Ambientes alimentares e sua interface com a promoção da alimentação adequada e saudável

Abstract

Introduction: The theme of food environments is becoming increasingly evident in studies in Brazil and around the world. Knowing its aspects and their possible influences on the promotion of adequate and healthy food for the population based on national food guidelines is of great relevance, especially in the local scenario. Objectives: To understand the food environments in the municipality of Natal/RN and their relationship with the promotion of adequate and healthy eating according to the population's eating practices and the recommendations of the Food Guide for the Brazilian Population (GAPB). Method: The thesis was prepared using different methods organized into three sections: 1) Methodological study on the applicability of the GAPB adherence scale as a marker of healthy eating practices, which compared the Food Guide adherence scale with the scale weighted by the level of adherence of the study population. For this purpose, the statistics used were the ROC curve and the Kappa test; 2) A cross-sectional study on the relationship between the food environments (food deserts and swamps) of Natal/RN and adherence to the GAPB. To analyze the association, multiple linear regression was carried out by “backward stepwise” to ascertain the relationship between the variables in question; 3) Methodological study for the development of an instrument to evaluate the food environment of popular restaurants, considering the recommendations of the GAPB and the legislation of the Popular Restaurants Program. The instrument was evaluated by a panel of experts using a checklist for content validity, considering the Content Validity Index (CVI). Two rounds of evaluation were carried out and the aspects of practical relevance and clarity of language of the instrument's items were analyzed. Results: 1) In the methodological study on the applicability of the Food Guide adherence scale, an accuracy of 98.7% (AUC = 0.987 and p<0.001; 95%CI 0.979-0.995) was observed for the new weighted indicator to correctly classify the individual in terms of their adherence to the GAPB, with almost perfect agreement between the scales (Kappa = 0.90; p<0.001). 2) The cross-sectional study on food environments and adherence to the GAPB showed that living in a food desert reduces the adherence score to the Guide by 2.41 (p=0.014), regardless of income, age and gender; and reduces the adherence score by 1.39 (p=0.006) when considering practices contrary to the GAPB recommendations. Food swamps were not associated with the GAPB adherence score (p=0.886). 3) Regarding the study on the instrument developed, it was found that of the 46 checklist items assessed for practical relevance in the first round by the panel of experts, 6 were excluded for having a CVI < 0.8. The remaining 40 items were assessed for clarity of language and of these, 24 needed to be revised for having a CVI < 0.8. The experts also suggested adding 20 additional items to the instrument. Both the revised and additional items were assessed for clarity of language in the second round of the panel and obtained CVI ≥0.8. Conclusions: We conclude that the community food environment in the municipality of Natal/RN is unevenly shaped across the territory, negatively influencing access to healthy food and the adoption and promotion of an adequate and healthy diet for the population according to the GAPB. In this context, promoting healthy food environments in this municipality, such as public food and nutrition security facilities, is essential, as is having evaluation tools to monitor these spaces, such as the instrument developed to evaluate the food environment of popular restaurants. Given this scenario, it is essential that the actors responsible for intersectoral actions aimed at promoting adequate and healthy food act together.