Pense - comportamentos, fatores psicossociais e sustentabilidade da alimentação de adolescentes brasileiros: da vigilância ao cuidado

Abstract

Adolescence is a time of changes in the body, behavior formation, and social interactions, which impact the eating patterns and nutritional status of individuals, with repercussions throughout life. Aiming to contribute to the process of surveillance and dietary and nutritional care of this public, the objective of this doctoral thesis was to investigate the prevalence of nutritional deviations, eating patterns, and behaviors of Brazilian adolescents and their associations with psychosocial, behavioral, and sustainability factors. Ten studies were developed, one methodological, eight association studies using a quantitative approach with data from sample 2 of the Pesquisa Nacional de Saúde do Escolar (PeNSE) 2015, and a theoretical essay. (1) The methodological study highlighted the potential of PeNSE databases in food and nutritional surveillance studies (VAN). The association studies explored the following food and nutritional issues of adolescents: (2) adherence to school feeding, (3) dietary and nutritional profiles, (4) obesity and status deficit, (5) indicators of food sustainability; (6) risk behaviors for eating disorders, (7) body image distortion, (8) experience of food insecurity and (9) dissatisfaction with body image. Finally, the essay discusses (10) food and nutritional care in adolescence. The dependent/main and independent/secondary variables of the association studies were representatives of individual, home, and school contexts. The identification of explanatory models for each problem occurred with the application of descriptive statistics, the Person Chisquare test, Poisson Regression Analysis (classic or multilevel), or Correspondence Analysis. The main results were: (1) PeNSE's databases allow several association analyses to explore food, nutritional, and behavioral issues relevant to the VAN process of Brazilian adolescents; (2) the prevalence of low school feeding (64.2%) was associated with individual behaviors, socioeconomic position of the family, and school context; (3) the most prevalent alimentary and nutritional profile among adolescents was characterized by an alimentary pattern of lower nutritional risk with eutrophy (42.6%) and the six profiles formed by combinations between categories of alimentary pattern and nutritional status were associated with different sociodemographic characteristics, behaviors and indicators of sustainability; (4) the status deficit (2.3%) was explained by biological variables and worse socioeconomic position of adolescents; and the prevalence of obesity (10.0%) was associated with individual behaviors, psychosocial risk factors for health and better socioeconomic position; (5) the average carbon footprint (1206 gCO2e/kg), water footprint (2760 liters/kg) and ecological footprint (8.07 g-m2/Kg) were higher among adolescents from the South and Southeast regions, with higher nutritional risk eating pattern; (6) the prevalence of risk behaviors for eating disorders (16.5%) presented association with worse socioeconomic position, with individual behaviors and with more vulnerable psychosocial factors, existing differences between the behaviors for weight loss (11.3%) and those for weight gain or muscle mass (8.8%); (7) overestimation (6.6%) and underestimation (37.1%) of body image were associated to individual behaviors (sex, body satisfaction and risk behaviors for eating disorders); (8) the experience of household food insecurity (22.8%) was explained by worse socioeconomic position, higher food and nutritional risk behaviors and by more vulnerable psychosocial factors; and (9) body dissatisfaction coexists with nutritional deviations, higher nutritional risk food consumption, food insecurity, inattentive eating, risk behaviors for eating disorders and better socioeconomic position. Based on the recognition of all this context, (10) a model of management and production of food and nutritional care of Brazilian adolescents should be thought based on (a) incorporation of new indicators to VAN, (b) qualification of educational actions for resilience and autonomy and (c) development of public policies on health, food, and nutrition for this population in Brazil