Desafios na execução do programa nacional de alimentação escolar durante a pandemia pela COVID-19 Challenges of the national school meals program during the COVID-19 pandemic

RESUMOObjetivo: Descrever e comparar estudos longitudinais que permitam inferir sobre a influência da creche no estado nutricional de crianças pré-escolares.Fontes de dados: Revisão sistemática de trabalhos científicos publicados entre janeiro de 1990 e dezembro de 2008. Buscaram-se os estudos nas seguintes bases de dados: Lilacs, Scielo e PubMed. Realizou-se também pesquisa manual dos artigos referenciados. A busca ocorreu no período de março de 2008 a junho de 2009, e os descritores utilizados foram: "creche", "estado nutricional", "antropometria", "consumo alimentar", "anemia" e "alimentação escolar".Síntese dos dados: Na primeira etapa do estudo, obtiveram-se 78 artigos, mas somente sete puderam ser incluídos. Os outros 71 não apresentaram dados para contribuir com o objetivo específico deste estudo. Entre os artigos pesquisados na literatura, existem poucos que permitem inferir sobre a influência que a creche pode ter em relação ao estado nutricional de pré-escolares. Contudo, estudos longitudinais têm mostrado a relação causal entre a presença frequente da criança na creche e a melhoria do estado nutricional.Conclusões: Existe uma relação positiva entre a frequên-cia da criança na creche e a melhoria do estado nutricional.Palavras-chave: estado nutricional; pré-escolar; criança; antropometria; consumo de alimentos. ABTRACTObjective: To describe and compare longitudinal studies on how daycare centers influence preschoolers' nutritional status.

The Amyotrophic lateral sclerosis (ALS) is the most common form of motor neuron disease in the adulthood, and it is characterized by rapid and progressive compromise of the upper and lower motor neurons. The majority of the cases of ALS are classified as sporadic and, until now, a specific cause for these cases still is unknown. To present the different hypotheses on the etiology of ALS. It was carried out a search in the databases: Bireme, Scielo and Pubmed, in the period of 1987 to 2011, using the following keywords: Amyotrophic lateral sclerosis, motor neuron disease, etiology, causes and epidemiology and its similar in Portuguese and Spanish. It did not have consensus as regards the etiology of ALS. Researches demonstrates evidences as regards intoxication by heavy metals, environmental and occupational causes, genetic mutations (superoxide dismutase 1), certain viral infections and the accomplishment of vigorous physical activity for the development of the disease. There is still no consensus regarding the involved factors in the etiology of ALS. In this way, new research about these etiologies are necessary, for a better approach of the patients, promoting preventive programs for the disease and improving the quality of life of the patients.

Fasciculations are characterized by visible subtle and fast contractions of muscle, even wormlike in movement, by the contraction of a fascicle of muscle fibers. The authors present the case study of a 28-year-old patient with the appearance of migratory and diffuse fasciculations with an onset after partial tapering off of oral corticosteroides (60 mg total dose) indicated for treatment of Minimal change Glomerulopathy. Clinical Neurological physical exam allied with an ENMG, besides other complementary laboratory exams were used for screening the above-mentioned patient. Afterwards, current research relating to the topic at hand was made in order to update the data available in the Bireme, Scielo and PubMed Data Banks using the following key words: Fasciculation's, motor neuron disease, and benign fasciculations in the Portuguese, English as well as Spanish language. Although fasciculation's are most commonly associated with Motor neuron disease as well as with certain metabolic disorders, they may also be present in individuals with absolutely no underlying pathological disorders. In our case, fasciculation potentials that have been present for six months, with no other signs of a neurogenic disorder as well as absence of laboratory findings, the patient received a diagnosis of Benign Fasciculation Syndrome (BFS).We believe that the use of corticosteroides in high doses with subsequent tapering contributed to the fasciculation's, especially due to the changes that this causes on the ionic channels. Fasciculation's are symptoms seen in a large range of conditions, and also being the main symptom of the so-called Benign Fasciculation Syndrome. We have presented an example of this clinical syndrome in a patient whose complaint was fasciculation's, with complete clinical remission of symptoms following complete tapering off of corticosteroid six months previously.

ResumoO objetivo do estudo foi monitorar o estado nutricional de pré-escolares de uma creche pública. Trata-se de um estudo longitudinal, antes (t 0 ) e depois (t 1 ), com 51 crianças de 2 a 4 anos de idade. Os procedimentos foram: avaliação antropométrica (P/I, P/E e E/I -OMS 2006, classificação SISVAN-2008); avaliação bioquímica (colesterol total, HDLc, LDLc, triglicerídeos e glicose); avaliação hematológica (hemoglobina); avaliação dietética (pesagem direta dos alimentos e registro alimentar). Para determinação de energia, carboidratos, lipídeos, proteína, fibra alimentar, cálcio, ferro, vitaminas A e C, utilizou-se software Diet Pro, 4.0. Utilizando-se o Índice de Adequação (IA= média do consumo/ EAR ou AI), avaliou-se a adequação do consumo alimentar. As ações em nutrição foram: modificações nos cardápios, atividades pedagógicas, oficina culinária e palestras com os pais e equipe da creche. Observou-se redução de prevalência para déficit E/I e P/I, redução da prevalência de anemia, aumento do consumo de energia, carboidratos, proteínas, vitaminas A e C, ferro e redução discreta do cálcio. Energia, ferro, cálcio e vitamina C apresentaram probabilidade de adequação ≥50%. Concluiu-se que se torna importante o monitoramento do estado nutricional de crianças pré-escolares atendidos em creches públicas, bem como ações de educação nutricional.Palavras-chave: pré-escolar; estado nutricional; transtornos da nutrição infantil. AbstractThe aim of the study was to monitor the nutritional status of preschool of public day care center. It is a longitudinal study, before (t 0 ) and after (t 1 ), with 51 children from 2 to 4 years old. The procedure were: anthropometric evaluation (W/A, W/H and H/A -OMS 2006 -SISVANs, 2008 Classification), blood exams (Total Cholesterol, HDLc, LDLc, triglycerides and glucose), hematological evaluation (hemoglobin) and dietetic evaluation (direct weighing food and dietary register). To calculate energy, carbohydrates, fat, fiber, calcium, iron, A and C vitamins, was used software Diet Pro, 4.0. An adequate Index was calculated (AI=consumer medium/ EAR ou AI) to evaluate de adequacy of food consumer. The nutrition acts were: day care center menus modification, pedagogic activities, culinary offices, and discussion with parents and school team. We could observe a reduction in prevalence of nutritional deficit H/A and W/A, reduction on prevalence of anemia, increases on consumer of: energy, carbohydrates, protein, A and C vitamins, iron and decrease on consumer of calcium were observed. Energy, iron, calcium and C vitamin showed a probability of adequacy ≥50%. Inadequacy of fats consume was observed in both moments. We conclude that monitor the status nutritional of preschool children attending in public day care centers is important as well the education nutrition actions.

Background Dietary patterns are associated with health outcomes and environment sustainability, having socioeconomic drivers. This ecological study aims to identify dietary patterns in food availability data at the global level using multivariate statistical methodology, to associate the identified dietary patterns with socioeconomic data and to analyze the adequacy of the applied multivariate statistical methods for this purpose. Methods Principal Component Analysis was applied to median values of times series of food availability data of 172 UN registered countries available at FAOSTAT database in Food Balance Sheets section in a sectional manner, after calculating median values of time series for each food group and country. Principal Components were associated with socioeconomic data available from the World Bank database. Sensitivity analyses were realized to verify the stability of dietary patterns through five different times. Results Five principal components were identified in the median values of each time series, each characterizing a possible dietary pattern. The first one, a westernized dietary pattern, was composed of energy-dense and processed foods, foods of animal origin, alcoholic beverages, but also, albeit less, by vegetables, fruits and nuts, being associated with income, urbanization and trade liberalization. This westernized pattern was characterized more animal origin and processed foods, such as vegetable oils, alcoholic beverages and stimulants yet preserving unprocessed and regional foods. The other dietary patterns were three agricultural patterns characterized more by regional foods, especially starchy staples, and one coastal dietary pattern composed of fish and seafoods, being associated with GINI index, poverty, and female labor force. Sensitivity analyses demonstrated the stability of dietary patterns. Conclusions Principal Component Analysis was adequate to identify dietary patterns in food availability data. A westernized dietary pattern was identified, being associated with income, urbanization, and trade liberalization. This association did not occur for the remain of the dietary patterns identified, these being less driven by economic development.

O Guia Alimentar para a População Brasileira é reconhecido como um potente indutor de políticas públicas de alimentação e nutrição. Nessa perspectiva, este artigo apresenta o percurso metodológico e as evidências que subsidiaram a elaboração dos novos parâmetros de aquisição de alimentos do Programa Nacional de Alimentação Escolar (PNAE). Tal elaboração envolveu as análises de: (1) participação dos recursos federais utilizados para compra de alimentos, agrupados segundo a classificação NOVA, empregada no Guia Alimentar para a População Brasileira, pelo conjunto de municípios brasileiros e segundo classificação da execução (positiva ou negativa); (2) cardápios mensais de referência que foram elaborados seguindo recomendações do Guia Alimentar para a População Brasileira; (3) aquisição de alimentos por amostra de 525 municípios, envolvendo a participação relativa dos grupos de alimentos (segundo a NOVA) no total de gastos e de energia e a qualidade nutricional dos alimentos adquiridos; e (4) alimentos ultraprocessados que não devem ser ofertados no ambiente escolar. Foi proposta a adoção dos seguintes parâmetros para participação dos grupos de alimentos em relação ao total de recursos federais empregados na compra de alimentos: ≥ 75% de recursos para alimentos in natura ou minimamente processados; < 20% para alimentos processados ou ultraprocessados e < 5% para ingredientes culinários processados e a ampliação da lista de alimentos cuja aquisição com recursos federais do PNAE é proibida. Esse processo subsidiou a elaboração da Resolução CD/FNDE nº 6, de 8 de maio de 2020, que dispõe sobre o atendimento da alimentação escolar aos alunos da educação básica no âmbito do PNAE.

Purpose: To design culturally acceptable and healthy diets with reduced caloric share of ultra-processed foods (UPF%) at no cost increment and to evaluate the impact of the change in the UPF% on diet quality. Methods: Food consumption and price data were obtained from the Household Budget Survey (n=55,970 households) and National Dietary Survey (n=32,749 individuals). Linear programming models were performed to design diets in which the mean population UPF% was reduced up to 5% with no cost increment relative to the observed costs. The models were iso-caloric or allowed the energy content to vary according to the UPF%, and they were not constrained to nutritional goals (nutrient-free models) or maximised the compliance with dietary recommendations (nutrient-constrained models). Constraints regarding food preference were introduced in the models to obtain culturally acceptable diets. Results: The mean population UPF% was 23.8%. The lowest UPF% attained was approximately 10%. The optimised diet cost was up to 20% cheaper than the observed cost, depending on the model and the income level. In the optimised diets, the reduction in the UPF% was followed by an increase in fruit, vegetables, beans, tubers, dairy, nuts, fibre, potassium, magnesium, vitamin A, and vitamin C in the nutrient-constrained models, compared with the observed consumption in the population. There was little variation in most nutrients across the UPF% reduction. The UPF% reduction in the nutrient-free models impacted only trans-fat and added sugar content. Conclusion: UPF% reduction and increase in diet quality are possible at no cost increment.