Dietary Guidelines for the Brazilian Population: implementation and potential impact on the diet quality of the population

Author(s)

Kamila Tiemann Gabe

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Saúde Pública (FSP/CIR)
• Defense date: 2023-11-10

Examining board members

Patricia Constante Jaime; Daniela Silva Canella; Janaina Calu Costa; Bárbara Hatzlhoffer Lourenço

• Advisor: Patricia Constante Jaime

Abstract

Introduction: The 2nd edition of the Dietary Guidelines for the Brazilian Population (2014) (Guide) was considered innovative for adopting a broad perspective on nutrition and health and presenting non-quantitative recommendations addressing dietary practices. Nearly 10 years after its publication, evaluating its potential impact on the population\'s diet is important to orient new implementation actions. Objectives: To analyze the implementation of the Guide and its potential to impact the quality of the population\'s diet. Specific objectives: a) to analyse the strategies adopted in Brazil to implement the Guide\' recommendations; b) to evaluate the convergent validity and invariance of a scale measuring adherence to dietary practices recommended by the Guide; c) to investigate whether adherence to these food practices recommended by the Guide is associated with diet quality; and, d) to investigate the association between nutrition knowledge based on food processing level and adherence to those dietary practices. Methods: A review of scientific literature and official documents on the implementation of Food-Based Dietary Guidelines informed the construction of a conceptual model and analysis of the implementation of the Brazilian Guidelines. Specific objectives b, c, and d were achieved through analyses conducted using data from the NutriNet-Brasil study, from which a sub-sample (n = 2,145) based on sex, macro-region, and education level quotas was recruited. Participants were asked to complete a scale measuring the adherence to dietary practices recommended by the Guide, which was validated in the study (b) and used in studies (c) and (d). Analyses: The score on this scale (eGuide) was compared to scores of consumption of minimally processed foods (eG1) and ultra-processed foods (eG4). Confirmatory factor analysis with multiple groups was used to assess invariance across sex, age, and education level (b). Based on 24-hour recalls, the usual percentage of energy intake from ten food groups encompassed in the Guide was calculated (%energy). The association between the eGuide and the %energy from each group was analyzed through linear regression (c). An instrument that identifies whether respondents recognize ultra-processed foods as unhealthy was used to measure food processing knowledge. The association between the food knowledge score and eGuide was tested through linear regression (d). Results: The implementation of the Guide primarily occurred through dissemination actions (a). Participants in the NutriNet study included in this study had an average age of 39, with 53% being women. The correlations between eGuide, eG1, and eG4, as well as the variation in fit indices in the invariance analysis, indicated convergent validity and measurement equivalence across subgroups of the studied characteristics (b). Except for red meat, all the other food groups showed a linear association with the eGuide in the expected direction (c). For each 1-point increase in food knowledge, eGuide increased by 0.6 points, in average. Closing remarks: The Guide\'s recommendations based on dietary practices appear to be appropriate as healthy eating promotion messages, as they are associated with a higher-quality diet. Increasing individuals\' knowledge about food processing may lead to increased adherence to these practices. However, additional public policies based on the Guidelines are needed to enhance the population\'s adherence to these recommendations. (AU)

• FAPESP's process: 19/01206-8 - Study of the adherence to the recommendations of the Dietary Guidelines for the Brazilian population
• Grantee: Kamila Tiemann Gabe
• Support Opportunities: Scholarships in Brazil - Doctorate