Cenários alimentares para redução de prevalências de inadequação de ingestão de nutrientes no Brasil

Abstract

The thesis describes scenarios for reducing the prevalence of inadequate nutrient intake in Brazil, based on data from the first National Dietary Survey (NDS) conducted between 2008/2009, with 34,003 individuals over 10 years old. The usual dietary intake was estimated using two non-consecutive days of food records. The usual intake of nutrients and food was estimated by the National Cancer Institute method that corrects the intraindividual variability of consumption. The results are shown in four articles. In the first article, given the importance of consumption of folic acid by reproductive-age women to prevent neural tube defects, and given the wide availability of folic acid supplements of different doses, it was evaluated the safety of these supplements in this population. Five scenarios were simulated by adding different daily doses of fortification to folic acid derived from food consumed by the women. To define a safe dose of the supplement, the total folate was compared with the Tolerable Upper Intake Level. It was concluded that the use of supplements up to 700 mcg of folic acid are safe. The second article presents a simple method to evaluate the mandatory flour fortification in Brazil. Iron was estimated based on data for folic acid consumption, since it is possible to calculate folate separately from food. The impact of fortification in relation to iron consumption is low in Brazil. In the third article, using the linear programming technique an optimized diet was obtained that reaches most recommendations for 22 nutrients, based on the usual consumption in Brazilian adults and elderly. The fourth article evaluated the adherence to the Mediterranean Diet adapted to the Brazilian reality, prioritizing the foods most consumed in Brazil. Simulation techniques were used to evaluate changes in the prevalence of inadequate nutrient intake in two scenarios. In the first scenario, it was assumed that food intake would follow the normal distribution; in the second, the distribution of food would follow the distribution observed in the INA (skewed-to-the-right for all food groups). To calculate the prevalence of nutrient intake inadequacy, Estimated Average Requirement values were used as the cut-off point, except for sodium in which the Tolerable Upper Intake Level was used. It was concluded that if the Brazilian population adopts the Mediterranean diet, the prevalence of inadequate nutrient intake would be much lower than the current ones, in both scenarios. The different analyzes and results obtained can inform the public policies because they converge in the sense that it is possible to reach the nutrients recommendations, with the use of local foods that are part of the Brazilian food habits.