Ausência de aspectos simbólicos e sustentáveis nas recomendações para alimentação saudável: uma análise qualitativa dos guias alimentares

FABRI, Rafaela Karen; MARTINELLI, Suellen Secchi; PERITO, Maria Angela; FANTINI, Andrea; CAVALLI, Suzi Barletto

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Sumário

ORIGINAL • Rev Nutr 34 • 2021 • https://doi.org/10.1590/1678-9865202134e200120 copiar

Ausência de aspectos simbólicos e sustentáveis nas recomendações para alimentação saudável: uma análise qualitativa dos guias alimentares

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo

Analisar o conteúdo das principais mensagens de guias alimentares para promoção de alimentação saudável, identificando recomendações nutricionais, simbólicas e sustentáveis.

Métodos

Foram analisadas as mensagens de 90 guias alimentares selecionados a partir do banco de dados da Organização das Nações Unidas para Agricultura e Alimentação. Para a extração dos dados, todas as mensagens foram exportadas para o software Nvivo e categorizadas em categorias pré-definidas em revisão narrativa, conforme as dimensões correspondentes e outras categorias emergentes.

Resultados

Categorizou-se um total de 1.982 mensagens, agrupadas nas dimensões: nutricional (n=73,9%); sustentável (3,2%); simbólica (3,3%) e outras (19,7%). Todos os guias abordavam aspectos nutricionais, sendo que a recomendação mais frequente foi em relação ao consumo de gordura, seguida do consumo de sal e vegetais e frutas, citadas por pelo menos 75 guias. Menos da metade dos guias (n=40) abordaram aspectos sustentáveis ou simbólicos da alimentação e 13 abordaram ambos; contudo, essas mensagens representaram 6,5% do total presente nos documentos.

Conclusão

As recomendações para alimentação saudável presentes nos guias alimentares são incipientes no que se refere a questões sustentáveis e simbólicas. Recomendações para a adoção de dietas saudáveis precisam considerar a integralidade do alimento, as diversas combinações, os padrões alimentares e os fatores associados ao seu consumo, bem como as relações do indivíduo com o alimento, com o ambiente e com a sociedade.

Palavras-chave
Cultura; Alimentos, dieta e nutrição; Guias alimentares; Hábitos alimentares; Desenvolvimento sustentável

Predefined categories		References
Dimension 1 – Essentially nutritional recommendations
	Nutrient content of foods; food groups (meats, fruits and vegetables, cereals, among others)	[⁷7 Popkin B. Ultra-processed foods’ impacts on health: 2030 food, agriculture and rural development in Latin America and the Caribbean. Santiago de Chile: Food and Agriculture Organization; 2020.,³⁵35 Sobhani SR, Rezazadeh A, Omidvar N, Eini-Zinab H. Healthy diet: a step toward a sustainable diet by reducing water footprint. Sci Food Agr. 2019;99:3769-75. https://doi.org/10.1002/jsfa.9591 https://doi.org/10.1002/jsfa.9591... 36 Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, et al. Food in the anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393:447-92. https://doi.org/10.1016/s0140-6736(18)31788-4 https://doi.org/10.1016/s0140-6736(18)31... 37 World Health Organization. Healthy diet: fact sheet n°394 updated august 2018. Rome: Organization; 2018.-³⁸38 Paquette MC. Perceptions of healthy eating: state of knowledge and research gaps. Can J Public Health. 2005;96(Suppl3):S16-21. https://doi.org/10.1007/BF03405196 https://doi.org/10.1007/BF03405196... ]
	Energy content; amount of calories	[⁷7 Popkin B. Ultra-processed foods’ impacts on health: 2030 food, agriculture and rural development in Latin America and the Caribbean. Santiago de Chile: Food and Agriculture Organization; 2020.,³⁵35 Sobhani SR, Rezazadeh A, Omidvar N, Eini-Zinab H. Healthy diet: a step toward a sustainable diet by reducing water footprint. Sci Food Agr. 2019;99:3769-75. https://doi.org/10.1002/jsfa.9591 https://doi.org/10.1002/jsfa.9591... 36 Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, et al. Food in the anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393:447-92. https://doi.org/10.1016/s0140-6736(18)31788-4 https://doi.org/10.1016/s0140-6736(18)31... -³⁷37 World Health Organization. Healthy diet: fact sheet n°394 updated august 2018. Rome: Organization; 2018.]
	Salt consumption	[⁷7 Popkin B. Ultra-processed foods’ impacts on health: 2030 food, agriculture and rural development in Latin America and the Caribbean. Santiago de Chile: Food and Agriculture Organization; 2020.,³⁷37 World Health Organization. Healthy diet: fact sheet n°394 updated august 2018. Rome: Organization; 2018.]
	Sugar consumption	[³⁷37 World Health Organization. Healthy diet: fact sheet n°394 updated august 2018. Rome: Organization; 2018.,³⁹39 Ruanpeng D, Thongprayoon C, Cheungpasitporn W, Harindhanavudhi T. Sugar and artificially sweetened beverages linked to obesity: a systematic review and meta-analysis. QJM. 2017;110:513-20. https://doi.org/10.1093/qjmed/hcx068 https://doi.org/10.1093/qjmed/hcx068... ]
	Consumption of oils and fats	[³⁶36 Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, et al. Food in the anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393:447-92. https://doi.org/10.1016/s0140-6736(18)31788-4 https://doi.org/10.1016/s0140-6736(18)31... ,³⁷37 World Health Organization. Healthy diet: fact sheet n°394 updated august 2018. Rome: Organization; 2018.]
	Consumption of food additives	[⁴⁰40 Scapin T, Fernandes AC, Proença RPC. Added sugars: definitions, classifications, metabolism and health implications. Rev Nutr. 2017;30:663-77. https://doi.org/10.1590/1678-98652017000500011 https://doi.org/10.1590/1678-98652017000... ,⁴¹41 Belloir C, Neiers F, Briand L. Sweeteners and sweetness enhancers. Curr Opin Clin Nutr Metab Care. 2017;20:279-85. https://doi.org/10.1097/mco.0000000000000377 https://doi.org/10.1097/mco.000000000000... ]
	Consumption of processed foods	[³⁶36 Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, et al. Food in the anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393:447-92. https://doi.org/10.1016/s0140-6736(18)31788-4 https://doi.org/10.1016/s0140-6736(18)31... ,³⁷37 World Health Organization. Healthy diet: fact sheet n°394 updated august 2018. Rome: Organization; 2018.]
	Consumption of whole foods	[⁷7 Popkin B. Ultra-processed foods’ impacts on health: 2030 food, agriculture and rural development in Latin America and the Caribbean. Santiago de Chile: Food and Agriculture Organization; 2020.,³⁶36 Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, et al. Food in the anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393:447-92. https://doi.org/10.1016/s0140-6736(18)31788-4 https://doi.org/10.1016/s0140-6736(18)31... ,³⁷37 World Health Organization. Healthy diet: fact sheet n°394 updated august 2018. Rome: Organization; 2018.]
Dimension 2 – Essentially symbolic recommendations
	Taste	[³3 Poulain JP. Sociologia da alimentação: os comedores e o espaço social alimentar. Florianópolis: EDUFSC; 2012.,⁴²42 Proença RPC, Sousa AA, Veiros MB, Hering B. Qualidade nutricional e sensorial na produção de refeições. Santa Catarina: Universidade Federal de Santa Catarina; 2005.]
	Presentation, color, and smell of foods	[³3 Poulain JP. Sociologia da alimentação: os comedores e o espaço social alimentar. Florianópolis: EDUFSC; 2012.,⁴²42 Proença RPC, Sousa AA, Veiros MB, Hering B. Qualidade nutricional e sensorial na produção de refeições. Santa Catarina: Universidade Federal de Santa Catarina; 2005.]
	Valuing the cultural context of the individual or group; preservation of food culture and identity; consumption of typical and traditional foods	[³3 Poulain JP. Sociologia da alimentação: os comedores e o espaço social alimentar. Florianópolis: EDUFSC; 2012.,⁴³43 Menegassi B. Eat regularly and carefully, in appropriate environments and in company: a brief analysis of this recommendation of the Brazilian Food Guide. Appetite. 2020;149:104619. https://doi.org/https://doi.org/10.1016/j.appet.2020.104619 https://doi.org/10.1016/j.appet.2020.104... 44 Fabri RK, Proença RPC, Martinelli SS, Cavalli SB. Regional foods in Brazilian school meals. Br Food J. 2015;117:1706-19. https://doi.org/10.1108/BFJ-07-2014-0275 https://doi.org/10.1108/BFJ-07-2014-0275... 45 Ministério da Saúde (Brasil). Guia alimentar para a população brasileira: promovendo a alimentação saudável. Brasília: Ministério; 2006.-⁴⁶46 Montanari M. Food is culture. New York: Columbia University Press; 2006.]
	Valuing the knowledge and beliefs of the individual or group	[³3 Poulain JP. Sociologia da alimentação: os comedores e o espaço social alimentar. Florianópolis: EDUFSC; 2012.,⁴³43 Menegassi B. Eat regularly and carefully, in appropriate environments and in company: a brief analysis of this recommendation of the Brazilian Food Guide. Appetite. 2020;149:104619. https://doi.org/https://doi.org/10.1016/j.appet.2020.104619 https://doi.org/10.1016/j.appet.2020.104... ,⁴⁶46 Montanari M. Food is culture. New York: Columbia University Press; 2006.]
	Eating as a time of social integration and friendship	[⁴³43 Menegassi B. Eat regularly and carefully, in appropriate environments and in company: a brief analysis of this recommendation of the Brazilian Food Guide. Appetite. 2020;149:104619. https://doi.org/https://doi.org/10.1016/j.appet.2020.104619 https://doi.org/10.1016/j.appet.2020.104... ,⁴⁷47 Brillat-Savarin J-A. A fisiologia do gosto. São Paulo: Cia das Letras; 1995.]
	Take time to prepare and eat meals. Slow eating	[⁴³43 Menegassi B. Eat regularly and carefully, in appropriate environments and in company: a brief analysis of this recommendation of the Brazilian Food Guide. Appetite. 2020;149:104619. https://doi.org/https://doi.org/10.1016/j.appet.2020.104619 https://doi.org/10.1016/j.appet.2020.104... ,⁴⁷47 Brillat-Savarin J-A. A fisiologia do gosto. São Paulo: Cia das Letras; 1995.]
	Eating with pleasure	[⁴³43 Menegassi B. Eat regularly and carefully, in appropriate environments and in company: a brief analysis of this recommendation of the Brazilian Food Guide. Appetite. 2020;149:104619. https://doi.org/https://doi.org/10.1016/j.appet.2020.104619 https://doi.org/10.1016/j.appet.2020.104... ,⁴⁷47 Brillat-Savarin J-A. A fisiologia do gosto. São Paulo: Cia das Letras; 1995.]
Dimension 3 – Essentially sustainable recommendations
	Respect for seasonality	[³⁷37 World Health Organization. Healthy diet: fact sheet n°394 updated august 2018. Rome: Organization; 2018.]
	Valuing biodiverse food	[⁴4 Food and Agriculture Organization. Sustainable diets and biodiversity. Rome (Italy): Food; 2010.,³⁶36 Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, et al. Food in the anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393:447-92. https://doi.org/10.1016/s0140-6736(18)31788-4 https://doi.org/10.1016/s0140-6736(18)31... ,⁴⁸48 Rose D, Heller MC, Roberto CA. Position of the society for nutrition education and behavior: the importance of including environmental sustainability in dietary guidance. J Nutr Educ Behav. 2019;51:3-15.e1. https://doi.org/10.1016/j.jneb.2018.07.006 https://doi.org/10.1016/j.jneb.2018.07.0... ]
	Consumption of wild and unconventional plants	[⁴⁹49 Hunter D, Borelli T, Beltrame DMO, Oliveira CNS, Coradin L, Wasike VW, et al. The potential of neglected and underutilized species for improving diets and nutrition. Planta. 2019;250:709-29. https://doi.org/10.1007/s00425-019-03169-4 https://doi.org/10.1007/s00425-019-03169... ,⁵⁰50 Leal ML, Alves RP, Hanazaki N. Knowledge, use, and disuse of unconventional food plants. J Ethnobiol Ethnomed. 2018;14:6. https://doi.org/10.1186/s13002-018-0209-8 https://doi.org/10.1186/s13002-018-0209-... ]
	Organic food consumption and enhancement of the agroecological production system	[⁵¹51 Frison E, Clément C. The potential of diversified agroecological systems to deliver healthy outcomes: making the link between agriculture, food systems & health. Food Policy. 2020:101851. https://doi.org/https://doi.org/10.1016/j.foodpol.2020.101851 https://doi.org/10.1016/j.foodpol.2020.1... 52 United Nations. Transforming our world: the 2030 Agenda for Sustainable Development: General Assembley 70 session. New York: Department of Economic and Social Affairs; 2015.-⁵³53 Food and Agriculture Organization. Agroecology knowledge hub: overview. Rome: Organization; 2020 [cited 2020 May 22]. Available from: http://www.fao.org/agroecology/overview/en/ http://www.fao.org/agroecology/overview/... ]
	Consumption of non-genetically modified food	[¹⁰10 Cortese RDM, Martinelli SS, Fabri RK, Proença RPC, Cavalli SB. A label survey to identify ingredients potentially containing GM organisms to estimate intake exposure in Brazil. Public Health Nutr. 2018;21:2698-713. https://doi.org/10.1017/S1368980018001350 https://doi.org/10.1017/S136898001800135... ,⁵⁴54 Cortese RDM, Martinelli SS, Fabri RK, Cavalli SB. Alimentação na atualidade: reflexões sobre o consumo de alimentos geneticamente modificados. Agroecología. 2018;12(2):71-9.,⁵⁵55 Almeida VES, Friedrich K, Tygel AF, Melgarejo L, Carneiro FF. Use of genetically modified crops and pesticides in Brazil: growing hazards. Ciênc Saúde Coletiva. 2017;22:3333-9.]
	Food waste	[²³23 Lawrence MA, Baker PI, Pulker CE, Pollard CM. Sustainable, resilient food systems for healthy diets: the transformation agenda. Public Health Nutr. 2019;22:2916-20. https://doi.org/10.1017/S1368980019003112 https://doi.org/10.1017/S136898001900311... ,³⁶36 Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, et al. Food in the anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393:447-92. https://doi.org/10.1016/s0140-6736(18)31788-4 https://doi.org/10.1016/s0140-6736(18)31... ,⁵⁶56 Food Agriculture Organization. HLPE: agroecological and other innovative approaches for sustainable agriculture and food systems that enhance food security and nutrition. Rome: Organization; 2019. p.161. A report by the High Level Panel of Experts on Food Security and Nutrition of the Committee on World Food Security.,⁵⁷57 Béné C, Oosterveer P, Lamotte L, Brouwer ID, Haan S, Prager SD, et al. When food systems meet sustainability: current narratives and implications for actions. World Dev. 2019;113:116-30. https://doi.org/10.1016/j.worlddev.2018.08.011 https://doi.org/10.1016/j.worlddev.2018.... ]
	Consumption of local food and short marketing chains	[⁴⁸48 Rose D, Heller MC, Roberto CA. Position of the society for nutrition education and behavior: the importance of including environmental sustainability in dietary guidance. J Nutr Educ Behav. 2019;51:3-15.e1. https://doi.org/10.1016/j.jneb.2018.07.006 https://doi.org/10.1016/j.jneb.2018.07.0... ,⁵¹51 Frison E, Clément C. The potential of diversified agroecological systems to deliver healthy outcomes: making the link between agriculture, food systems & health. Food Policy. 2020:101851. https://doi.org/https://doi.org/10.1016/j.foodpol.2020.101851 https://doi.org/10.1016/j.foodpol.2020.1... ,⁵⁷57 Béné C, Oosterveer P, Lamotte L, Brouwer ID, Haan S, Prager SD, et al. When food systems meet sustainability: current narratives and implications for actions. World Dev. 2019;113:116-30. https://doi.org/10.1016/j.worlddev.2018.08.011 https://doi.org/10.1016/j.worlddev.2018.... ,⁵⁸58 Maluf RS, Burlandy L, Santarelli M, Schottz V, Speranza JS. Nutrition-sensitive agriculture and the promotion of food and nutrition sovereignty and security in Brazil. Ciêc Saúde Coletiva. 2015;20:2303-12. https://doi.org/10.1590/1413-81232015208.14032014 https://doi.org/10.1590/1413-81232015208... ]
	Food consumption by family farmers and small producers	[¹⁹19 O’Kane G. A moveable feast: contemporary relational food cultures emerging from local food networks. Appetite. 2016;105:218-31. https://doi.org/10.1016/j.appet.2016.05.010 https://doi.org/10.1016/j.appet.2016.05.... ,⁵⁸58 Maluf RS, Burlandy L, Santarelli M, Schottz V, Speranza JS. Nutrition-sensitive agriculture and the promotion of food and nutrition sovereignty and security in Brazil. Ciêc Saúde Coletiva. 2015;20:2303-12. https://doi.org/10.1590/1413-81232015208.14032014 https://doi.org/10.1590/1413-81232015208... ]
	Food consumption from home and community gardens	[¹⁹19 O’Kane G. A moveable feast: contemporary relational food cultures emerging from local food networks. Appetite. 2016;105:218-31. https://doi.org/10.1016/j.appet.2016.05.010 https://doi.org/10.1016/j.appet.2016.05.... ]
	Consumption of fair-trade foods from a supportive economy	[⁵⁶56 Food Agriculture Organization. HLPE: agroecological and other innovative approaches for sustainable agriculture and food systems that enhance food security and nutrition. Rome: Organization; 2019. p.161. A report by the High Level Panel of Experts on Food Security and Nutrition of the Committee on World Food Security.,⁵⁹59 Von Koerber K, Bader N, Leitzmann C. Wholesome nutrition: an example for a sustainable diet. Proc Nutr Soc. 2017;76:34-41. https://doi.org/10.1017/S0029665116000616 https://doi.org/10.1017/S002966511600061... ]
	Sustainable animal production/animal well-being	[²³23 Lawrence MA, Baker PI, Pulker CE, Pollard CM. Sustainable, resilient food systems for healthy diets: the transformation agenda. Public Health Nutr. 2019;22:2916-20. https://doi.org/10.1017/S1368980019003112 https://doi.org/10.1017/S136898001900311... ]
	Vegetable-based food	[³⁶36 Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, et al. Food in the anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393:447-92. https://doi.org/10.1016/s0140-6736(18)31788-4 https://doi.org/10.1016/s0140-6736(18)31... ,⁴⁸48 Rose D, Heller MC, Roberto CA. Position of the society for nutrition education and behavior: the importance of including environmental sustainability in dietary guidance. J Nutr Educ Behav. 2019;51:3-15.e1. https://doi.org/10.1016/j.jneb.2018.07.006 https://doi.org/10.1016/j.jneb.2018.07.0... ]

Characterization of the identified guidelines and categories		FGDB		FGDB
		FGDB		Essentially nutritional		Essentially symbolic		Essentially sustainable
		n	%	n	%	n	%	n	%
Year of publication^* * The date of publication was not specified in one of the analyzed FBDG (Food-Based Dietary Guidelines).
	Before the year 2000	4	4.5	4	100.0	1	25.0	2	50.0
	2000-2008	27	30.3	27	100.0	7	26.0	8	30.0
	2009-2013	38	42.7	38	100.0	15	39.0	8	21.0
	2014-2017	20	22.5	20	100.0	5	25.0	5	25.0
Place of publication
	Europe	33	36.7	33	100.0	8	24.0	10	30.0
	Latin America and the Caribbean	28	31.1	28	100.0	9	32.0	12	43.0
	Asia	18	20.0	18	100.0	2	11.0	4	22.0
	Africa	7	7.8	7	100.0	2	29.0	2	29.0
	Middle East	4	4.4	4	100.0	2	50.0	2	50.0

Dimensions and Category		Messages (n)	FBDGs (n)
Dimension 1 – Essentially nutritional recommendations
	Fat consumption and use (Control of fat consumption in general, saturated fat, selection of foods with less fat)	163	79
	Consumption and use of Salt (Control of the use of salt and foods with a large amount of salt/sodium and selection of foods with less salt/sodium)	162	79
	Consumption of Vegetables and Fruits (Encouraging the consumption of vegetables and fruits in quantity and variety)	156	75
	Meat Consumption (Encourage and control of meat consumption, lean meat consumption, control of fatty meat consumption)	128	57
	Sugar Consumption (Control of the consumption of sugar and high-sugar foods and beverages, and selection of foods with less sugar)	124	69
	Milk Consumption (Encourage the consumption of dairy products in general and low-fat content)	93	53
	Varied food consumption (encouraging the consumption of different types of foods and food groups)	92	67
	Fish (Encouraging fish consumption)	77	47
	General recommendations for a healthy and balanced diet (Healthy diet, balanced and/or moderate diet; regular consumption and control of food consumption)	59	34
	Fibers (Encouraging the consumption of whole foods and foods rich in fiber)	57	41
	Oil (Control of oil consumption and vegetable oil consumption)	57	42
	Cereals and starches (Encourage the consumption)	56	41
	Other groups of food (Encouraging the consumption of nuts, seeds, among others)	45	27
	Legumes (Encourage the consumption)	38	30
	Eggs (Encourage the consumption)	36	25
	Food processing (control over the consumption of processed, ultra-processed foods; preference for less processed foods)	32	15
	Nutrients (Encourage the consumption of protein, carbohydrate, calcium, iron, among others)	30	19
	Meals (Hours, number, and type of meals)	23	13
	Calories (Control the amount of calories consumed)	18	12
	Food labeling (reading nutritional information)	18	11
Total		1,464	90
Dimension 2 – Essentially symbolic recommendations
	Appreciation of food culture, food, and traditional cuisine	24	11
	Appreciation of the place, environment, and mealtimes	23	8
	Enjoying the meal	18	13
Total		65	22
Dimension 3 – Essentially sustainable recommendations
	Consumption of fresh and/or natural food	24	17
	Valuing local food	14	11
	Vegetable-based diet	11	9
	Respect for seasonality	9	7
	Valorization of organic foods	2	1
	Environmental protection	2	2
	Waste reduction	1	1
Total recommendations		63	30
Dimension 4 – Other recommendations
	Physical activity	74	62
	Hygiene	71	41
	Water and other liquids	66	55
	Weight	64	49
	Alcoholic beverages	48	42
	Breastfeeding	31	21
	For different population groups	11	6
	Complementary diet	9	8
	Health care and disease prevention (not associated with food)	9	6
	Use of financial resources	4	3
	Smoking	3	3
	Total	390	88

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[1] Correspondence to: RK FABRI. E-mail: rafaela.kfabri@gmail.com.