A Segurança Alimentar e Nutricional (SAN) é a realização do direito de todos ao acesso regular e permanente a alimentos de qualidade, em quantidade suficiente, sem comprometer o acesso a outras necessidades essenciais, tendo como base práticas alimentares promotoras de saúde, que respeitem a diversidade cultural e que sejam social, econômica e ambientalmente sustentáveis. Nos últimos anos esta temática tem se destacado no cenário político nacional, principalmente após sua institucionalização por meio da Lei Orgânica de Segurança Alimentar e Nutricional (LOSAN 11.346/06) que cria o Sistema de Segurança Alimentar e Nutricional. Considerando os esforços para a implantação deste Sistema, nacionalmente, e a proximidade entre as proposições deste campo e o ideário da Promoção da Saúde, este estudo objetivou analisar um conjunto de programas de segurança alimentar e nutricional, desenvolvidos no município de São Paulo, sob a perspectiva da Promoção da Saúde, buscando verificar se ele compõe uma política de SAN promotora da saúde. A pesquisa, de caráter qualitativo, contou com análise de documentos referentes aos programas e entrevistas, por meio de questionários semi-estruturados, junto aos profissionais responsáveis por estas iniciativas. Verificou-se que os programas são distribuídos em todos os eixos de SAN (produção, abastecimento, consumo de alimentos e programas de suplementação alimentar e monitoramento da insegurança alimentar) com maior ênfase no eixo do consumo. Com relação à perspectiva da promoção da saúde, o conjunto dos programas não demonstrou ações intersetoriais, que atuassem sobre os determinantes da saúde e da má alimentação ou que promovessem a autonomia, participação e empoderamento dos indivíduos. A maior parte deles apresentou características próprias de políticas de um Estado neoliberal: assistencialistas, com ações limitadas ao oferecimento de alimentos ou renda; focalização, com atendimento apenas à população mais excluída da sociedade e alguns, de execução terceirizada, aumentando o distanciamento 2 entre Estado e população. Conclui-se que o conjunto dos programas analisados não compõe uma política municipal de SAN promotora da saúde. Descritores: Segurança Alimentar e Nutricional, Promoção da Saúde, Política de alimentação e nutrição, Nutrição e Saúde Pública / The Food and Nutrition Security is the realization of the right of everyone to the regular and permanent access to quality food, in enough quantity, without compromising the access to other essential necessities, based on health-promoting food practices that respect the cultural diversity and that are socially, economically and environmentally sustainable. In recent years this issue has been highlighted in the national political scene, especially after its institutionalization through the ´Organic Law on Food and Nutrition Security ´ (LOSAN 11.346/06) which creates the System of Food and Nutrition Security. Considering the efforts to implement this system, nationally, and the proximity between the propositions of this field and the idea of Health Promotion, this study aimed to analyze a set of programs for food and nutrition security, developed in the city of São Paulo, from the perspective of Health Promotion, to check if it makes up a policy of Food and Nutrition Security health-promoting. The qualitative research, included analysis of documents related to programs and interviews, through semi-structured questionnaires, with those professionals responsible for these initiatives. It was found that the programs are distributed on all axles of Food and Nutritional Security (production, supply, food consumption and nutritional supplement programs and monitoring of food insecurity) with greater emphasis on the axis of consumption. Regarding the perspective of health promotion, all the programs did not demonstrate intersectoral action, which acted on the determinants of health and bad nutrition or that promote autonomy, participation and empowerment of individuals. Most of them had characteristics of a neoliberal State policies: welfare, with actions limited to the offering of food or income; focus with service only to the population most excluded from society and some, outsourced execution, increasing the distance between the State and population. We conclude that all the programs analyzed did not make up a municipal policy of Food and Nutritional Security health-promoting

The 2004 Canadian Community Health Survey (CCHS) revealed many indicators of poor diet quality in Canada which, together with the high rates of obesity and diet-related chronic disease, suggest that shifts in dietary patterns are urgently needed. Given the widespread promotion of foods on the basis of nutrition and health, the aim of this work was to explore the population health implications of voluntary food fortification and nutrition-related marketing in Canada. Using the CCHS, the potential impact of a proposed discretionary food fortification policy on nutrient inadequacies and excesses was examined, in addition to the relationship between consumption of foods eligible to be fortified under this policy and indicators of dietary quality. To better understand the potential risk associated with liberal fortification practices, the National Health and Nutrition Examination Survey (2007-08) was used to examine potential for risk of excess associated with voluntarily fortified food consumption in the US, where these practices have long been permitted. The results suggest that proposed changes to voluntary fortification may reduce inadequacy and increase excess, and may reinforce poor diet patterns. Excessive nutrient intakes were also found to be associated with consumption of voluntarily fortified foods in the US, particularly among children. Therefore, there appears to be real potential for risk associated with voluntary fortification practices in Canada. The extent, nature, and population health implications of nutrition marketing in Canada was examined, using a survey of front-of-package nutrition-related marketing on foods within three large grocery stores in Toronto. Nutrition-related marketing was found on 41% of all foods surveyed, and was widely found on highly processed, often fortified foods. References to nutrients of public health concern (e.g. sodium, vitamin D) were infrequently found. Overall, this practice provides limited nutritional guidance. Current directions in nutrition policy in Canada should be re-evaluated, to ensure that they support healthy diet patterns.

Energy and nutrient intake from agency meals (AM), other meals (OM) and total daily intake (TDI) of 61 day care and homebound subjects was studied for differences associated with age, income, education, marital status, living arrangements, gender, race, vitamin-mineral supplementation, Body Mass Index (BMI), Health Assessment (HA), Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL).The AM provided more than one-third of the recommended allowances for all nutrients except vitamin B6 plus energy for men. TDI was low because of inadequate OM intake. TDI was less than 100 percent of recommended amounts for zinc plus fiber for women. were most significantly associated with intake from OM and TDI followed by education and income. No age, marital status or racial effects were noted.The ADLs and the IADLs were problematic for most of the participants. They were positively correlated with energy and nutrient intake, as intakes increased so did functional difficulties.Ball State UniversityMuncie, IN 47306 / Center for Gerontology

The 2004 Canadian Community Health Survey (CCHS) revealed many indicators of poor diet quality in Canada which, together with the high rates of obesity and diet-related chronic disease, suggest that shifts in dietary patterns are urgently needed. Given the widespread promotion of foods on the basis of nutrition and health, the aim of this work was to explore the population health implications of voluntary food fortification and nutrition-related marketing in Canada. Using the CCHS, the potential impact of a proposed discretionary food fortification policy on nutrient inadequacies and excesses was examined, in addition to the relationship between consumption of foods eligible to be fortified under this policy and indicators of dietary quality. To better understand the potential risk associated with liberal fortification practices, the National Health and Nutrition Examination Survey (2007-08) was used to examine potential for risk of excess associated with voluntarily fortified food consumption in the US, where these practices have long been permitted. The results suggest that proposed changes to voluntary fortification may reduce inadequacy and increase excess, and may reinforce poor diet patterns. Excessive nutrient intakes were also found to be associated with consumption of voluntarily fortified foods in the US, particularly among children. Therefore, there appears to be real potential for risk associated with voluntary fortification practices in Canada. The extent, nature, and population health implications of nutrition marketing in Canada was examined, using a survey of front-of-package nutrition-related marketing on foods within three large grocery stores in Toronto. Nutrition-related marketing was found on 41% of all foods surveyed, and was widely found on highly processed, often fortified foods. References to nutrients of public health concern (e.g. sodium, vitamin D) were infrequently found. Overall, this practice provides limited nutritional guidance. Current directions in nutrition policy in Canada should be re-evaluated, to ensure that they support healthy diet patterns.

Edited by Alan Berg, Nevin S. Scrimshaw [and] David L. Call. / Includes bibliographical references.

O consumo de alimentos processados tem crescido mundialmente e esse aumento tem sido relacionado em parte, pelas estratégias de marketing utilizadas pelas indústrias alimentícias que tem como objetivo aumentar as vendas e expandir o mercado consumidor. Segundo documento Recomendações da Consulta de Especialistas da Organização Pan-Americana da Saúde sobre a Promoção e a Publicidade de Alimentos e Bebidas Não Alcoólicas para Crianças nas Américas, a publicidade televisiva é a forma mais utilizada de marketing de alimentos para crianças e está associada a maior preferência e aumentos nos pedidos de compra de alimentos e bebidas com elevado teor de gordura, açúcar e sal. No âmbito da discussão mais recente sobre a possível influência da propaganda de alimentos na epidemia mundial de obesidade e doenças crônicas, o governo brasileiro, por meio da Agência Nacional de Vigilância Sanitária (ANVISA), formulou uma proposta de Regulamento Técnico que normatiza os termos das atividades publicitárias e que se concretizou na Resolução da Diretoria Colegiada n 24 de 2010 (RDC24/2010). Logo após sua publicação, grupos de interesse empresarial entraram na justiça e obtiveram diversas liminares que suspenderam a aplicação da RDC 24/2010 com base em parecer contrário da Advocacia Geral da União (AGU). O debate sobre ações regulatórias no campo da alimentação e nutrição como estratégia de controle e prevenção da obesidade envolve diversos atores sociais e opiniões bastante distintas e antagônicas, principalmente quando se trata dos argumentos do grupo de indivíduos que acredita na regulamentação da publicidade como uma forma de promover a saúde versus os argumentos contrários dos setores econômicos ligados ao tema a ser regulado. Neste sentido, este trabalho teve a intenção de descrever como e por que, neste processo, algumas práticas se estabeleceram no cotidiano das instituições e identificar os embates, argumentos e conflitos de interesses que apareceram nas discussões a respeito da formulação da resolução. Para isso, foi feita, primeiramente, análise documental de todo o processo de formulação, através de arquivos institucionais, documentos, pareceres, relatórios, entre outros. Posteriormente, foram identificados e caracterizados os sujeitos que participaram do processo e em seguida, realizadas entrevistas semi-estruturadas com atores chaves. Foram encontradas duas teses centrais no debate em torno da formulação da resolução: a primeira, se o Estado deve estabelecer uma regulamentação sobre publicidade de alimentos e a segunda diz respeito à competência legal da ANVISA em exercer o papel regulador sobre a propaganda de alimentos. As disputas em torno destas duas teses e os argumentos que se apresentaram para defendê-las são evidentemente incomensuráveis entre si, não havendo esperança de acordo entre as partes. O caso descrito elegeu a ANVISA como o território da disputa e a aparente maioria no jogo democrático desta arena mostrou-se ineficaz diante da captura pelo questionamento da pertinência desta Agência para função de regular a publicidade de alimentos. / The consumption of processed foods has grown globally and this increase has been related in part to the marketing strategies used by the food industry that aims to increase sales and expand the consumer market. As document Recommendations from a Pan American Health Organization Expert Consultation on the Marketing of Food and Non-Alcoholic Beverages to Children in the Americas, television advertising is the most widely used form of food marketing to children and is associated with greater preference and increases in orders for food and drinks high in fat , sugar and salt (PAHO, 2012). Within the most recent discussion on the possible influence of food advertising in the global epidemic of obesity and chronic diseases, the Brazilian government, through the National Health Surveillance Agency (ANVISA) , formulated a proposal for Technical Regulation that regulates the terms of advertising activities and which has resulted in Board Resolution No. 24 of 2010 (RDC24/2010). Soon after its publication, business interest groups filed a lawsuit and obtained several injunctions suspended application of RDC 24/2010 based on negative opinion of the Attorney General (AGU). The debate on regulatory actions in food and nutrition area as a strategy of control and obesity prevention involves several quite distinct and antagonistic social actors and opinions, especially when it comes to the arguments of the group who believe in the regulation of advertising as a way to promote health versus the counter arguments of economic sectors related to the subject to be regulated. Thus, this study was intended to describe how and why, in this process, some settled in the daily practices of institutions and identify conflicts, arguments and conflicts of interest that arose during the discussion about the wording of the resolution. To this, was first made documentary analysis of the entire formulation process through institutional archives, documents, opinions, reports, among others. Subsequently, we identified and characterized the subjects who participated in the process and then conducted semi -structured interviews with key actors. Two central theses were found in the debate over the wording of the resolution: the first, whether the state should establish rules on food advertising and the second concerns the legal competence of ANVISA in exercising regulatory role on the advertising of food. Disputes around these two theses and arguments presented to defend them are clearly incommensurate with each other, with no hope of agreement between the parties. The case described ANVISA elected as the territory of the dispute and the apparent majority in this democratic game arena was ineffective before the capture by questioning the relevance of this Agency to regulating food advertising.

Philosophiae Doctor - PhD / Type 2 diabetes mellitus (T2DM) and pre-diabetes contribute increasingly to the global burden of disease. Along with other behavioural risk factors, diet plays a key role in the onset and management of the disease, in turn largely determined by what foods are immediately accessible in local food environments. With this in mind, this thesis aims to answer the research question: What role do local food environments play in promoting or inhibiting access to healthy foods as part of the self - management of T2DM in urban and rural communities in South Africa, and what can be learned from an international perspective? Specific research objectives include, to: 1. Understand the current national-level policy context with regard to the observed rise in NCDs, their proximal determinants (specifically an observed change in diet patterns), and contributing environmental factors; 2. Identify the current food-related environmental factors associated with the onset and/or management of T2DM in an urban and a rural setting (as well as in four additional international settings in order to provide an international perspective); 3. Explore community perspectives of the role the local food environment plays in the self-management of T2DM in an urban and a rural setting; and, consequently 4. Recommend intervention- and/or policy-related actions that can be implemented based on study findings. A review of the literature and relevant policies was conducted towards achieving the first research objective. Quantitative data were systematically collected at an urban and rural site in South Africa through the creation of an ‘environmental profile’ in an attempt to achieve the second objective – comparable urban and rural data was also collected as part of a larger study at two other international sites (Kampala, Uganda and Stockholm, Sweden) to provide an international perspective. Included in the third objective is the collection of qualitative data through a community based participatory research method at the same urban and rural sites in South Africa. Finally, intervention and/or policy-related recommendations are developed based on study findings and in consultation with relevant stakeholders through interviews. / 2018-12-14

A presente dissertação trata da Segurança Alimentar e Nutricional (SAN) entre os povos indí-genas sob a perspectiva do Direito Humano a Alimentação Adequada (DHAA) e da Soberania Alimentar (SA). Apresenta à experiência dos indígenas Asheninkas do Alto Rio Envira, nar-rada a partir deles mesmos, com o Programa de Aquisição de Alimentos (PAA) enquanto be-neficiários fornecedores, no Município de Feijó, Estado do Acre. O PAA invest igado é exe-cutado pelo governo do estado e a modalidade é a Compra com Doação Simultânea. Demons-tra-se, por meio do Estudo de Caso, que o PAA pode fortalecer a segurança alimentar e nutri-cional dessas sociedades diferenciadas com manutenção da sua autonomia cultural. Com isso, debate-se as questões sobre a prioridade legal conferida a estes segmentos e a valorização para a aquisição de produtos tradicionais, intrínsecos á cultura, alimentação e culinária indí-gena. A ressignificação e adequação do Programa localmente unida aos laços de reciprocidade e parentesco, típicos das comunidades indígenas, contribuem para o acesso e manutenção de famílias isoladas geograficamente no Programa. Argumenta-se ainda, que a participação indí-gena no PAA, uma vez seguido os princípios legislativos do Programa e o respeito à autode-terminação dos povos, fortalece o resgate e manutenção dos sistemas alimentares tradicionais dos povos indígenas em seus territórios e terras indígenas já conquistadas legalmente. Assim, o PAA constitui-se não apenas em uma politica geradora de renda, mas, reúne, principalmen-te, características opostas às politicas indigenistas praticadas no passado. / This dissertation discusses food security and nutrition between indigenous people under the consideration of The Human Right to Adequate Food and Food sovereignty perspectives. It presents the experience of the Asheninkas’ people from the high Envira River with the Food Acquisition Program (PAA) in Feijo municipality, from their narratives as suppliers-beneficiaries. The program studied is implemented by the state government in the modality of Buy with Simultaneous donation. It is demonstrated through this case study that the PAA can strengthen food security and nutrition of these diverse societies maintaining their cultural au-tonomy. By this means, questions about the legal priority given to these segments and the appreciation to the acquisition of traditional products, intrinsic to indigenous culture, food and cuisine, are raised and debated. The local reinterpretation and adaptation of the program com-bined with the reciprocity ties and parentage, typical of indigenous communities, contribute to the access and maintenance of geographically isolated families in the program. It is further argued that the indigenous participation on PAA, once its legislative principles and the respect for these people self-determination are observed, strengthens the recovery and maintenance of indigenous traditional food systems in indigenous territories and lands already occupied legal-ly. Therefore, the PAA is not just a income generation policy, but also, and specially, a policy with opposite characteristics from the old indigenous policies.

O consumo de alimentos processados tem crescido mundialmente e esse aumento tem sido relacionado em parte, pelas estratégias de marketing utilizadas pelas indústrias alimentícias que tem como objetivo aumentar as vendas e expandir o mercado consumidor. Segundo documento Recomendações da Consulta de Especialistas da Organização Pan-Americana da Saúde sobre a Promoção e a Publicidade de Alimentos e Bebidas Não Alcoólicas para Crianças nas Américas, a publicidade televisiva é a forma mais utilizada de marketing de alimentos para crianças e está associada a maior preferência e aumentos nos pedidos de compra de alimentos e bebidas com elevado teor de gordura, açúcar e sal. No âmbito da discussão mais recente sobre a possível influência da propaganda de alimentos na epidemia mundial de obesidade e doenças crônicas, o governo brasileiro, por meio da Agência Nacional de Vigilância Sanitária (ANVISA), formulou uma proposta de Regulamento Técnico que normatiza os termos das atividades publicitárias e que se concretizou na Resolução da Diretoria Colegiada n 24 de 2010 (RDC24/2010). Logo após sua publicação, grupos de interesse empresarial entraram na justiça e obtiveram diversas liminares que suspenderam a aplicação da RDC 24/2010 com base em parecer contrário da Advocacia Geral da União (AGU). O debate sobre ações regulatórias no campo da alimentação e nutrição como estratégia de controle e prevenção da obesidade envolve diversos atores sociais e opiniões bastante distintas e antagônicas, principalmente quando se trata dos argumentos do grupo de indivíduos que acredita na regulamentação da publicidade como uma forma de promover a saúde versus os argumentos contrários dos setores econômicos ligados ao tema a ser regulado. Neste sentido, este trabalho teve a intenção de descrever como e por que, neste processo, algumas práticas se estabeleceram no cotidiano das instituições e identificar os embates, argumentos e conflitos de interesses que apareceram nas discussões a respeito da formulação da resolução. Para isso, foi feita, primeiramente, análise documental de todo o processo de formulação, através de arquivos institucionais, documentos, pareceres, relatórios, entre outros. Posteriormente, foram identificados e caracterizados os sujeitos que participaram do processo e em seguida, realizadas entrevistas semi-estruturadas com atores chaves. Foram encontradas duas teses centrais no debate em torno da formulação da resolução: a primeira, se o Estado deve estabelecer uma regulamentação sobre publicidade de alimentos e a segunda diz respeito à competência legal da ANVISA em exercer o papel regulador sobre a propaganda de alimentos. As disputas em torno destas duas teses e os argumentos que se apresentaram para defendê-las são evidentemente incomensuráveis entre si, não havendo esperança de acordo entre as partes. O caso descrito elegeu a ANVISA como o território da disputa e a aparente maioria no jogo democrático desta arena mostrou-se ineficaz diante da captura pelo questionamento da pertinência desta Agência para função de regular a publicidade de alimentos. / The consumption of processed foods has grown globally and this increase has been related in part to the marketing strategies used by the food industry that aims to increase sales and expand the consumer market. As document Recommendations from a Pan American Health Organization Expert Consultation on the Marketing of Food and Non-Alcoholic Beverages to Children in the Americas, television advertising is the most widely used form of food marketing to children and is associated with greater preference and increases in orders for food and drinks high in fat , sugar and salt (PAHO, 2012). Within the most recent discussion on the possible influence of food advertising in the global epidemic of obesity and chronic diseases, the Brazilian government, through the National Health Surveillance Agency (ANVISA) , formulated a proposal for Technical Regulation that regulates the terms of advertising activities and which has resulted in Board Resolution No. 24 of 2010 (RDC24/2010). Soon after its publication, business interest groups filed a lawsuit and obtained several injunctions suspended application of RDC 24/2010 based on negative opinion of the Attorney General (AGU). The debate on regulatory actions in food and nutrition area as a strategy of control and obesity prevention involves several quite distinct and antagonistic social actors and opinions, especially when it comes to the arguments of the group who believe in the regulation of advertising as a way to promote health versus the counter arguments of economic sectors related to the subject to be regulated. Thus, this study was intended to describe how and why, in this process, some settled in the daily practices of institutions and identify conflicts, arguments and conflicts of interest that arose during the discussion about the wording of the resolution. To this, was first made documentary analysis of the entire formulation process through institutional archives, documents, opinions, reports, among others. Subsequently, we identified and characterized the subjects who participated in the process and then conducted semi -structured interviews with key actors. Two central theses were found in the debate over the wording of the resolution: the first, whether the state should establish rules on food advertising and the second concerns the legal competence of ANVISA in exercising regulatory role on the advertising of food. Disputes around these two theses and arguments presented to defend them are clearly incommensurate with each other, with no hope of agreement between the parties. The case described ANVISA elected as the territory of the dispute and the apparent majority in this democratic game arena was ineffective before the capture by questioning the relevance of this Agency to regulating food advertising.

A presente dissertação trata da Segurança Alimentar e Nutricional (SAN) entre os povos indí-genas sob a perspectiva do Direito Humano a Alimentação Adequada (DHAA) e da Soberania Alimentar (SA). Apresenta à experiência dos indígenas Asheninkas do Alto Rio Envira, nar-rada a partir deles mesmos, com o Programa de Aquisição de Alimentos (PAA) enquanto be-neficiários fornecedores, no Município de Feijó, Estado do Acre. O PAA invest igado é exe-cutado pelo governo do estado e a modalidade é a Compra com Doação Simultânea. Demons-tra-se, por meio do Estudo de Caso, que o PAA pode fortalecer a segurança alimentar e nutri-cional dessas sociedades diferenciadas com manutenção da sua autonomia cultural. Com isso, debate-se as questões sobre a prioridade legal conferida a estes segmentos e a valorização para a aquisição de produtos tradicionais, intrínsecos á cultura, alimentação e culinária indí-gena. A ressignificação e adequação do Programa localmente unida aos laços de reciprocidade e parentesco, típicos das comunidades indígenas, contribuem para o acesso e manutenção de famílias isoladas geograficamente no Programa. Argumenta-se ainda, que a participação indí-gena no PAA, uma vez seguido os princípios legislativos do Programa e o respeito à autode-terminação dos povos, fortalece o resgate e manutenção dos sistemas alimentares tradicionais dos povos indígenas em seus territórios e terras indígenas já conquistadas legalmente. Assim, o PAA constitui-se não apenas em uma politica geradora de renda, mas, reúne, principalmen-te, características opostas às politicas indigenistas praticadas no passado. / This dissertation discusses food security and nutrition between indigenous people under the consideration of The Human Right to Adequate Food and Food sovereignty perspectives. It presents the experience of the Asheninkas’ people from the high Envira River with the Food Acquisition Program (PAA) in Feijo municipality, from their narratives as suppliers-beneficiaries. The program studied is implemented by the state government in the modality of Buy with Simultaneous donation. It is demonstrated through this case study that the PAA can strengthen food security and nutrition of these diverse societies maintaining their cultural au-tonomy. By this means, questions about the legal priority given to these segments and the appreciation to the acquisition of traditional products, intrinsic to indigenous culture, food and cuisine, are raised and debated. The local reinterpretation and adaptation of the program com-bined with the reciprocity ties and parentage, typical of indigenous communities, contribute to the access and maintenance of geographically isolated families in the program. It is further argued that the indigenous participation on PAA, once its legislative principles and the respect for these people self-determination are observed, strengthens the recovery and maintenance of indigenous traditional food systems in indigenous territories and lands already occupied legal-ly. Therefore, the PAA is not just a income generation policy, but also, and specially, a policy with opposite characteristics from the old indigenous policies.