Effectiveness of school-based nutrition education interventions to prevent and reduce excessive weight gain in children and adolescents: a systematic review

OBJETIVO: Avaliar a efetividade da educação nutricional em escolas na redução ou prevenção de sobrepeso e obesidade em crianças e adolescentes. FONTES DOS DADOS: Busca sistemática em 14 bases de dados e cinco revisões sistemáticas por ensaios controlados randomizados realizados em escolas com o objetivo de reduzir ou prevenir o sobrepeso em crianças e adolescentes. O índice de massa corporal e o consumo de frutas e verduras foram utilizados como desfechos primário e secundário, respectivamente. Não houve restrição de data de publicação ou idioma, exceto para idiomas com logogramas. Excluímos estudos em populações com distúrbios alimentares, dislipidemia, diabetes e deficiência física ou mental, e que utilizassem medicamentos ou suplementos alimentares. A avaliação por título e resumo e a avaliação de qualidade foram realizadas de forma independente por dois pesquisadores. Utilizamos as orientações do Centre for Reviews and Dissemination para a elaboração de artigos de revisão em saúde e o programa EPPI-Reviewer 3. SÍNTESE DOS DADOS: Das 4.809 referências inicialmente encontradas, 24 artigos preencheram os critérios de inclusão. Os dados extraídos apresentam evidências de efeitos antropométricos positivos e de aumento no consumo de frutas e verduras. As intervenções com as seguintes características demonstraram ser efetivas: duração > 1 ano, introdução como atividade regular da escola, envolvimento dos pais, introdução da educação nutricional no currículo regular e fornecimento de frutas e verduras pelos serviços de alimentação da escola. CONCLUSÃO: As intervenções para reduzir o sobrepeso e a obesidade e aumentar o consumo de frutas e verduras foram efetivas nos estudos bem conduzidos.OBJECTIVE: To evaluate the effectiveness of school-based nutrition education in reducing or preventing overweight and obesity in children and adolescents. SOURCES: Systematic search in 14 databases and five systematic reviews for randomized controlled trials conducted in schools to reduce or prevent overweight in children and adolescents. Body mass index and fruit and vegetable intake were used as primary and secondary measures of outcome, respectively. There was no restriction by date of publication or language, except for languages with structured logograms. We excluded studies on specific populations presenting eating disorders, dyslipidemia, diabetes, and physical or mental disabilities, as well as studies that used drugs or food supplements as components of the intervention. The assessment by title and abstract and the quality assessment were performed independently by two researchers. We used the Centre for Reviews and Dissemination's guidance for undertaking reviews in health care and the software EPPI-Reviewer 3. SUMMARY OF THE FINDINGS: From the initially retrieved 4,809 references, 24 articles met the inclusion criteria. The extracted data show that there is evidence of positive effects on anthropometry and of increase in fruit and vegetable consumption. Characteristics of the interventions that demonstrated effectiveness are: duration > 1 year, introduction into the regular activities of the school, parental involvement, introduction of nutrition education into the regular curriculum, and provision of fruits and vegetables by school food services. CONCLUSION: Interventions in schools to reduce overweight and obesity, as well as to increase fruits and vegetable consumption, have demonstrated effectiveness in the best-conducted studies

Physical activity promotion by health practitioners: a distance-learning training component to improve knowledge and counseling

Aim To report an evaluation of health professionals' participation in a distance-learning physical activity training course developed in a low socio-economic region of São Paulo city, Brazil. BACKGROUND In countries with public universal health systems, physical activity promotion in primary health care settings can reap results, particularly given that such interventions have the potential to reach a large percentage of the population. However, few studies proposed physical activity training for health professionals in low- and middle-income countries. Brazil is a continental country and has the Unified Health System which incorporates family health teams in over 85% of Brazilian cities. METHODS The physical activity training was part of the fifth module of an educational intervention throughout a distance-learning course focusing on health professionals at M'Boi Mirim district in São Paulo city. The training totaled 3 h and had five themes of physical activity: (1) concepts, definitions benefits; (2) evaluation; (3) recommendation; (4) interventions; (5) physical activity counseling. The opinion of health professionals was evaluated after training by two open questions. Findings Out of 106 professionals who took part of the course, only 22.6% (n=24) had accessed the fifth module. These professionals were predominantly female (79.2%), nurses (66.7%) and aged 30 years or older. Responses highlighted the course approach focused on physical activity for improving patient's quality of life and well-being, disease prevention and health improvements. Regarding the themes for improvement, the health professionals identified that there was a need to experience physical activity classes first-hand, and the need to link physical activity counseling to the local venues that provide structured physical activity programs. We recommend that further training courses can be conducted based on this model for health professionals to promote physical activity to the community in Brazil

Implications on Mineral Elements, Sugars and Fatty Acids Accumulation in Tissues

Funding Information: This work received funding from PDR2020-101-030734 and Fundação para a Ciência e a Tecnologia, I.P. (FCT), Portugal, through the research units UIDB/04035/2020 (GeoBioTec), UIDB/00239/2020 (CEF) and UID/FIS/04559/2020 (LIBPhys) from the FCT/MCTES/PIDDAC. This work was further supported by the grant of Fundação para a Ciência e Tecnologia (FCT) UI/BD/150718/2020. Publisher Copyright: © 2022 by the authors.Following an agronomic approach for the Ca enrichment of Rocha pears, this study aimed to assess the interactions between mineral nutrients in fruit tissues at harvest and after storage for 5 months and to characterize the implications on the profile of sugars and fatty acids (FA). A total of seven foliar sprays (with concentrations of 0.1–0.6 kg·ha−1 Ca(NO3)2 and 0.8–8 kg·ha−1 CaCl2) were applied to pear trees. After harvest, the fruits were stored for 5 months, in environmentally controlled chambers, and the mineral contents in five regions (on the equatorial section) of the fruits were assessed, while the sugar and FA content were quantified. For both dates, all foliar sprayed treatments, at different extends, increased Ca content in the center and near the epidermis of Rocha pear fruits and the levels of K, Mn, Fe, Zn and Cu also varied. At harvest, the Ca treatments did not affect the levels of sucrose, glucose, fructose and sorbitol and, after storage, their concentrations remained higher in Ca-treated fruits. Additionally, the tendency of the relative proportions of FA was C18:2 > C18:1 > C16:0 > C18:3 > C18:0 > chains inferior to 16 C ( C16:0 > C18:3 > C18:0 > C18:1 > chains inferior to 16 C (<16:0). It is concluded that the heterogeneous distribution of Ca in the tissues of Rocha pear fruits results from its absorption in the peel after Ca(NO3)2 and CaCl2 sprays and from the xylemic flux in the core prior to maturity. Additionally, the hydrolysis of complex polysaccharides affects the contents of simpler sugars during maturation, ripening and senescence, while storage decreases the amount of total fatty acids (TFA), but the double bond index (DBI) indicate that cell membrane fluidity remains unaffected.publishersversionpublishe

Can foliar pulverization with CaCl2 and Ca(NO3)2 trigger Ca enrichment in solanum tuberosum L. tubers?

project PDR2020-101-030719 IDB/00239/2020 UIDP/04035/2020This study aimed to assess the efficiency of Ca enrichment in tubers of three genotypes of Solanum tuberosum L., through foliar spraying with CaCl2 and Ca(NO3)2 solutions. In this context, soil heterogeneity of three potato-growing fields, as well as the implications of Ca accumulation among tissues and some quality parameters were assessed. Three potato varieties (Agria, Picasso and Rossi) were grown in three production fields and during the life cycle, four pulverizations with calcium chloride (3 and 6 kg ha−1) or calcium nitrate (0.5, 2 and 4 kg ha−1) were applied. For screening the potential phytotoxicity, using Agria as a test system, the potential synthesis of photoassimilates was determined, and it was found that after the 3rd Ca application, leaf gas exchanges were moderately (net photosynthesis), to strongly (stomatal conductance) affected, although without impact on Ca accumulation in tubers. At harvest, the average Ca biofortification index varied between 5–40%, 40–35% and 4.3–13% in Agria, Picasso and Rossi, respectively. Moreover, the equatorial region of the tubers in general showed that Ca accumulation prevailed in the epidermis and, in some cases, in inner areas of the potato tubers. Biofortified tubers with Ca also showed some significant changes in total soluble solids and colorimetric parameters. It is concluded that Ca enrichment of potato tubers through foliar spraying complemented the xylem mass flow of Ca from roots, through phloem redistribution. Both fertilizers showed similar efficiency, but Rossi revealed a lower index of Ca accumulation, eventually due to different metabolic characteristics. Although affected by Ca enrichment, potato tubers maintained a high quality for industrial processing.publishersversionpublishe

Enrichment of Grapes with Zinc-Efficiency of Foliar Fertilization with ZnSO4 and ZnO and Implications on Winemaking

PDR2020-101-030727Grapes and wine are widely consumed in the world, yet their mineral content can be influenced by many factors such as the mineral composition of soils, viticulture practices and environmental conditions. In this context, considering the importance of Zn in the human physiology, the enrichment of Moscatel and Castelão grapes (white and red variety, respectively) with this nutrient prompted this study; further assessment of tissue deposition and some implications for wine production. Using two foliar fertilizers (ZnO or ZnSO4, at 150, 450 and 900 g ha−1), decreases in net photosynthesis and stomatal conductance occurred in both varieties, suggesting that the physiological threshold of Zn toxicity was reached without visible symptoms. Following foliar spraying with both fertilizers, the content of Zn in leaves of the Castelão and Moscatel varieties showed higher values in all treatments relative to the control. Moreover, in grapes this tendency occurred only in Castelão. Concerning Cu, Fe, Ca, K, S and P, some significant differences also happened in leaves and grapes among treatments. At harvest, the indexes of Zn enrichment in grapes increased between 2.14-and 8.38-fold and between 1.02-and 1.44-fold in Castelão and Moscatel varieties, respectively. Zinc in the dried skin of Castelão only increased with ZnO and ZnSO4 sprayed at 900 g ha−1 (ca. 2.71-and 1.5-fold relative to the control, respectively), but in Moscatel a clear accumulation trend could not be found. The dry weight of grapes ranged (in %) between 16 and 23 (but did not vary significantly among treatments of each variety or in each treatment between varieties), and total soluble solids (e.g., mainly soluble sugars and proteins) and color parameters showed some significant variations. Through winemaking, the contents of Zn increased in both varieties (1.34-and 3.57-fold, in Castelão and Moscatel, respectively) and in all treatments, although non-significantly in Castelão. It is concluded that, to increase the contents of Zn in grapes without reaching the threshold of toxicity, ZnO or ZnSO4 can be used for foliar spraying of Castelão and Moscatel varieties until 900 g ha −1 And that winemaking augments the level of this nutrient.publishersversionpublishe

Interaction with Calcium at Tissue Level and Implications on Quality

This work received funding from PDR2020-101-030701 UID/FIS/04559/2020 (LIBPhys) from the FCT/MCTES/PIDDAC. Publisher Copyright: © 2022 by the authors.As the productivity and quality of tomato fruits are responsive to Mg applications, without surpassing the threshold of toxicity, the assessment of potential levels of Mg accumulation in tissues, as well as the interactions with Ca and physicochemical properties, prompt this study. An agronomic workflow for Mg enrichment, consisting of six foliar applications of MgSO4 with four concentrations (0%, 0.25%, 1% and 4%), equivalent to 0, 43.9, 175.5 and 702 g ha−1, was applied on two tomato (Lycopersicum esculentum L.) genotypes (Heinz1534 and Heinz9205). During fruit development, leaf gas exchange was screened, with only minor physiological deviations being found. At harvest, Mg contents among tissues and the interactions with Ca were analyzed, and it was found that in both varieties a higher Mg/Ca ratio prevailed in the most external part of the fruit sprayed with 4% MgSO4. However, Mg distribution prevailed relatively near the epidermis in H1534, while in H9205 the higher contents of this nutrient occurred in the core of the fruit, which indicated a decrease of the relative proportion of Ca. The morphologic (height and diameter), physical (dry weight and density) and colorimetric parameters, and the total soluble solids of fruits, did not reveal significant changes in both tomato varieties. It was further concluded that foliar application until 4% MgSO4 does not have physiological impacts in the fruit’s quality of both varieties, but in spite of the different patterns of Mg accumulation in tissues, if the mean value in the whole fruit is considered, this nutrient prevails in H1534. This study thus suggests that variety H1534 can be used to attain tomato fruits with added value, providing an option of further processing to achieve food products with functional properties, ultimately proving a beneficial option to producers, the food processing industry and consumers. Moreover, the study reinforces the importance of variety choice when designing enrichment workflows.publishersversionpublishe

Effect of rice grain (Oryza sativa L.) enrichment with selenium on foliar leaf gas exchanges and accumulation of nutrients

grant number 101-030671An agronomic itinerary for Se biofortification of two rice cultivars (Ariete and Ceres) through foliar fertilization with sodium selenate and sodium selenite with different concentrations (25, 50, 75 and 100 g Se.ha−1), was implemented in experimental fields. The selenium toxicity threshold was not exceeded, as shown by the eco-physiological data obtained through leaf gas exchanges. The highest Se enrichment in paddy grains was obtained with selenite for both cultivars, especially at the highest doses, i.e., 75 and 100 g Se.ha−1, with approximately a 5.0-fold increase compared with control values. In paddy grains, Zn was the most affected element by the treatments with Se with decreases up to 54%. When comparing the losses between rough and polished grains regardless of the cultivars, Se species and concentrations, it was observed that only Cu, Mg and Zn exhibited losses 70%. The loss of Se is more pronounced in Ceres cultivar than in Ariete but rarely exceeds 50%. The analysis by µ-EDXRF showed that, in Ariete cultivar, Se is mostly homogeneously distributed in the grain regardless of any treatments, while in Ceres cultivar, the Se distribution seems to favor accumulation in the periphery, perhaps in the bran.publishersversionpublishe

Calcium biofortification of Rocha pears, tissues accumulation and physicochemical implications in fresh and heat-treated fruits

Low dietary intake of Ca in humans has been epidemiologically linked to various diseases, which can have serious health consequences over time. Accordingly, the development of an agronomic itinerary for Ca biofortification of Rocha pears and the assessment of physicochemical deviations prompted this study. Two orchards with contrasting soil and water characteristics were selected, characterized through orthophotomaping and, during fruits development, leaves were sprayed twice with Ca(NO3)2 (0.1, 0.3 and 0.6 kg ha - 1) or CaCl2 (0.4, 0.8 and 1.6 kg ha - 1), followed by pulverization only with CaCl2 (first once with 4 kg ha - 1 and then four times with 8 kg ha - 1). During fruits development net photosynthesis, stomatal conductance, transpiration rates, instantaneous and water use efficiency, only showed minor deviations, which indicated that the threshold of toxicity was not surpassed. Calcium contents varied during fruits development and at harvesting the average biofortification index varied between 47 %–63 % and 24 %–59 % in each of the orchards. Besides, the equatorial region of the fruits showed for all treatments (substantially in Ca treated samples) higher Ca contents in the epidermal and in the central regions. Fresh and heat-treated fruits (in a thermomix at 90 ◦C, during 10 min) biofortified with Ca only revealed minor differences and the sensory acceptability did not vary markedly. It is concluded that, although prevailing a heterogeneous distribution of Ca in fruit tissues, high indexes of biofortification in Rocha pears can be prompt in the orchards, without substantial physicochemical changes. Accordingly, agronomic biofortification with Ca can be used as a strategy for benefiting consumer’s healthinfo:eu-repo/semantics/publishedVersio

Implications for Quality and Wine Production

UID/FIS/04559/2020Nowadays, there is a growing concern about micronutrient deficits in food products, with agronomic biofortification being considered a mitigation strategy. In this context, as Zn is essential for growth and maintenance of human health, a workflow for the biofortification of grapes from the Vitis vinifera variety Fernão Pires, which contains this nutrient, was carried out considering the soil properties of the vineyard. Additionally, Zn accumulation in the tissues of the grapes and the implications for some quality parameters and on winemaking were assessed. Vines were sprayed three times with ZnO and ZnSO4 at concentrations of 150, 450, and 900 g ha−1 during the production cycle. Physiological data were obtained through chlorophyll a fluorescence data, to access the potential symptoms of toxicity. At harvest, treated grapes revealed significant increases of Zn concentration relative to the control, being more pronounced for ZnO and ZnSO4 in the skin and seeds, respectively. After winemaking, an increase was also found regarding the control (i.e., 1.59-fold with ZnSO4-450 g ha−1). The contents of the sugars and fatty acids, as well as the colorimetric analyses, were also assessed, but significant variations were not found among treatments. In general, Zn biofortification increased with ZnO and ZnSO4, without significantly affecting the physicochemical characteristics of grapes.publishersversionpublishe