Alimentação no âmbito do sistema brasileiro de vigilância de fatores de risco e proteção à saúde de adolescentes: padrão alimentar e validade dos indicadores

Abstract

With the intention to subsidize prevention and control actions of the non communicable chronic disease in the world, one of the actions proposed by the World Health Organization is creating surveillance systems of risk and protective behavioral factors for these specific diseases for adolescent that are developed in the school environment. In line with this recommendation, in Brazil, was held in 2009 the National School-Based Adolescent Health Survey (PeNSE) with the prospect of being repeated regularly and serve as a source of data for the Brazilian system of surveillance of risk and protective factors for adolescent health that includes, among other themes, food consumption. To date, no validation studies of the instrument used were performed. Furthermore, analyzes of consumption and eating routines held so far have been restricted to exam food and routines markers of healthy and unhealthy eating separately. The aim of this study was to assess dietary practices within the Brazilian surveillance system for risk and protective factors for adolescent health. Their results are presented in the form of two articles. The first aimed to assess the validity of indicators of dietary practices adopted in PeNSE among adolescent of Rio de Janeiro city. For this, in 2011, 174 students in the 9th grade of the elementary education from nine public and private schools were studied. The students completed the questionnaire (QUEST) using a Personal Digital Assistant. Then, responded by telephone three 24-hour records (R-24h) (reference method). The indicators evaluated were the regular intake (≥5 times/week) of healthy diet markers (MAS), unhealthy diet markers (MANS) and the following eating routines: having meal with parent(s), having breakfast and eating while studying or watching TV. Were examined the difference between the proportions of regular consumption and of eating routines obtained from the QUEST and the three R-24h, and specificity, sensitivity and accuracy index obtained from the QUEST. For all MAS there was no difference in the proportion of regular intake according to both methods. Compared to the R-24h, the proportions of students with regular consumption of packaged salty snaks and biscuits were higher and those who consumed sausages and similar products were lower when estimated by QUEST. Indicators of regular consumption of MAS and the one referring to having breakfast had higher accuracy than those of regular consumption of MANS and the other two indicators of eating routines. The indicators evaluated showed satisfactory performance. The second aimed to identify the dietary patterns of adolescents and describe their distribution in the 26 Brazilian capitals and Federal District. Were studied 60.954 students from public and private schools which attended the PeNSE conducted in 2009. Was used cluster analysis and three dietary patterns were identified: healthy (27.7%), unhealthy (34.6%) and mixed (37.7%). In general, the proportion of adolescents with healthy food pattern was low. It was observed a higher proportion of adolescents classified as belonging to the healthy pattern in the capitals of the Southeast, South and Midwest Regions. Both inter and intraregional differences were identified in the patterns prevalences, with greater heterogeneity in the North and Northeast Regions. The Municipal Human Development Index was positively correlated with the healthy pattern and negatively correlated with the mixed pattern. The identification of different dietary patterns among Brazilian capitals allows elaborating health promotion activities more appropriate to each context