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Objective To describe the development and validation of a workshop protocol for the implementation of the Dietary Guidelines for the Brazilian Population in primary healthcare units. Methods This descriptive study was developed in the state of São Paulo, Brazil, and it involved 20-25 professionals in the experimentation phase and 12 experts in the content validity phase. The workshop protocol was developed according to three theoretical references: Dietary Guidelines, Interprofessional Collaborative Practice and Critical Reflexive Methodology. The protocol consisted of four 4-hour modules, 16 activities in 16 hours. The activities matrix was composed of three axes: (a) organizational strategies, (b) dietary guideline comprehension and (c) dietary guideline implementation. For the validity analysis, the expert panel assessed clarity, relevance and theoretical representativeness. Content validity index was calculated, and adequate activities scored >0.80. The proportion of experts who recognized the presence of the theoretical framework in the activities was calculated. Results All 16 proposed activities obtained a score greater than the established cut-off point, both for clarity and relevance. For theoretical representativeness analysis, the dietary guidelines reached higher scores on the (b) and (c) axes of the protocol and was less recognized on the (a) axis, whose highest score was for the Critical Reflexive Methodology. Interprofessional Collaborative Practice presented a higher score on the (c) axis and a lower one on the (b) axis. Conclusion The protocol was considered appropriate for its purpose and with potential application in the different scenarios of primary health care in Brazil.

Background Capacity-building of health professionals regarding to nutrition is a strategy for qualifying public health work to promote healthy diets in primary health care (PHC) services. Objective To evaluate the effect of an intervention based on Brazilian Dietary Guidelines (BDG) on the knowledge, self-efficacy (SE) and collective efficacy (CE) of interprofessional teams working in PHC. Methods It refers to a pre-post intervention study involving 24 health professionals divided into a control group (CG) and intervention (IG). The IG received a 16-h educational workshop on the BDG, guided by a validated protocol. Knowledge, SE and CE for using the BDG were assessed via a self-administered scale, ranging from 0 to 16 and 0 to 36 points, respectively; the scale was previously validated, completed before and after 2 months of the intervention. The effects of the intervention were estimated by paired t-test for intragroup comparisons over time. Results The mean difference in the knowledge and SE scores of the IG pre- and post-intervention was 2.0 (CI 0.49–3.51) and 6.75 (CI 4.05–9.45) points, respectively. These results means the IG participants obtained 59 and 52.8% more points in knowledge and in SE in relation to CG, with significative difference (p = 0.007 and p <  0.00, respectively). There was no significant variation in the CE scores in both groups. Conclusions Considering the results presented and due to the originality of the study in question, the educational workshop was effective in increasing the knowledge and SE of professionals working in PHC in using the Dietary Guidelines in their work routines. These findings can assist other research in developing nutrition interventions with interprofessional teams.

Objective: This study aimed to develop a conceptual framework of the process of Food-Based Dietary Guidelines (FBDG) implementation and analyse Brazil’s employed measures to implement Dietary Guidelines for the Brazilian Population (2014). Design: Qualitative research. Setting: Aiming to develop the conceptual framework, a literature review on FBDGs implementation was carried out. Both documents scoped within the macropolitical sphere and scientific articles were reviewed. In the study case, measures took in Brazil were identified through a search on institutional websites and technical management reports of government sectors responsible for FBDG implementation in the country. Participants: This study does not involve humans. Results: The new conceptual framework frames FBDGs implementation as a part of a larger set of intersectoral public policies to promote healthy eating and highlights two main implementation ways: educational materials and public policies. Brazil has a range of policies to promote healthy eating guided by the perspective of food as a right. Most of the implemented measures focused on the concept of “FBDGs as educational materials,” although the recommendations have also been implemented in public policies. Conclusion: The FBDG implementation should be carried out in an integrated manner with multi-sector involvement. The Brazilian’s case analysis can be helpful to decision makers in food policy across the globe be inspired by the Brazilian efforts, considering that the Brazilian FBDG was one of the firsts to has adopted a multidimensional paradigm of healthy eating, including diet sustainability.

TRAMONTT, C.R. Impact of an educational intervention to implement the Dietary Guidelines for the Brazilian Population in primary health care [thesis]. São Paulo.

To describe the methodology of development of a protocol for application of the Brazilian Dietary Guidelines by primary healthcare professionals in individual dietary advice. A five-step approach was followed: (1) format definition; (2) definition of the instrument for assessment of individuals’ food consumption; (3) Dietary Guidelines’ content extraction; (4) protocol content development; (5) content and face validity. An example from Brazil was displayed with the development of a protocol to guide healthcare professional decision-making when providing nutrition advice based on the Brazilian Dietary Guidelines. The instrument of the Brazilian Nutrition Surveillance System (SISVAN) was chosen to the food consumption assessment, which contains questions about the consumption of seven healthy or unhealthy food groups and one question about eating modes. The Guidelines’ content extraction process led to the identification of recommendations related to the food consumption markers assessed by the SISVAN questionnaire. Then, a protocol was developed in a flowchart format, in which the professional’s conduct is guided by the answer given to each question of the SISVAN instrument. For each ‘non-compliant’ answer (unhealthy eating practice), the professional is instructed how to provide recommendations and identify obstacles. Lastly, experts and healthcare professionals highlighted pertinence, clarity and usability of the protocol. This study provides the blueprint for the phase-wise development of protocols of application of the Dietary Guidelines and may contribute to promote healthier eating and ending malnutrition in all its forms.

RESUMOIntrodução: Estudos nacionais mostram variações na prevalência de compulsão alimentar entre 14,9 a 18,1%, enquanto a bulimia nervosa (BN) apresenta-se em torno de 1 a 3,6%. Indivíduos que apresentam transtornos alimentares procuram espaços onde o exercício físico é estimulado e assim mascaram características da doença, exercitando-se compulsivamente após um episódio de compulsão alimentar. Objetivo: Identificar a prevalência de transtorno da compulsão alimentar periódica (TCAP) e bulimia nervosa em praticantes de exercício físico associando ao estado nutricional, modalidade, frequência, duração e objetivo da prática do exercício físico. Métodos: Estudo transversal composto por 103 indivíduos maiores de 18 anos com idade média de 37,7 (DP±15,6) anos, de ambos os sexos, praticantes de exercício físico há pelo menos três meses ininterruptos antes do início da pesquisa. Para análise da prevalência de TCAP e BN foi utilizado o Questionário sobre Alimentação e Peso (QEWP-R) e um questionário específico sobre exercício físico. O estado nutricional foi classificado conforme o IMC. Resultados: A prevalência de TCAP entre os indivíduos praticantes de exercício físico foi de 0,97%. Houve associação entre valores de IMC mais alto (p=0,026), idade menor (para TCAP p=0,036, BN p=0,01) e objetivo da prática de exercício físico declarado "estética" (para TCAP p=0,011 e BN p=0,043) com maiores pontuações nos escores de TCAP e BN. Conclusão: A prevalência de TCAP e BN encontrada neste estudo está de acordo com o referido na literatura internacional. Não foram encontradas associações entre compulsão alimentar e maior frequência de exercício físico.Palavras-chave: transtornos da alimentação, comportamento alimentar, treinamento de resistência. ABSTRACT

Resumo Objetivo Desenvolver e validar um protocolo de uso do Guia Alimentar para a População Brasileira na orientação alimentar da pessoa idosa durante as consultas clínicas individuais na Atenção Primária à Saúde (APS). Métodos Esta construção seguiu seis etapas metodológicas, sendo elas: (1) definição do formato do protocolo; (2) definição do instrumento de avaliação do consumo alimentar dos indivíduos; (3) extração das recomendações do Guia Alimentar aplicáveis para orientação alimentar individual; (4) sistematização de evidências sobre necessidades de alimentação e nutrição da pessoa idosa; (5) desenvolvimento de mensagens de orientação alimentar para a pessoa idosa; (6) validação de conteúdo e aparente e análise dos dados. Resultados Como produtos das etapas, foi definida a estrutura do protocolo e construída as orientações alimentares baseadas nas necessidades nutricionais e de saúde da população idosa, considerando a capacidade funcional e alterações fisiológicas e sociais desse ciclo de vida. O protocolo foi bem avaliado por especialistas e profissionais de saúde nos critérios de clareza, pertinência (Índice de validade de conteúdo >0,8) e aplicabilidade. Além disso, os participantes deram sugestões para melhoria da clareza das mensagens e para ampliar a aplicabilidade do instrumento com pessoas idosas brasileiras. Conclusão O protocolo pode contribuir para qualificação da orientação alimentar na APS, disseminação das informações do Guia Alimentar e promoção do cuidado integral e envelhecimento saudável da população.