Objective: To evaluate the effectiveness of school-based nutrition education in reducing or preventing overweight and obesity in children and adolescents.Sources: Systematic search in 14 databases and five systematic reviews for randomized controlled trials conducted in schools to reduce or prevent overweight in children and adolescents. Body mass index and fruit and vegetable intake were used as primary and secondary measures of outcome, respectively. There was no restriction by date of publication or language, except for languages with structured logograms. We excluded studies on specific populations presenting eating disorders, dyslipidemia, diabetes, and physical or mental disabilities, as well as studies that used drugs or food supplements as components of the intervention. The assessment by title and abstract and the quality assessment were performed independently by two researchers. We used the Centre for Reviews and Dissemination's guidance for undertaking reviews in health care and the software EPPI-Reviewer 3. Summary of the findings:From the initially retrieved 4,809 references, 24 articles met the inclusion criteria. The extracted data show that there is evidence of positive effects on anthropometry and of increase in fruit and vegetable consumption. Characteristics of the interventions that demonstrated effectiveness are: duration > 1 year, introduction into the regular activities of the school, parental involvement, introduction of nutrition education into the regular curriculum, and provision of fruits and vegetables by school food services. Conclusion:Interventions in schools to reduce overweight and obesity, as well as to increase fruits and vegetable consumption, have demonstrated effectiveness in the best-conducted studies.J Pediatr (Rio J). 2011;87(5):382-92: Review, children, adolescent, nutrition policy, education, randomized controlled trials, body mass index, fruit, vegetables, school. ResumoObjetivo: Avaliar a efetividade da educação nutricional em escolas na redução ou prevenção de sobrepeso e obesidade em crianças e adolescentes. Fontes dos dados:Busca sistemática em 14 bases de dados e cinco revisões sistemáticas por ensaios controlados randomizados realizados em escolas com o objetivo de reduzir ou prevenir o sobrepeso em crianças e adolescentes. O índice de massa corporal e o consumo de frutas e verduras foram utilizados como desfechos primário e secundário, respectivamente. Não houve restrição de data de publicação ou idioma, exceto para idiomas com logogramas. Excluímos estudos em populações com distúrbios alimentares, dislipidemia, diabetes e deficiência física ou mental, e que utilizassem medicamentos ou suplementos alimentares. A avaliação por título e resumo e a avaliação de qualidade foram realizadas de forma independente por dois pesquisadores. Utilizamos as orientações do Centre for Reviews and Dissemination para a elaboração de artigos de revisão em saúde e o programa EPPI-Reviewer 3.Síntese dos dados: Das 4.809 referências inicialmente encontradas, 24 artigos pree...

The aim of this study was to analyze trends and factors associated with food insecurity in Brazil in 2004, 2009, and 2013, using microdata from the National Household Sample Survey (PNAD). Food insecurity was assessed using the Brazilian Food Insecurity Scale. Independent variables were selected from a conceptual model of determination of food insecurity, which was also used in the elaboration of multiple generalized linear models. The results show a downward trend in food insecurity prevalence from 2004 to 2013, especially for moderate and severe food insecurity, from 17% in 2004 (95%CI: 15.7-18.4) to 7.9% in 2013 (95%CI: 7.2-8.7). Despite important decreases in the prevalence of moderate and severe food insecurity, regardless of the level of determination, the population strata with the lowest prevalence in 2004 showed the largest relative reduction. As for factors associated with moderate and severe food insecurity, they remained the same in the ten years covered by the PNAD survey, namely: the North and Northeast regions, urban areas with inadequate sanitation, household density > 2 persons per bedroom, ≤ 4 household durable consumer goods, and households headed by females, individuals < 60 years, and non-whites, ≤ 4 years of schooling, and being unemployed. From 2004 to 2013, the prevalence of Brazilian households with moderate and severe food insecurity dropped by half, but from the perspective of equity the advances occurred unequally and were lower in strata with greater social, economic, and demographic vulnerability.

Este artigo se propõe a estudar o processo de insegurança alimentar e fome em domicílios brasileiros com crianças menores de cinco anos. É um estudo transversal com representatividade nacional executado com dados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS-2006) tendo como variável dependente a insegurança alimentar moderada e grave (IAM+G), medida através da Escala Brasileira de Insegurança Alimentar (EBIA). Foram geradas estimativas de prevalência e razão de prevalência com intervalos de 95% de confiança. Os resultados apontam para alta prevalência de IAM+G concentrada nas regiões Norte e Nordeste (30,7%), nas classes econômicas D e E (34%) e em beneficiários de Programas de Transferência de Renda (PTR; 36,5%). O modelo de análise multivariada constatou que os riscos sociais (beneficiário de PTR), regionais (Norte e Nordeste) e econômicos (classes D e E) eram de 1,8, 2,0 e 2,4, respectivamente. Agregando-se os três riscos observou-se que 48% dos domicílios encontravam-se em IAM+G, ou seja, crianças e adultos passaram fome nos três meses anteriores ao inquérito.

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This study reviewed the effectiveness of school-based physical activity interventions aimed at reducing overweight, obesity and hypertension in children. We searched 14 databases and analyzed studies published between April 2009 and September 2012. Only randomized controlled trials performed at the school level that included elements of physical activity but did not include nutritional co-interventions were analyzed. Studies were assessed by two recommended tools (EPHPP and GRADE), and the standardized mean differences with 95% confidence intervals were collected for a random-effect meta-analysis. A total of 12 papers were included in the meta-analysis, and these were divided according to three outcomes: body mass index (11 trials, n  =  4,273, −0.02, 95% CI: −0.13 to 0.17, p  =  0.8); body weight (5 trials, n  =  1,330, −0.07, 95% CI: −0.18 to 0.04, p  =  0.2); and blood pressure (6 trials, n  =  1,549), including systolic (0.11, 95% CI: −0.10 to 0.31, p  =  0.3) and diastolic pressure (−0.00, 95% CI: −0.10 to 0.10, p  =  0.9). This meta-analysis of data from 11 randomized, school-based physical activity interventions suggests that, regardless of the potential benefits of physical activity in the school environment, the interventions did not have a statistically significant effect. However, it is difficult to generalize from these results because the duration, intensity and type of physical activity used in the interventions varied greatly.