Lyra, Clélia de OliveiraCabral, Natalia Louise de Araújo2022-03-252022-03-252021-02-09CABRAL, Natalia Louise de Araújo. Proposta metodológica para avaliação da insegurança alimentar e nutricional - estudo Brazuca Natal. 2021. 142f. Tese (Doutorado em Saúde Coletiva) - Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, 2021.https://repositorio.ufrn.br/handle/123456789/46684The conceptual complexity of Food and Nutrition Security (FNS) makes its assessment a challenge. Indicators that include the food and nutritional components and their different dimensions are necessary to complement the dimension of access measured by the Brazilian Food Insecurity Scale (EBIA in Portuguese), the main instrument used in Brazil. The formulation of a global indicator is essential for tracking individuals in food insecurity (FI) situation, especially in food and nutrition surveillance (FNS). Thus, the present study aimed to assess the factors associated with food and nutritional insecurity (FNI) and to develop a multidimensional methodological proposal for screening (Vigi-INSAN in Portuguese). VigiINSAN was proposed based on a predictive model of FI, with data from the Brazuca Natal Study, a cross-sectional study, conducted with 411 adults and elderly people living at home. Home interviews were conducted with the application of an electronic questionnaire to obtain demographic, socioeconomic, anthropometric data (weight, height, body perimeters), food consumption (items on the scale of adherence to the Dietary Guidelines for the Brazilian Population) and FI measured by EBIA. The Vigi-INSAN construction occurred in three stages: 1- Organization of the theoretical basis and selection of items, based on bivariate analysis; 2- Multiple Poisson regression to select the variables of the methodological proposal: variables with p <0.20 were included in the model and those with p <0.05 remained in the final model; 3 - Analysis of the assumptions of adjustment with the Omnibus test and deviance, and, ROC curve to analyze the efficiency of the model and definition of the cutoff point. A cut was conducted to identify the factors associated with FI in the elderly population (n = 191). For this, the crude (PRc) and adjusted prevalence ratios (PRaj) were analyzed using Poisson Regression. The prevalence of FI was 42.1% (37.4% - 46.9%). Women (47.5%), adults (48.2%) and people of non-white color / race (52.7%) had significantly higher FI. After multiple analysis, the predictive model was composed of: presence of children under 18 at home (A) (PRaj = 1.3; 1.1 - 1.6), family income (B) (in quintiles) (Q1: PRaj = 5.4; 2.5 - 11.7; Q2: PRaj = 4.8; 2.2 - 10.5; Q3: PRaj = 3.8; 1.8 - 8.5; Q4 PRaj = 2 , 2; 1.0 - 5.1), inadequate drinking water treatment (C) (PRaj = 1.3; 1.1 - 1.5), presence of chronic non-communicable diseases (D) (PRaj = 1.3; 1.1 - 1.7), absence of the habit of eating fruit for breakfast (E) (PRaj = 1.7; 1.3 - 2.5), habit of eating meals on the living room sofa or in bed (F) (RPaj = 1.3; 1.1 - 1.6) and skipping at least lunch or dinner (G) (PRaj = 1.4; 1.2 - 1.7). The area under the ROC curve indicated 83% of FNI prediction. The score assigned to the items was: (A) = 0.3; (B): Q1 = 1.7; Q2 = 1.6; Q3 = 1.4; Q4 = 0.8; Q5 = 0; (C) = 0.2; (D) = 0.3; E = 0.6; (F) = 0.3; (G) = 0.3. A cutoff point of 2.3 was adopted (Kappa = 0.47; Sensitivity = 0.82; Specificity = 0.67; PPV = 0.64; NPV = 0.83). It is concluded that VigiINSAN has potential for use in FNSV , with high predictive power of based on multidimensional indicators of the food and nutritional components of FNS.Acesso AbertoSaúde públicaSegurança alimentar e nutricionalVigilância nutricionalInquéritos e questionáriosdoctoralThesis