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OBJECTIVES. Population-based data on body mass index for developing countries are scarce. Body mass index data from two Brazilian surveys were examined to determine regional and temporal variations in the prevalences of underweight, overweight, and obesity. METHODS. Nationwide surveys in 1974/75 and 1989 collected anthropometric data in Brazil from 55,000 and 14,455 households, respectively. Trained interviewers used the same methods to measure weight and stature in both surveys, and survey designs were identical. Prevalences of underweight, overweight, and obesity were determined for persons 18 years of age and older. RESULTS. In the 1989 survey, body mass index varied greatly according to region of the country, urbanization, and income. In the wealthier South, the prevalence of overweight/obesity was the highest and the prevalence of underweight was the lowest; in the poorer rural Northeast, these patterns were reversed. For both surveys, overweight/obesity was more common among women than among men and peaked at age 45 to 64 years in both sexes. Over the 15 years between surveys, the prevalence of both overweight and obesity increased strikingly. CONCLUSIONS. In contrast to findings in developed countries, obesity in Brazil was positively associated with income and was much more prevalent among women than among men. For Brazilian women, the overall prevalence of overweight was nearly as high as that among women in the United States.

Objective: Studies on the independent role of parity in long-term body weight change in economically developing countries are scarce and inconclusive, and only a few studies have taken into account patterns of breast-feeding. This association was examined in a national cross-sectional survey representative of Brazilian parous women. Design and setting: The survey conducted in 1996 measured women's height and weight in the household and data on weight prior to the first pregnancy, parity and breast-feeding were recalled. Subjects: A sample of 2338 parous women, 15 to 49 years of age, 29 months after last delivery on average, had current body mass index (BMI, in kg m 22 ) modelled through hierarchical multiple linear regression analysis. Explanatory variables included parity, days of predominant breast-feeding, BMI pre-pregnancy, socioeconomic, geographic, demographic and other reproductive variables. Results: Prevalences of overweight BMI 25X0±29X9 kg m 22 and obesity BMI $ 30X0 kg m 22 were 25.2% and 9.3%. The overall mean weight gain per year after the first pregnancy was 0.90 kg for an average time since first pregnancy of eight years. BMI pre-pregnancy modified the association between current BMI and parity. Therefore, weight change attributed to parity calculated for a woman of average height (1.56 m) was 0.60 kg greater for primiparous women with a BMI pre-pregnancy of 30 kg m 22, compared with women with BMI pre-pregnancy of 25 kg m 22 . This greater weight retention among obese women was 1.21 kg for women with two children and 1.82 kg for women with three or more children. Parity reduced the effect of weight loss associated with lactation (1.75 kg for six months of lactation among primiparous women and 0.87 kg among women with three or more children). For the sub-sample of 793 primiparous women, a weight decrease of 300 g was associated with each month of predominant breast-feeding for all prior BMI levels. Conclusions: In this study, weight change associated to reproduction was highly dependent on BMI previous to pregnancy and the effects of parity and lactation were small. Prevalence of overweight and obesity is high in most of the economically developed world and is increasing in developing countries 1 . In Brazil the prevalence of overweight/obesity has increased sharply in the last two decades, particularly among women of reproductive age. Nation-wide nutritional surveys have shown a 20% increase in the prevalence of obesity for parous women aged 15 to 49 years from 1989 to 1996 2 . Reproductive factors, especially parity, have been positively associated with weight gain and the onset of obesity in population-based studies in developed countries 3±10. The extent of this relationship and the pathways leading to the parity-associated weight gain in the different populations are, however, yet to be understood.Only one study has investigated this relationship for the developing world 11 , and it showed that two or more pregnancies significantly increased the risk of overweight.We studied, in a na...

Nutrition and health stakeholders need to be engaged in key climate change adaptation and mitigation initiatives, including science-based assessment by the Intergovernmental Panel on Climate Change (IPCC), and policies and actions formulated by the UN Framework Convention on Climate Change (UNFCCC). Improved multi-sectoral coordination and political will is required to integrate nutrition-sensitive actions into climate-resilient sustainable development efforts in the UNFCCC work and in the post 2015 development agenda. Placing human rights at the center of strategies to mitigate and adapt to the impacts of climate change and international solidarity is essential to advance sustainable development and to create a climate for nutrition security.

RESUMOApresentamos sugestões para a definição de guias alimentares para a população brasileira, excetuando as crianças. Os principais objetivos dessas recomedações são a manutenção de peso saudável e a prevenção da obesidade, das doenças cardiovasculares, do diabetes mellitus tipo 2 e da osteoporose. As mensagens para o público têm duas pressuposições: retomar hábitos saudáveis da dieta brasileira e estimular o consumo de alimentação saudável ao invés de formular proibições. As principais mensagens incluem: consumo de alimentos variados, em 4 refeições ao dia; manutenção de um peso saudável; aumento da atividade física diária; ingestão de arroz e feijão todos os dias, acompanhados de legumes e vegetais folhosos; ingestão de 4 a 5 porções de frutas todos os dias; redução do açúcar; evitar uso de refrigerantes; para lanches, comer frutas ao invés de biscoitos, bolos e salgadinhos; comer pouco sal; usar óleos e azeite ao invés de outras gorduras; tomar leite e comer produtos lácteos, com baixo teor de gordura, pelo menos 3 vezes por dia. ABSTRACTWe present suggestions for dietary guidelines for healthy Brazilians, excluding young children. These guidelines aim to prevent obesity, cardiovascular diseases, type 2 diabetes mellitus and osteoporosis. The messages to the public were based on two presumptions: to get back traditional Brazilian healthy dietary patterns and to stimulate the consumption of these foods more than to formulate prohibitions. The main messages are: eat at least four meals a day, and do not skip meals; maintain a healthy weight; increase daily physical activity and exercise; eat rice and beans with vegetables everyday; eat four to five portions of fruits everyday; reduce sugar, sweets and sodas; choose a fruit instead of deep fried foods or sweets for snacks; use salt only in moderation; use oil or olive oil instead of other fats; drink or eat low fat dairy products at least three times a day. O ESTABELECIMENTO DE GUIAS DE ALIMENTAÇÃO e nutrição saudável tem por base o reconhecimento de que um nível ótimo de saúde depende da nutrição. Com o aumento da obesidade e das doenças associadas à obesidade, no Brasil, há que se combinar orientações para a redução das deficiências nutricionais, ainda presentes, com orientações visando a prevenção das doenças crônicas não transmissíveis.

Objectives: To present the way the Brazilian government is addressing the prevention of nutrition-related non-communicable diseases (NR-NCDs). Results: Innovative legislative and regulatory actions, mass communications and capacity building have been combined to create a comprehensive approach for addressing poor dietary and activity patterns in Brazil that are leading to obesity and NR-NCDs. Included are new nutrition-related initiatives in the labelling area, shifts in the types of food purchased for the school food programme, use of mass media to communicate components of the food guidelines, establishment of a smart shopping initiative, and training of teachers and health workers. Conclusions: The entire effort has taken several years to get underway. This paper describes the process and some of the initial changes seen. Keywords Brazil Health promotion Healthy diets Active lifestylesChanges in the nutritional status of the Brazilian population have been intense in the last quarter of the 20th century 1,2 . Although undernutrition systematically declined from 1975 to 1997 for all ages, regions and income groups, nutritional deficiencies are still important in the country, particularly among lower-income children living in the north-eastern region. Obesity has increased, in the same time period, throughout the country among older children, adolescents and adults, with the single exception of middle-and higher-income, adult women in the south-eastern region -for whom the trends towards increased obesity seem to have stopped or even reversed in the 1990s. Undernutrition largely predominated over obesity in all regions and age groups of the Brazilian population in 1975, while in 1997, the same picture was only seen among lower-income, younger children. Evidence of simultaneous changes towards high energydense diets and lower energy expenditure patterns was also documented across the country, as well as the increasing importance of diet-and sedentary-lifestylerelated non-communicable diseases.To cope with these rapid changes, the Brazilian government has been working at the national and local level to initiate a wide range of activities to address these emerging needs. A new national food and nutrition policy has been developed following a wide-ranging set of discussions, meetings and negotiations between the Ministry of Health, relevant parts of Brazilian civil society (scholars, professional and scientific associations, workers' unions, representatives of private companies, and others) and other relevant governmental bodies (including those linked to the economic, agricultural, education and law sectors) 3 . The main goal of the new policy is essentially to promote, protect and support eating practices and lifestyles conducive to optimum nutritional and health status for all.This new policy attempts to continue to combat nutritional deficiencies with focused and targeted integrated interventions. It also attempts to shift increasing attention towards the prevention of nutritional disorders associated wi...

To assess the effectiveness on child growth and body composition of a supplementary feeding program (Milk Supplement Program), a prospective, controlled study was conducted in Northeast Brazil. When entering the Program, children from 10 municipalities with the highest coverage rates in the Program (intervention group) were compared to non-beneficiary children from 10 municipalities with the lowest coverage rates (control group). A total of 219 children aged 6-18 months were enrolled. At entry, both groups were comparable in terms of age, sex, and nutritional status. There were frequent gaps in delivery of the supplement, no extra milk was provided to siblings less than 5 years of age, intra-household redistribution of milk was high, and maternal compliance with recommendations was low. Adjusted analyses by multilevel modelling showed average changes in weight, length, weight-age and length-age Z-scores, and % body water (deuterium method), at 6 months, of 1.53kg, 6.34cm, 0.33, 0.05, and 1.11% respectively among supplemented children as compared to 1.54kg, 6.5cm, 0.26, 0.07, and 4.10% among controls, with no statistically significant difference between groups. Thus, the Program failed to compensate for nutritional deficiencies in undernourished children in Northeast Brazil.

ObjetivoAnalisar e comparar o conhecimento sobre nutrição de professores e alunos do Projeto "a escola promovendo hábitos alimentares saudáveis", submetidos a duas estratégias de educação nutricional em escolas do Distrito Federal. MétodosO Projeto Escola utilizou duas estratégias de intervenção em educação nutricional: intervenção nutricional (A) ações educativas realizadas na comunidade escolar pela equipe; e intervenção nutricional (B) ações educativas desenvolvidas por professores que frequentaram oficinas de capacitação. O conhecimento das crianças foi avaliado por meio de um instrumento sobre pirâmide dos alimentos e um sobre higiene pessoal; sendo aplicado com os professores um questionário do tipo verdadeiro ou falso.