[Food and nutrition in primary care in Brazil]

Food and nutrition actions for the maternal and child population in primary healthcare: comparative analysis of municipalities in the Metropolitan Region of Baixada Santista, São Paulo, Brazil

ABSTRACT Objective Characterize and comparatively analyse the organization of nutritional attention to prenatal care, the puerperium period and breastfeeding, in primary health care, in two municipalities of Baixada Santista, São Paulo, Brazil. Methods This was an exploratory-analytical study of family health units and the mixed basic care units of Cubatão (n=17) and Guarujá (n=14). For this purpose, seven domains of the Nutritional Attention Assessment Instrument in Primary Health Care were used. Descriptive analysis and the Mann-Whitney and Pearson’s chi-square tests were performed. Results In the comparison between the municipalities, the best scores were obtained in Guarujá. Statistically significant differences were found for the following indicators: support for nutritional attention actions: infrastructure and permanent education (<0.001); food and nutritional surveillance (<0.001); nutritional attention focused on prenatal care (<0.001); and nutritional attention focused on postpartum care and breastfeeding (0.012). Nutritional attention actions for mother-infant groups were more frequent in the city of Guarujá, which compared with Cubatão, achieved better scores for the nutritional attention evaluation indicators. Conclusion The municipality of Guarujá had better indicators of infrastructure and permanent education, food and nutrition surveillance, and puerperal and breastfeeding nutritional care. However, weaknesses persist in the organization of nutritional care in the two cities studied, especially regarding the work process.

Advances and setbacks in the 20 years of the Brazilian National Food and Nutrition Policy

We sought to analyze the processes of formulation, updating and implementation of the Brazilian National Food and Nutrition Policy (PNAN), from 1999 to April 2020. This is a discussion paper, using institutional documentary sources, bibliographic search in national and international databases, as well as theses and dissertations. The theory of the cycle of public policies was adopted to systematize and present the set of information. PNAN was established in 1999 and updated ten years later, in a participatory process, based on an innovative approach centered on the paradigms of healthy food practices, the human right to food and nutritional security, aligned with the Brazilian Unified National. Regarding implementation, there are advances related to the publication of Food Guides with national guidelines; to the promotion of research in food and nutrition; to collective action to build the regulatory agenda, even if with disputes, and to the decentralization of financial resources for the execution of PNAN actions. The monitoring and evaluation focused on the food and nutritional situation; we found that there were insufficient mechanisms to feed back the policy. After 20 years, PNAN maintains the challenge of effectively fulfilling its historic commitment: the universal guarantee of the human right to adequate and healthy food.

Nutritional deviations in children: comparative analysis of data from the food and nutrition surveillance system and those obtained by anthropometrists

Objective:

To compare the prevalence rates of nutritional deviations in children under five years of age according to data from the Food and Nutrition Surveillance System (Sistema de Vigilância Alimentar e Nutricional — SISVAN) and those obtained by trained anthropometrists.

Methods:

This is a descriptive cross-sectional study based on data from 10 municipalities and 2 sources: i) SISVAN Web (secondary database) and ii) an investigation that evaluated the implementation of food and nutrition actions in the Family Health Strategy in the state of Paraíba (primary database), with 24,137 and 897 individuals, respectively. Proportions of overweight — according to weight/age (W/A), weight/height (W/H), and body mass index/age (BMI/A) — and stunting — according to the height/age (H/A) index — based on classifications of SISVAN Web and those obtained by trained anthropometrists were compared using the two-proportion Z-test.

Results:

Frequencies of overweight, according to W/A (10.0 vs. 7.8%), W/H (17.2 vs. 14.3%), and BMI/A (18.1 vs. 14.4%), as well as stunting (12.3 vs. 8.6%), were higher on data from SISVAN Web than on those obtained by trained anthropometrists, and the differences were significant.

Conclusions:

The findings point to distortions in the nutritional classification of children under five years of age monitored by SISVAN Web.

[Family Health Strategy: contributions of health teams in the nutritional care of children]

The scope of this article is to evaluate the structure and work processes of Family Health Strategy teams related to the nutritional care of children. It involved an assessment survey of 136 health teams in 45 municipalities in the State of Paraíba. The data on structure (availability of anthropometric equipment, supplements and technical documents) and processes (management, intersectoriality and activities of the Brazilian Breastfeeding and Feeding Strategy) were summarized in scores and classified as incipient, intermediate or advanced. Analyses were performed according to contextual characteristics of the municipality (population size and human development) and the health team (whether from the Programa Mais Médicos or conventional teams, and whether accompanied by a nutritionist or not). Nutritional care was classified at the intermediate level, with the availability of technical documents, the use of SISVAN or the e-SUS and the implementation of the Brazilian Breastfeeding and Feeding Strategy being the most deficient items. Large municipalities and expanded health teams with nutritionists had better structure and process conditions, respectively. The fragmented implementation of nutritional care calls for improvements in structure and processes for due fitness for purpose.

Evolução das ações de nutrição na atenção primária à saúde nos 20 anos da Política Nacional de Alimentação e Nutrição do Brasil

O objetivo do estudo é sistematizar as ações de alimentação e nutrição desenvolvidas na atenção primária à saúde (APS), de 1999 a 2019, identificando os avanços no período e perspectivas atuais. É uma pesquisa qualitativa realizada baseando-se na análise de documentos publicados entre 1999 e 2020, disponíveis em bases de dados científicos e na literatura cinza. Adicionalmente, realizou-se análise quantitativa valendo-se de sistemas de informação do Ministério da Saúde, como o Sistema de Vigilância Alimentar e Nutricional e o Sistema de Informação em Saúde para a Atenção Básica e dos microdados do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). As ações e marcos normativos identificados foram categorizados em gestão, vigilância alimentar e nutricional, promoção da alimentação adequada e saudável, atenção nutricional - múltipla carga de má nutrição e formação. Os resultados revelam que as ações de alimentação e nutrição acompanharam o cenário epidemiológico, considerando-se a múltipla carga da má nutrição, estando a primeira década mais direcionada ao enfrentamento da fome, da desnutrição e carências de micronutrientes e; a partir de 2006, passou a dar ênfase à prevenção e cuidado de pessoas com obesidade e outras doenças crônicas não transmissíveis, além da promoção da alimentação adequada e saudável, desenvolvendo, durante todo o período, ações com forte caráter intersetorial e compreendendo o lócus da APS como campo prioritário de atuação no Sistema Único de Saúde. A universalização das ações de alimentação e nutrição na APS, contudo, é ainda um desafio atual.

Percepção de enfermeiros sobre o cuidado nutricional à criança na Estratégia Saúde da Família

RESUMO Objetivou-se analisar a percepção de enfermeiros sobre o cuidado nutricional de crianças menores de cinco anos. Trata-se de um estudo qualitativo envolvendo 18 profissionais de equipes de saúde da família de dois municípios da região metropolitana de João Pessoa, Paraíba. Realizou-se entrevista com foco na importância do desenvolvimento das ações de alimentação e nutrição para o cuidado nutricional da criança. As entrevistas foram conduzidas por meio de um roteiro de perguntas. O material foi submetido à análise de conteúdo e dela emergiram quatro categorias temáticas. Os enfermeiros apontaram a utilidade dos manuais do Ministério da Saúde para as ações de atenção nutricional e a educação em alimentação saudável como a prática mais importante desse cuidado. Entretanto, destacaram a situação socioeconômica das famílias e a capacitação dos profissionais como empecilhos para o desenvolvimento das ações. Ainda, apontaram a importância da atuação do nutricionista junto à equipe multidisciplinar para o desenvolvimento das ações de alimentação e nutrição. Além da necessidade implícita de capacitação em nutrição, evidencia-se a valorização dos documentos técnicos do Ministério da Saúde e do nutricionista para a melhoria do cuidado nutricional de crianças menores de cinco anos.

Nutritional Care for older adults in Primary Health Care, from the perspective of health professionals

Abstract Objective: to characterize and analyze Nutritional Care (NC) for older adults in Primary Health Care (PHC), identifying how food and nutrition actions (F&N) were performed and the conceptions that guided them. Methods: a cross-sectional, quantitative and qualitative study was performed in PHC in Santos, São Paulo, Brazil, in two phases: i) a census study was carried out of health units, N=28 (100%), with managers who answered a structured interview to assess NC; followed by descriptive analysis. ii) a deeper investigation of this diagnosis was performed, using semi-structured interviews with key informants (interviewees) of care for older adults; being a nutritionist was not a criteria, as there were only three such professionals throughout the entire PHC, and one of the health regions studied was not served by a nutrition professional. The concept of theoretical saturation was used for the sampling plan; content analysis was carried out and the inferences were supported by references of integrality and aging. Results: NC for older adults was highlighted by individual care, predominant in all the services studied (28) (100%); nutritionists participated in this activity in just nine units (32.1%). Theoretical saturation was achieved with nine interviews. According to the discourse analysis, F&N actions were generic, focused on the treatment of diseases, influenced by negative aspects attributed to aging, there was no planning based on the needs of the territory, and health professionals identified themselves as information transmitters, leaving the responsibility of acting on such information to the older adults themselves. Conclusion: F&N actions were guided by the biomedical paradigm, fragmented, restricted to disease management, imputing the responsibility for health to the individual themselves. Thus, NC distanced itself from the promotion of healthy aging, weakening its strategic role in the quest for integrated care.

Randomized controlled trial protocol: A quanti-quali approach for analyzing the results of an intervention on the waiting list for bariatric surgery

ABSTRACT Objective This article aims to describe the protocol of a randomized clinical trial and the baseline results of the study of a one-year interdisciplinary intervention in users of the public health system in the bariatric surgery waiting list. Methods A randomized, single-blind clinical trial will be conducted including 88 participants recruited on an outpatient clinic of the public health system. Participants were randomized into the control group (n=44), receiving the usual treatment; and into the intervention group (n=44), participating in the educational intervention. Participants had their food intake, negative affectivity and physical inactivity/sedentary behavior assessed, as well as anthropometric and body composition measurements; their blood samples were collected; and also had different physical capacity tests. Results Of the 157 participants invited, 27 had severe functional limitations, one was under-age, and four declined the study due to associated diseases. Eighty-eight participants were randomized: 44 for the Control Group and 44 for the Intervention Group. When comparing the demographic and biochemical characteristics, there were no differences between groups except for serum glucose (GC=110.4±46.8mg/dL and GI93.1±16.9mg/dL, p=0.039). Conclusion This study protocol describes the methodology used in the study of educational intervention for the promotion of health care of patients on the waiting list for bariatric surgery. It shows that there is similarity between the baseline comparison groups. Registro Brasileiro de Ensaios Clínicos (Brazilian Clinical Trials Registry), RBR-775y3d.