between 1993 and 1997, with nutrient and food data from 7dFD. Subjects: A subset of 20 437 participants. Results: The median daily phytoestrogen intake for men was 1.20mg (interquartile range (IQR) 0.93-1.54 mg; mean 1.50 mg, SD 1.50 mg) and 0.89 mg for women (IQR 0.71-1.14 mg; mean 1.20 mg, SD 1.70 mg). In soya-consumers (SC), median daily intakes were higher: 2.86 mg in men (IQR – 1.30-7.27mg; mean 5.05 mg, SD 5.03 mg) and 3.14 mg in women (IQR – 1.09-7.33mg; mean 5.40 mg, SD 6.09 mg). In both men and women, bread made the greatest contribution to phytoestrogen intake – 40.7% and 35.7% respectively. In SC men and women, vegetable dishes and soya/goat’s/sheep’s milks were the main contributors – 42.6% and 18.9% in men and 38.8% and 29.1% in women, respectively. Conclusions: The ability to estimate phytoestrogen intake in Western populations more accurately will aid investigations into their suggested effects on health.

AN ANALYSIS OF THE RELATIVE INFLUENCE OF RACE, INCOME, EDUCATION, AND FOOD STAMP PROGRAM PARTICIPATION/NONPARTICIPATION ON THE FOOD AND NUTRIENT CONSUMPTION OF A NORTH FLORIDA URBAN CLINIC POPULATION IN CONJUNCTION WITH A SURVEY OF NUTRITION RELATED HABITS AND ATTITUDES

The relative influence of race, income, education, and Food Stamp Program participation/nonparticipation on the food and nutrient intake of 102 fecund women ages 18-45 years in a Florida urban clinic population was assessed using the technique of multiple regression analysis. Study subgroups were defined by race and Food Stamp Program participation status. Education was found to have the greatest influence on food and nutrient intake. Race was the next most influential factor followed in order by Food Stamp Program participation and income. The combined effect of the four independent variables explained no more than 19 percent of the variance for any of the food and nutrient intake variables. This would indicate that a more complex model of influences is needed if variations in food and nutrient intake are to be fully explained.^ A socioeconomic questionnaire was administered to investigate other factors of influence. The influence of the mother, frequency and type of restaurant dining, and perceptions of food intake and weight were found to be factors deserving further study.^ Dietary data were collected using the 24-hour recall and food frequency checklist. Descriptive dietary findings indicated that iron and calcium were nutrients where adequacy was of concern for all study subgroups. White Food Stamp Program participants had the greatest number of mean nutrient intake values falling below the 1980 Recommended Dietary Allowances (RDAs). When Food Stamp Program participants were contrasted to nonparticipants, mean intakes of six nutrients (kilocalories, calcium, iron, vitamin A, thiamin, and riboflavin) were below the 1980 RDA compared to five mean nutrient intakes (kilocalories, calcium, iron, thiamin and riboflavin) for the nonparticipants. Use of the Index of Nutritional Quality (INQ), however, revealed that the quality of the diet of Food Stamp Program participants per 1000 kilocalories was adequate with exception of calcium and iron. Intakes of these nutrients were also not adequate on a 1000 kilocalorie basis for the nonparticipant group. When mean nutrient intakes of the groups were compared using Student's t-test oleicacid intake was the only significant difference found. Being a nonparticipant in the Food Stamp Program was found to be associated with more frequent consumption of cookies, sweet rolls, doughnuts, and honey. The findings of this study contradict the negative image of the Food Stamp Program participant and emphasize the importance of education. ^

Evaluating sustainability and food security of peasant farming systems in Mesoamerican highlands

En las últimas décadas, la agricultura sostenible ha sido objeto de gran interés y debate académico, no sólo en términos conceptuales, sino también en términos metodológicos. La persistencia de la inseguridad alimentaria y el deterioro de los recursos naturales en muchas regiones del mundo, ha provocado el surgimiento de numerosas iniciativas centradas en revitalizar la agricultura campesina así como renovadas discusiones sobre el rol que juega la agricultura como motor de desarrollo y principal actividad para alivio de la pobreza. Por ello, cuando hablamos de evaluar sistemas campesinos de montaña, debemos considerar tanto la dimensión alimentaria como las especificidades propias de los sistemas montañosos como base fundamental de la sostenibilidad. Al evaluar la contribución que han hecho alternativas tecnológicas y de manejo en la mejora de la sostenibilidad y la seguridad alimentaria de los sistemas campesinos de montaña en Mesoamérica, surgen tres preguntas de investigación: • ¿Se está evaluando la sostenibilidad de los sistemas campesinos teniendo en cuenta la variabilidad climática, la participación de los agricultores y las dinámicas temporales? • ¿Podemos rescatar tendencias comunes en estos sistemas y extrapolar los resultados a otras zonas? • ¿Son inequívocamente positivas las alternativas propuestas que se han llevado a cabo? En este trabajo se presentan tres evaluaciones de sostenibilidad que tratan de poner de manifiesto cuáles son los retos y oportunidades que enfrentan actualmente los sistemas campesinos de montaña. En primer lugar, se evalúan tres sistemas de manejo agrícola bajo dos años meteorológicamente contrastantes. Se determinó que durante el año que experimentó lluvias abundantes y temperaturas moderadas, los sistemas de bajos insumos, basados en el uso de abonos orgánicos y rotación de cultivos, obtuvieron los mejores resultados en indicadores ecológicos y similares resultados en los económicos y sociales que el sistema de altos insumos químicos. En el segundo año, con heladas tempranas y sequía invernal, la productividad se redujo para todos los sistemas pero los sistemas más diversificados (en variedades de maíz y/o siembra de otros cultivos) pudieron resistir mejor los contratiempos climáticos. En segundo lugar, se evalúa el grado de conocimiento (percepción) campesino para determinar los factores claves que determinan la sostenibilidad de sus sistemas y su seguridad alimentaria. Se determinó que los principales puntos críticos identificados por los campesinos (tamaño de parcela y pendiente del terreno) afectan de forma significativa a cuestiones de índole económica, pero no son capaces de explicar los desequilibrios alimenticios existentes. Realizando un análisis comparativo entre comunidades que presentaban buenos y malos resultados en cuanto a aporte energético y proteico, se determinó que la seguridad alimentaria estaba relacionada con la sostenibilidad de los sistemas y que concretamente estaba ligada a los atributos de equidad y autonomía. Otro resultado destacable fue que las comunidades más marginales y con mayor dificultad de acceso mostraron mayores niveles de inseguridad alimentaria, pero la variabilidad intergrupal fue muy alta. Eso demuestra que la seguridad alimentaria y nutricional forma parte de un complejo sistema de estrategias de autoabastecimiento ligada a la idiosincrasia misma de cada uno de los hogares. En tercer lugar, se evaluó el desempeño de las escuelas de campo de agricultores (ECAs) en la mejora de la sostenibilidad y la seguridad alimentaria de un sistema campesino de montaña. Para ver el efecto del impacto de estas metodologías a largo plazo, se estudiaron tres comunidades donde se habían implementado ECAs hace 8, 5 y 3 años. Encontramos que el impacto fue progresivo ya que fue la comunidad más antigua la que mejores valores obtuvo. El impacto de las ECAs fue rápido y persistente en los indicadores relacionados con la participación, el acceso a servicios básicos y la conservación de los recursos naturales. El estudio demostró un claro potencial de las ECAs en la mejora general de la sostenibilidad y la seguridad alimentaria de estos sistemas, sin embargo se observó una relación directa entre el aumento de producción agrícola y el uso de insumos externos, lo que puede suponer un punto crítico para los ideales sostenibles. ABSTRACT During the last decades, sustainable agriculture has been the subject of considerable academic interest and debate, not only in conceptual terms, but also in methodological ones. The persistence of high levels of environmental degradation and food insecurity in many regions has led to new initiatives focused on revitalizing peasant agriculture and renewed discussions of the role of sustainable agriculture as an engine for development, environmental conservation and poverty alleviation. Therefore, to assess mountain farming systems, we must consider food dimension and taking into account the specificities of the mountain systems as the foundation of sustainability. When evaluating contribution of technological and management alternative proposals in achieving sustainability and food security for peasant farming systems in Mesoamerican highlands, three research questions arise: • Is sustainability of peasant-farming systems being evaluated taking into account climate variability, participation of farmers and temporal dynamics? • Can we rescue common trends in these systems and extrapolate the results to other areas? • What alternative proposals that have been conducted are unequivocally positives? In this document, we present three evaluations of sustainability that try to highlight the challenges and opportunities that currently face mountain farming systems in Mesoamerica. First, we evaluate the sustainability of three agricultural management systems in two contrasting weather years. We determined that during the first year that exposed heavy rains and moderate temperatures, low-input systems, which are based on the use of organic fertilizers and crop rotation, provided better results in terms of ecological indicators and equal results in terms of economic and social indicators than those achieved using a high chemical input system. In the second year, which featured early frosts and a winter drought, productivity declined in all systems; however, the most diversified systems (in terms of the maize varieties grown and the sowing of other crops) more successfully resisted these climatic adversities. Second, we evaluate the farmers’ perception to determine the key drivers for achieving their sustainability and food and nutritional security. We determined that the key factors identified by farmers (landholding size and slope of cropland) exerted significant impacts on economic disparities but did not explain the malnutrition levels. We compared two contrasting hamlets according to their energy and protein supply, one namely Limón Timoté (LT), which did not present food problems and Limón Peña Blanca (LP), which did exhibit food insecurity. The results showed that FNS is linked to sustainability, and it is primarily related to the sustainability attributes of self-reliance and equity. Although the more marginated and inaccessible community exhibited more food insecurity, food and nutritional security depend upon a complex array of self-sufficiency strategies that remain linked to individual household idiosyncrasies. Third, we evaluated the impact of farmer field schools for improving the sustainability and food security of peasant mountain systems. In order to appreciate the long-term impact, we studied three communities where FFSs were implemented eight, five and three years ago, respectively. We found that FFSs have a gradual impact, as the community that first implemented FFSs scores highest. The impact of FFSs was broad and long-lasting for indicators related to participation, access to basic services and conservation of natural resources. This study demonstrates the potential of FFSs, but more attention will have to be paid to critical indicators in order to scale up their potential in the future. We observed a direct relationship between the increase in agricultural production and the use of external inputs, which is a critical point for sustainable ideals.

World food and agriculture: Outlook for the medium and longer term

The world has been making progress in improving food security, as measured by the per person availability of food for direct human consumption. However, progress has been very uneven, and many developing countries have failed to participate in such progress. In some countries, the food security situation is today worse than 20 years ago. The persistence of food insecurity does not reflect so much a lack of capacity of the world as a whole to increase food production to whatever level would be required for everyone to have consumption levels assuring satisfactory nutrition. The world already produces sufficient food. The undernourished and the food-insecure persons are in these conditions because they are poor in terms of income with which to purchase food or in terms of access to agricultural resources, education, technology, infrastructure, credit, etc., to produce their own food. Economic development failures account for the persistence of poverty and food insecurity. In the majority of countries with severe food-security problems, the greatest part of the poor and food-insecure population depend greatly on local agriculture for a living. In such cases, development failures are often tantamount to failures of agricultural development. Development of agriculture is seen as the first crucial step toward broader development, reduction of poverty and food insecurity, and eventually freedom from excessive economic dependence on poor agricultural resources. Projections indicate that progress would continue, but at a pace and pattern that would be insufficient for the incidence of undernutrition to be reduced significantly in the medium-term future. As in the past, world agricultural production is likely to keep up with, and perhaps tend to exceed, the growth of the effective demand for food. The problem will continue to be one of persistence of poverty, leading to growth of the effective demand for food on the part of the poor that would fall short of that required for them to attain levels of consumption compatible with freedom from undernutrition.