Guias alimentares brasileiros no contexto hospitalar materno-infantil: facilitadores e barreiras – um estudo de caso

Abstract

The promotion of adequate and healthy eating (PAAS) is fundamental in the prevention of various diseases. Therefore, health services must base their actions on guidelines such as the Dietary Guidelines for the Brazilian Population (GAPB) and the Dietary Guidelines for Brazilian Children Under Two Years of Age (GACB<2A), whose implementation remains a priority and challenge for public policies. Although PAAS in primary care is widely disseminated, there are gaps regarding the promotion of proper dietary practices in the hospital environment. Thus, this thesis aimed to understand the facilitators and barriers to the materialization of the recommendations of the Brazilian Food Guides in the maternal and child hospital context. Its results are presented in the form of two manuscripts. The first aimed to develop a matrix with potential interfaces between the principles and recommendations of the Brazilian Dietary Guidelines and the food and nutrition care actions developed in the maternal and child hospital environment. A theoretical-conceptual study was conducted that involved: analysis of the GAPB and GACB<2A; observation of care spaces in a maternal and child hospital (hospital wards, outpatient clinics, human milk bank, lactary, diet kitchen, restaurant, and cafeteria); identification of interfaces between food and nutrition care actions and the principles and recommendations of the Guidelines; and development of a matrix validated by specialists. The final version of the Matrix presents two sections, corresponding to each Guide, and highlights opportunities for its application in the hospital environment, such as food and nutritional education actions, menus aligned with the Guidelines, reorganization of spaces to promote communal eating, and the restriction of ultraprocessed foods. The matrix shows potential to strengthen PAAS and improve food and nutrition care in the hospital context. The second manuscript aimed to analyze the facilitators and barriers to the implementation of the recommendations of the Brazilian Food Guidelines from the perspective of health professionals and users inserted in the National Institute of Women's, Children's and Adolescents' Health Fernandes Figueira (IFF/Fiocruz).A qualitative and exploratory case study was conducted at the IFF/Fiocruz (RJ), between November 2023 and April 2024. Data collection included direct observation, interviews with healthcare professionals and users, and document analysis. The data were organized using QSR NVivo 11 software. The sample consisted of23 professionals and 11 users. The analysis resulted in three thematic axes: food environment, PAAS, and breastfeeding. Among the facilitators identified are the self-service restaurant, Menus aligned with the guidelines, and breastfeeding support; among the barriers are informal food trade, the availability of ultraprocessed foods in the surroundings, and aspects of the hospital routine. The study contributes to enhancing nutritional care in the Unified Health System and highlights that the hospital environment should be recognized as a strategic space for PAAS.