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Effectiveness of the promoting adequate and healthy eating (PAAS) program in primary care: community randomized controlled trial

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Abstract

Objective

To evaluate the effectiveness of the Adequate and Healthy Diet Promotion Program (PAAS) on food intake and nutritional status of primary health care (PHC) individuals in small and medium-sized cities of Minas Gerais, Brazil.

Methods

A randomized controlled community trial was conducted in the PHC of Nova Lima and Carmo do Cajuru-MG. Basic health units were allocated to the control group (CG) and intervention group (IG). The CG was offered traditional activities of the health service; the IG conducted innovative actions of the PAAS program. The IG professionals were qualified for the development of the program, which lasted five months and was based on the “Instructive: Methodology of Group Work for Food and Nutrition Actions in Primary Health Care.” It promotes the empowerment and autonomy of healthy food choices. Sociodemographic and food consumption data were evaluated, and weight, height, and waist circumference were measured before and after the intervention. Intragroup and intergroup differences were also evaluated.

Results

Of 163 individuals, 99 were re-evaluated (CG=39; GI=60), mostly women and adults. After the intervention, IG individuals increased the frequency of fresh food consumption (3.2 times/week to 3.4 times/week; p=0.044) and regular fruit consumption (46.7% to 73.3%; p=0.002). CG individuals had reduced weekly consumption of ultra-processed foods (1.3 times/week to 1.0 times/week; p=0.031).

Conclusion

The PAAS program improved dietary characteristics of PHC individuals. Therefore, its application in other municipalities is recommended to improve the health of the population.

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References

  • Barreto ML (2005) Efficacy, effectiveness, and the evaluation of public health interventions. J Epidemiol Community Health [Internet] 59(5):345–6. Available from: https://jech.bmj.com/content/59/5/345

  • Berardinelli LMM, Guedes NAC, Ramos JP, Silva MGNe (2014) Educational technology as a strategy for the empowerment of people with chronic illnesses. Revista Enfermagem UERJ [Internet] 22(5):603–9. Available from: https://www.e-publicacoes.uerj.br/index.php/enfermagemuerj/article/view/15509/12234

  • Bhattarai N, Prevost AT, Wright AJ, Charlton J, Rudisill C, Gulliford MC (2013) Effectiveness of interventions to promote healthy diet in primary care: systematic review and meta-analysis of randomised controlled trials. BMC Public Health [Internet]. ;13(1):1203. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-1203

  • Bicalho JMF, Guimarães EAA, de Freitas PP, Lopes MS, de Menezes MC, Lopes ACS et al (2021) Develo** models for the Adequate and Healthy Eating Promotion Program: an evaluability study. Res Soc Dev Res, Soc Dev. https://doi.org/10.33448/rsd-v10i10.19051

  • Bicalho JMF, de Guimarães EA A, Magalhães KA, de Menezes MC, Lorenzo C Di, Lopes ACS (2023) Evaluating the adequate and healthy food promotion program in primary care: a mixed methods research. Cien Saude Colet [Internet] 28(8):2247–60. https://doi.org/10.1590/1413-81232023288.06452023EN

  • Brasil (2012) Ministério do Desenvolvimento Social e Combate à Fome. Marco de referência de educação alimentar e nutricional para as políticas públicas. Ministério da Saúde, Brasília, DF

  • Brasil (2013) Ministério da Saúde. Secretaria de Atenção à Saúde. Política Nacional de Alimentação e Nutrição. Brasília, DF: Ministério da Saúde.86p

  • Brasil (2014) Ministério da Saúde, Secretaria de Atenção à Saúde. Guia Alimentar para a População Brasileira: promovendo a alimentação saudável. Brasília, DF: Ministério da Saúde. 158p

  • Brasil (2015) Ministério da Saúde. Secretaria Municipal de Saúde de Nova Lima. Núcleos de Apoio à Saúde da Família humanizam atendimento na cidade. vol 30

  • Brasil (2016a) Ministério da Saúde. Instrutivo Metodologias de Trabalho em Grupo para Promoção de Ações de Alimentação Adequada e Saudável na Atenção Básica. Brasília: Ministério da Saúde

  • Brasil (2016b) Ministério da Saúde. Secretaria de Atenção à Saúde. Coordenação-Geral da Política de Alimentação e Nutrição. Desmistificando dúvidas sobre alimentação e nutrição. Brasília. 166p

  • Brasil (2016c) Ministério da Saúde, Secretaria de Atenção à Saúde. Coordenação-Geral da Política de Alimentação e Nutrição. Na cozinha com as frutas, legumes e verduras. Brasília. 118p

  • Brasil Constituição (1988) Constituição da República Federativa do Brasil. Brasília, DF: Senado Federal: Centro Gráfico

  • Bueno JM, Leal FS, Saquy LPL, dos Santos CB, Ribeiro RPP (2011) Educação alimentar na obesidade: adesão e resultados antropométricos. Revista de Nutrição [Internet];24(4):575–84. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-52732011000400006&lng=pt&tlng=pt

  • Canella DS, da Silva ACF, Jaime PC (2013) Produção científica sobre nutrição no âmbito da Atenção Primária à Saúde no Brasil: uma revisão de literatura. Cien Saude Colet [Internet]. ;18(2):297–308. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232013000200002&lng=pt&tlng=pt

  • Danielle Fernandes V, Cássia P, Estela Maria B, José Eduardo C, Luiza Cristina Godim Dominigues D (2019) Evolução de pacientes dislipidêmicos em atividade educativa em grupo sobre alimentação e nutrição na atenção primária à saúde. Revista Ciência em Extensão [Internet] 15(3):62–74. Available from: https://ojs.unesp.br/index.php/revista_proex/article/view/2820

  • de Carvalho KM, Silva CRDT, do Figueiredo MLF, Nogueira LT, Andrade EMLR (2018) Intervenções educativas para promoção da saúde do idoso: revisão integrativa. Acta Paulista de Enfermagem [Internet]. ;31(4):446–54. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-21002018000400446&lng=pt&tlng=pt

  • de Menezes MC, Mingoti SA, Cardoso CS, de Mendonça RD, Lopes ACS (2015) Intervention based on Transtheoretical Model promotes anthropometric and nutritional improvements - a randomized controlled trial. Eat Behav [Internet] 17:37–44. Available from: https://pubmed.ncbi.nlm.nih.gov/25553558/

  • Ferreira NL, Mingoti SA, Jaime PC, Lopes ACS (2014) Effectiveness of nutritional intervention in overweight women in Primary Health Care. Revista de Nutrição [Internet] 27(6):677–87. Available from: https://www.scielo.br/j/rn/a/qTsJRYFqkH9TrmY7dKwdm7n/?lang=en

  • Figueira TR, Lopes ACS, Modena CM (2016) Barreiras e fatores promotores do consumo de frutas e hortaliças entre usuários do Programa Academia da Saúde. Revista de Nutrição [Internet]. 29(1):85–95. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-52732016000100085&lng=pt&tlng=pt

  • França CJ de, de Carvalho VCHS dos (2017) Estratégias de educação alimentar e nutricional na Atenção Primária à Saúde: uma revisão de literatura. Saúde em Debate [Internet]. (114):932–48. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-11042017000300932&lng=pt&tlng=pt

  • Freire P (1987) Pedagogia do oprimido (17th ed.). Rio de Janeiro: Paz e Terra

  • Frison S, Kerac M, Checchi F, Prudhon C (2016) Anthropometric indices and measures to assess change in the nutritional status of a population: a systematic literature review. BMC Nutr [Internet] 2(1):1–11. Available from: https://bmcnutr.biomedcentral.com/articles/10.1186/s40795-016-0104-4

  • Greaves C, Poltawski L, Garside R, Briscoe S (2017) Understanding the challenge of weight loss maintenance: a systematic review and synthesis of qualitative research on weight loss maintenance. Health Psychol Rev [Internet]. ;11(2):145–63. Available from: https://www.tandfonline.com/doi/full/10.1080/17437199.2017.1299583

  • Hall KD, Kahan S (2018) Maintenance of lost weight and long-term management of obesity. Med Clin North Am [Internet] 102(1):183–197. https://doi.org/10.1016/j.mcna.2017.08.012

  • Hall KD, Ayuketah A, Brychta R, Cai H, Cassimatis T, Chen KY et al (2019) Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. Cell Metab [Internet] 30(1):67-77.e3. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1550413119302487

  • Inelmen EM, Toffanello ED, Enzi G, Gasparini G, Miotto F, Sergi G, et al. (2005) Predictors of drop-out in overweight and obese outpatients. Int J Obes [Internet].;29(1):122–8. Available from: https://www.nature.com/articles/0802846

  • Jaime PC et al (2015) Prevalência e distribuição sociodemográfica de marcadores de alimentação saudável, Pesquisa Nacional de Saúde, Brasil 2013. Epidemiologia e Serviços de Saúde 24:267–276. https://doi.org/10.5123/S1679-49742015000200009

  • Kepple AW (2014) O estado da segurança alimentar e nutricional no Brasil: um retrato multidimensional. FAO, Brasília

    Google Scholar 

  • Lane MM, Davis JA, Beattie S, Gómez-Donoso C, Loughman A, O’Neil A, et al. (2021) Ultraprocessed food and chronic noncommunicable diseases: A systematic review and meta-analysis of 43 observational studies. Obesity Reviews [Internet].;22(3). Available from: https://onlinelibrary.wiley.com/doi/10.1111/obr.13146

  • Lemstra M et al (2016) Weight loss intervention adherence and factors promoting adherence: a meta-analysis. Patient Pref Adherence 10:1547

    Article  Google Scholar 

  • Lipschitz DA (1994 Mar) Screening for nutritional status in the elderly. Prim Care US 21(1):55–67

    Article  CAS  Google Scholar 

  • Monteiro CA, Cannon G, Lawrence M, Costa Louzada ML, Machado PP (2019a) The NOVA food classification system and its four food groups [Internet]. Ultra-processed foods, diet quality, and health using the NOVA classification system. Rome;. Available from: http://www.wipo.int/amc/en/mediation/rules

  • Monteiro CA, Cannon G, Levy RB, Moubarac J-C, Louzada ML, Rauber F et al (2019b) Ultra-processed foods: what they are and how to identify them. Public Health Nutr [Internet] 22(5):936–41. Available from: https://pubmed.ncbi.nlm.nih.gov/30744710/

  • Morgan C, de Wildt G, Prado RBR, Thanikachalam N, Virmond M, Riley R (2020) Views and Experiences of Adults who are Overweight and Obese on the Barriers and Facilitators to Weight Loss in Southeast Brazil: A Qualitative Study. Int J Qual Stud Health Well-being [Internet]. 15(1):1852705. Available from: https://www.tandfonline.com/doi/full/10.1080/17482631.2020.1852705

  • Nasreddine L, Tamim H, Itani L, Nasrallah MP, Isma’eel H, Nakhoul NF, et al. (2018) A minimally processed dietary pattern is associated with lower odds of metabolic syndrome among Lebanese adults. Public Health Nutr [Internet]. 21(1):160–71. Available from: https://www.cambridge.org/core/product/identifier/S1368980017002130/type/journal_article

  • Patrocinio M, De Guzman E, Molano WL (1994) Nutrition indicators for development: Priority and intervention efforts. Food Nutr Bull. 15(3)

  • Rogers M, Lemstra M, Bird Y, Nwankwo C, Moraros J (2016) Weight-loss intervention adherence and factors promoting adherence: a meta-analysis. Patient Prefer Adherence [Internet]. Volume 10:1547–59. Available from: https://www.dovepress.com/weight-loss-intervention-adherence-and-factors-promoting-adherence-a-m-peer-reviewed-article-PPA

  • Ryan RM, Deci EL (2006) Self-regulation and the problem of human autonomy: Does psychology need choice, self-determination, and will? J Pers Blackwell Publishing Ltd 74(6):1557–1586

    Google Scholar 

  • Schwingshackl L, Hoffmann G, Kalle-Uhlmann T, Arregui M, Buijsse B, Boeing H (2015) Fruit and vegetable consumption and changes in anthropometric variables in adult populations: A systematic review and meta-analysis of prospective cohort studies. PLoS One. Public Library of Science 10(10)

  • Vileigas DF, Pegoretti C, Barim EM, Corrente JE, Dias LCGD (2019) Evolução de pacientes dislipidêmicos em atividade educativa em grupo sobre alimentação e nutrição na atenção primária à saúde. Revista Ciência em Extensão 15(3):62–74

    Google Scholar 

  • WHO, FAO (2003) Diet nutrition, and the prevention of chronic diseases (Report of a joint WHO and FAO Expert Consulation). WHO Technical Report Series [Internet] 916:1–160. Available from: https://apps.who.int/iris/bitstream/handle/10665/42665/WHO_TRS_916.pdf?sequence=1

  • Wiggins N (2012) Popular education for health promotion and community empowerment: a review of the literature. Health Promot Int [Internet] 27(3):356–71. https://doi.org/10.1093/heapro/dar046

  • World Health Organization (WHO) (1995) Physical status: the use and interpretation of anthropometry. Technical report series no. 854. Geneva

  • World Health Organization (2011) Burden: mortality, morbidity, and risk factors. In: Global status report on communicable diseases 2010. World Health Organization, Geneva

    Google Scholar 

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Acknowledgments

To the project individuals for their cooperation and participation, the research group for interventions in nutrition (GIN/UFMG) team for field supervision, data collection, and data entry; to the managers and professionals of primary health care and the municipal health secretaries of Nova Lima and Carmo do Cajuru-MG for their technical and material support.

Funding sources

National Council for Scientific and Technological Development (CNPq) for the ACSL productivity grant; the Minas Gerais Research Funding Foundation (FAPEMIG) for funding the project (PPSUS CDS - APQ-03720-17); and Coordination for the Improvement of Higher Education Personnel (CAPES; Funding Code 001) for the scholarships.

Authorship

BB LIMA: data collection, statistical analysis of the data, interpretation of the data, writing and revision of the manuscript.

ACS LOPES: conception and design of the research, obtaining the funding, administrative, technical, and material support for the research; review of the manuscript, review of the final version of the article and approval for publication.

LAA MENEZES-JÚNIOR: statistical analysis of the data, interpretation of data, writing and revision of the manuscript.

MS LOPES: research design, field supervision, data collection and entry, data interpretation, revision of the manuscript, revision of the final version of the article and approval for publication.

PP FREITAS: research design, field supervision, data collection and entry, data interpretation, manuscript revision, revision of the final version of the article, and approval for publication.

MC MENEZES: conception and design of the research, revision of the manuscript, revision of the final version of the article and approval for publication.

Data availability

The datasets generated and/or analyzed as part of the current study are not publicly available due to confidentiality agreements with subjects. However, they can be made available solely for the purpose of review and not for the purpose of publication from the corresponding author upon reasonable request (Bicalho et al. 2023; Bicalho et al. 2021)

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Authors and Affiliations

  1. Group for Research and Studies in Public Health, Federal University of Ouro Preto, Ouro Preto, Brazil

    Bianca Bastos Lima & Luiz Antônio Alves de Menezes-Júnior

  2. Department of Nutrition, Nutrition Intervention Research Group, Federal University of Minas Gerais, Belo Horizonte, Brazil

    Aline Cristine Souza Lopes

  3. Nutrition Intervention Research Group, Federal University of Minas Gerais, Belo Horizonte, Brazil

    Mariana Souza Lopes & Patrícia Pinheiro de Freitas

  4. Department of Clinical and Social Nutrition, Federal University of Ouro Preto, Ouro Preto, Brazil

    Mariana Carvalho de Menezes

Authors
  1. Bianca Bastos Lima
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  2. Aline Cristine Souza Lopes
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  3. Luiz Antônio Alves de Menezes-Júnior
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  4. Mariana Souza Lopes
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  6. Mariana Carvalho de Menezes
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Corresponding author

Correspondence to Mariana Carvalho de Menezes.

Ethics declarations

Ethical approval

This study was approved by the university ethics committee (N°. 1,913,195), with the consent of the municipalities involved. Additionally, the Community Trial was registered in the Brazilian Registry of Clinical Trials (RBR-78vcb9).

Consent to participate

The individuals were informed about the objectives of the study, and they signed an informed consent form.

Consent for publication

Not applicable.

Ethical approval

This study was approved by the university ethics committee (Nº. 1,913,195), with the consent of the municipalities involved. Additionally, the Community Trial was registered in the Brazilian Registry of Clinical Trials (RBR-78vcb9).

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Lima, B.B., Lopes, A.C.S., Menezes-Júnior, L.A.A.d. et al. Effectiveness of the promoting adequate and healthy eating (PAAS) program in primary care: community randomized controlled trial. J Public Health (Berl.) (2023). https://doi.org/10.1007/s10389-023-02131-9

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