Agricultura sensível à nutrição : um novo referencial para políticas públicas?

A agricultura e os sistemas alimentares se deparam atualmente com um complexo conjunto de desafios ambientais, sociais, econômicos e políticos para promover a Segurança Alimentar e Nutricional (SAN) da população mundial. Assim, é crescente a demanda por abordagens sistêmicas e integrativas na elaboração de políticas alimentares. Considerando o cenário de coexistência de múltiplas formas de má nutrição, intrinsecamente relacionado a aspectos de disponibilidade, acesso, consumo e qualidade de alimentos em padrões alimentares, a abordagem da agricultura e dos sistemas alimentares sensíveis à nutrição surge enfatizando o objetivo de contribuir positivamente para a nutrição humana. Tendo em vista que a literatura sobre Agricultura Sensível à Nutrição (ASN) é recente e escassa no Brasil, esta dissertação visa contribuir para a sua divulgação, compreensão e problematização. Para tanto, foi mapeado e analisado, em âmbito internacional e nacional, a evolução e a conformação do campo de pesquisa sobre ASN, a partir de uma revisão sistemática da literatura, seguida por análise bibliométrica e de conteúdo. Amparando-se na abordagem cognitiva de análise de políticas públicas pela perspectiva dos referenciais, buscou-se identificar como a abordagem da ASN vem sendo compreendida e aplicada, a fim de analisar se esta pode ser considerada um novo referencial para políticas agrícolas com potencial para lidar com a complexidade dos desafios atuais. Constatou-se que pesquisas sobre ASN começaram a surgir a partir de 2013, com maior produção nos anos recentes, conduzidas principalmente por pesquisadores da América do Norte, Europa, África e Ásia. Foram identificadas oito ênfases de pesquisa (clusters temáticos). A abordagem é aplicada majoritariamente em países de baixa e média renda, principalmente na África e na Ásia, e o principal público-alvo são agricultores de pequenas propriedades e suas famílias, dedicando-se especial atenção às mulheres em idade reprodutiva, mães, gestantes e crianças pequenas. A ASN vem sendo compreendida sob variadas perspectivas, observando-se uma tendência a abordagens integrativas, ainda que falte uma maior aproximação entre saúde humana e ecossistêmica. As possibilidades de intervenções são diversas, sendo a estratégia mais frequente a diversificação da produção e do consumo de alimentos, priorizando-se alimentos ricos em nutrientes e/ou o acesso a mercados para possibilitar geração de renda e acesso a alimentação diversificada e nutritiva (frutas, legumes, verduras, alimentos de origem animal, alimentos biofortificados). A ASN vem sendo mobilizada como um objetivo da agricultura, a ser alcançado com base em um conjunto de princípios, mas sem rigidez quanto aos instrumentos de ação e de avaliação, a fim de atender às necessidades de cada contexto. Conclui-se que essa abordagem pode ser considerada um importante referencial para a agricultura em todos os países, sugerindo-se enfatizar as conexões entre modos de produção, sustentabilidade e nutrição, e alinhar seu quadro conceitual ao referencial sistêmico de SAN. Trata-se de um referencial que está se estruturando e ainda tem pouca inserção em políticas públicas. Sendo um campo de pesquisa recente, novas evidências devem modelar novas orientações. A dissertação ainda identifica as limitações e potenciais da abordagem, apresentando sugestões de direções para pesquisas futuras.Agriculture and food systems are currently entrenched in a complex set of environmental, social, economic and political challenges to promote Food and Nutrition Security (SAN) for the world's population. Thus, there is a growing demand for systemic and integrative approaches in the design of food policies. Considering the scenario of coexistence of multiple forms of malnutrition, intrinsically related to aspects of availability, access, consumption and quality of foods in dietary patterns, the approach of agriculture and nutrition-sensitive food systems emerges emphasizing the objective to contribute positively to human nutrition. Considering that the literature on Nutrition-Sensitive Agriculture (NSA) is recent and scarce in Brazil, this dissertation aims to contribute to its dissemination, understanding and debate. For this purpose, the evolution and structure of the field of research on NSA was mapped and analyzed, at international and national level, based on a systematic review of the literature, followed by bibliometric and content analysis. Based on the cognitive approach of public policy analysis from the perspective of referentials, the research sought to identify how the NSA approach has been understood and applied, in order to analyze whether it can be considered a new referential for agricultural policies with potential to deal with the complexity of current challenges. It was found that research on NSA began to emerge in 2013, with greater production in recent years, conducted mainly by researchers from North America, Europe, Africa and Asia. Eight research emphasis (thematic clusters) were identified. The approach is mostly applied in low and middle-income countries, mainly in Africa and Asia. The main target public are smallholder farmers and their families, with special attention being paid to women of reproductive age, mothers, pregnant women and small children. NSA has been understood from different perspectives, but it was observed a trend towards integrative approaches, even though a closer relationship between human and ecosystem health is lacking. The possibilities for interventions are diverse, with the most frequent strategy being the diversification of food production and consumption, prioritizing nutrient-rich foods and/or access to markets to enable income generation and access to diversified and nutritious foods (fruits, vegetables, animal-sourced foods, biofortified foods). NSA has been mobilized as an objective of agriculture to be achieved based on a set of principles, but without rigidity regarding the instruments of action and evaluation, in order to meet the needs of each context. It is concluded that this approach can be considered an important referential for agriculture in all countries, being suggested that it should emphasize the connections between means of production, sustainability and nutrition, and that its conceptual framework should be aligned with the systemic referential of SAN. NSA is a referential under construction and still has little insertion in public policies. As a recent field of research, it is expected that new evidence will model new guidelines. This dissertation also identifies the limitations and potentials of the approach, presenting suggestions of directions for future research

Evaluation of a Tobacco Educational Intervention for Pregnant Alaska Native Women

Tobacco cessation interventions developed and evaluated for Alaska Native women do not exist. As part of routine clinical care provided at a prenatal visit, a brief tobacco educational intervention for Alaska Native pregnant women (N=100; mean ± SD age = 25.9±6.2 years; mean 6.3± 2.6 months gestation) was piloted at the Y-K Delta Regional Hospital in Bethel, Alaska. This retrospective study reports on the evaluation of this clinical program. The intervention was consistent with the clinical practice guidelines (i.e., 5 A’s – ask, advise, assess, assist, arrange), with an average duration of 20.2 ± 6.8 minutes. The self-reported tobacco abstinence rate following the intervention was 11% at the last prenatal visit and 12% at delivery. Delivering a tobacco cessation intervention at a prenatal visit is feasible, but there is a need to identify more effective interventions for Alaska Native pregnant women

Association between cardiorespiratory fitness and cardiometabolic risk factors in Brazilian children and adolescents: the mediating role of obesity parameters

Background There is a lack of clarity as to which obesity parameters may be more important in the association between cardiorespiratory fitness (CRF) and cardiometabolic risk factors (CMRF). Aim To verify the mediating role of different obesity parameters on the association between CRF and CMRF in normal weight and overweight/obese children and adolescents. Methods This cross-sectional study comprised 999 children and adolescents (534 boys) aged 7–14 years from the south of Brazil. Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and percentage of body fat were assessed. Participants were classified as normal weight, overweight and obese according to BMI. CRF was evaluated by the 6-minute run/walk test. . A continuous CMRF score was calculated by summing the Z-scores of the following variables: systolic and diastolic blood pressure, glucose, total cholesterol, high-density lipoprotein cholesterol and triglycerides. Data analysis was performed using partial correlation and linear regression models. Results BMI, WC, WHtR and percentage of body fat mediated the relationship between CRF and CMRF in overweight/obese boys and girls but not those of normal weight. Additionally, the percentage of the influence of each obesity parameter was 20% for BMI and WC, 16% for percentage of body fat and 18% for WHtR in girls. For boys, the mediation effect was 25% for BMI, 26% for WC, 28% for percentage of body fat and 25% for WHtR. Conclusion Adiposity plays a central role in CMRF; therefore, maintaining an adequate weight status should be an important objective of health-promoting programmes in early age

Translational research in pituitary tumours

Although effective treatment regimens (surgical resection, drug treatment with dopamine agonists or somatostatin analogues, radiotherapy) have been established for the therapy of most pituitary tumours, a considerable proportion of affected patients cannot completely cured due to incomplete resection or drug resistance. Moreover, even if hormone levels have been normalized, patients with hormone-secreting tumours still show persistent pathophysiological alterations in metabolic, cardiovascular or neuropsychiatric parameters and have an impaired quality of life. In this review reasons for the discrepancy between biochemical cure and incomplete recovery from tumour-associated comorbidities are discussed and the clinical management is delineated exemplarily for patients with acromegaly and Cushing's disease. In view of the development of additional treatment concepts for the treatment of pituitary adenomas we speculate about the relevance of RSUME as a potential target for the development of an anti-angiogenic therapy. Moreover, the role of BMP-4 which stimulates prolactinoma development through the Smad signalling cascade is described and its role as putative drug target for the treatment of prolactinomas is discussed. Regarding the well-known resistance of a part of somatotropinomas to somatostatin analogue treatment, recently identified mechanisms responsible for the drug resistance are summarized and ways to overcome them in future treatment concepts are presented. Concerning novel therapeutic options for patients with Cushing's disease the impact of retinoic acid, which is currently tested in clinical studies, is shown, and the action and putative therapeutic impact of silibinin to resolve glucocorticoid resistance in these patients is critically discussed.Fil: Stalla, Günter K. No especifíca;Fil: Dimopoulou, Christina. Technische Universitat München; AlemaniaFil: Jung Sievers, Caroline. No especifíca;Fil: Arzt, Eduardo Simon. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigación en Biomedicina de Buenos Aires - Instituto Partner de la Sociedad Max Planck; ArgentinaFil: Paez Pereda, Marcelo. Max Planck Institut Fur Psychiatrie; AlemaniaFil: Theodoropoulou, Marily. Technische Universitat München; AlemaniaFil: Ciato, Denis. Technische Universitat München; AlemaniaFil: Renner, Ulrich. Max Planck Institut Fur Psychiatrie; Alemani

A multicomponent intervention program with overweight and obese adolescents improves body composition and cardiorespiratory fitness, but not insulin biomarkers

Objective: To verify the effect of a multicomponent intervention with overweight/obese adolescents on physical fitness, body composition, and insulin biomarkers. Methods: A quasi-experimental study with 37 adolescents, aged 10 to 17 years, of both sexes, overweight and obese, allocated in two groups (Intervention—IG Group, n = 17; Control—GC Group, n = 20). The IGs were submitted to a multicomponent intervention for 6 months (three weekly sessions) consisting of physical exercises (sports, functional circuit, recreational, and water activities) and nutritional and psychological guidance. Participants were assessed before and after intervention on body composition [body mass index (BMI), body fat, waist circumference, and waist-to-hip ratio (WHR)], physical fitness [cardiorespiratory fitness (CRF) and abdominal strength], and biomarkers of insulin (glucose, insulin, evaluation of the homeostasis model of insulin, and resistin resistance). The prevalence of responders in both groups was obtained according to the theoretical model applied in previous studies similar to this one to determine the cutoff points for response to intervention. Poisson regression was used to verify the difference in the prevalence ratio (PR) of the interviewees between the groups. Results: The responders' prevalence between groups CG and IG showed significant differences for body fat (CG = 30.0%; IG = 70.6%; PR = 1.396; p < 0.001), WHR (CG = 30.0%; IG = 76.5%; PR = 1.730; p < 0.001), and CRF (CG = 15.0%; IG = 52.5%; PR = 1.580; p < 0.001). Conclusions: A 6-month multicomponent intervention program improved certain body composition parameters and the CRF of overweight and obese adolescents but did not improve insulin biomarkers. Clinical Trial Registration: Clinical Trials under Protocol ID: 54985316.0.0000.534

Like Mother, like Son: Physical Activity, Commuting, and Associated Demographic Factors

We would like to express our gratitude to the children, parents, and schools participating in the study.A mother’s healthy conduct may lead to the healthy conduct of their children. Thus, this study aimed to verify the role of demographic factors in the relationship between mothers’ physical activity (PA) and commuting to work with children and adolescent’s PA and commuting to school. This cross-sectional study comprised 1421 children and adolescents aged 6 to 17 years and 1421 mothers, from Brazil. PA, commuting, socioeconomic status (SES), skin color/ethnicity, and living area were evaluated by questionnaire. Logistic binary regression models were used. Results indicated that mothers’ PA and commuting were associated with children and adolescent’s PA and commuting to school in crude and adjusted models. Considering the role of the demographic factors, an association was only observed for girls in the relationship between mother’s PA with children’s PA. In adolescents, an association was observed in both high/low SES, boys/girls, and rural/urban areas. Regarding children and adolescent active commuting to school, there was an association with mothers commuting. All demographic factors were strongly associated, except for rural areas. Therefore, mothers’ PA as well as commuting to work are associated with children and adolescent’s PA and commuting to school. Sex, living area, and SES are the related demographic factors.CAPESPortuguese Foundation for Science and Technology SFRH/BSAB/142983/2018 UID/DTP/00617/20

Osteoarticular and musculoskeletal disorders, chronic pain, quality of life and physical activity level distributed by age and gender in elderly people participating in a water aerobics program

The study aims to describe osteoarticular and musculoskeletal disorders, chronic pain, quality of life (QOL) and physical activity level (PAL) distributed by age group and gender in the elderly. The design was quantitative, descriptive and cross-sectional. The non-probabilistic sample, for convenience, comprised 101 elderly people, over 60 years old, who regularly participate in water aerobics activities in the municipality of Dois Irmãos, RS. The instruments used were: Multidimensional Pain Assessment Scale, Survey of Pain Attitudes, IPAQ and EUROHIS-QOL. Descriptive frequency analyzes were performed, which showed the predominance of women in water aerobics activities, most frequently in the age group of 70 years. Similarly, the presence of osteoarticular and musculoskeletal disorders and chronic pain intensity (moderate and severe) were more expressive in females and in the age group of 70 years. The distribution of QOL and pain intensity in relation to age, gender and PAL shows in the age group of 60 years, the male, irregularly active with higher average, with higher occurrence of pain (moderate) in the active elderly. Active females, on the other hand, show better QOL scores and higher pain intensity in irregularly active aspect. In conclusion, the actions promoted by the municipality have a positive impact on QOL. However, there is a need for greater involvement of participants to achieve more adequate levels of regular physical activity, taking into account the significant presence of pain complaints in females and in the age group of 70 years

Combination of sleep duration, TV time and body mass index is associated with cardiometabolic risk moderated by age in youth

The combination of sleep duration, television (TV) time and body mass index (BMI) may be related to the alteration of cardiometabolic risk. However, there are few studies that use these variables grouped, and showing the moderating role of age. This study aimed to verify if the combination of sleep duration, TV time and BMI is associated with cardiometabolic risk and the moderating role of age in this relationship in youth. Methods Cross-sectional study conducted with 1411 adolescents (611 male), aged 10–17 years. Sleep duration, TV time and BMI were assessed and grouped into eight categories. Cardiometabolic risk was assessed by a continuous metabolic risk score, including the following variables: low HDL-cholesterol, elevated triglycerides, dysglycemia, high systolic blood pressure, high waist circumference and low cardiorespiratory fitness. Generalized linear models were used to test moderation of age in the relationship between the eight categories of sleep duration/television time/BMI with cardiometabolic risk. Results Cardiometabolic risk factor showed association with all overweight or obesity independent of sleep time and TV time. Age moderated the relationship between sleep duration/television time/BMI with cardiometabolic risk. This association was stronger in younger adolescents (11 and 13 years), indicating that individuals with inadequate sleep, prolonged TV time and overweight/obesity present higher cardiometabolic risk values when compared to 15-year-old adolescents. Conclusion Overweight/obesity, independently of sleep duration and TV time, is the main risk factor for cardiometabolic disorders in adolescence. When moderated by age, younger adolescents that presented the combination of risk factors had higher cardiometabolic risk

Food consumption is associated with hyperuricemia in boys

Hyperuricemia is related to health issues among children and adolescents, once the uric acid concentration is associated with metabolic syndrome, hypertension, insulin resistance, obesity, and dyslipidemia. However, few studies are addressing uric acid levels and food uptake in this age group. Aim To verify the association between food consumption and uric acid in children and adolescents. Methods This is a cross-sectional study developed with 2335 children and adolescents of both genders aged 6–17 years old. Blood collection was performed after 12 h of fasting. Uric acid values were classifed according to tertiles, in which the highest tertile was considered as hyperuricemia. Food consumption was evaluated by weekly consumption frequency questionnaire. Pearson correlation and logistic binary regressions were used for statistical analysis. Models were adjusted for age, systolic blood pressure, body mass index (BMI), and skin color/ethnicity. Results It was found an association between red meat consumption and hyperuricemia only in boys in the crude model (OR=1.56; 95% CI 1.12; 2.18). Also, there was an association between pasta (OR=1.52; 95% CI 1.11; 2.10) with hyperuricemia in boys, when adjusted age, systolic blood pressure, BMI, and skin color/ethnicity. Conclusion The knowledge of food patterns which are predisposing factors for the increase in serum uric acid levels is important for the implementation of strategies and public health policies for health promotion among children and adolescents

Acceptability of yogurt and yogurt-like products: influenceof product information and consumer characteristics and preferences

19 pages, 8 tables, 3 figures.-- Printed version published in July 2010.-- The definitive version is available at www3.interscience.wiley.comThis work aims to investigate whether the information about product type and the nutritional label affects consumer acceptability of yogurt and fermented milk. Hedonic evaluations of seven commercial samples, three yogurts and four fermented milks were elicited from 120 consumers under blind tasting conditions, looking at a card with the product type and with the label nutritional facts and finally, tasting labeled products. For the whole group of consumers, nutritional information did not affect the acceptability of these products although analysis of individual consumer behavior showed that only for around 50% of consumers surveyed, this result reflects on their actual response. When data for subgroups of consumers of different gender or age or with different preference pattern were considered, differences in the influence of nutritional information on samples acceptability were detected. These results confirm that the data averaged from the consumer whole population cannot accurately reflect the real behavior of the population surveyed. More complete and valid information can be gained from analyzing the responses of the consumer subgroups of different characteristics or with different individual preferences.To MICINN of Spain for financial support (Project AGL 2007-63444). To Fondo Social Europeo for financing the contract of author S. Bayarri in the program I3P from CSICPeer reviewe