RESUMO Objetivo: Este estudo teve como objetivo verificar a associação entre a adesão à alimentação escolar fornecida pelo Programa Nacional de Alimentação Escolar e os padrões alimentares em adolescentes de escolas públicas brasileiras. Métodos: Foram utilizados dados da Pesquisa Nacional de Saúde Escolar de 2019, com uma amostra nacionalmente representativa de adolescentes brasileiros (n=53.477; 13–17 anos). O consumo de alimentos marcadores saudáveis e não saudáveis foi obtido a partir de um questionário de consumo alimentar. O consumo regular foi considerado ≥5 vezes/semana. A análise de classes latente foi utilizada para identificar padrões alimentares cuja associação com a adesão à alimentação escolar foi avaliada por modelos de regressão logística multinomial, com ajuste para variáveis sociodemográficas e de comportamento alimentar. Resultados: Foram identificados três padrões alimentares: “não saudável” — maior consumo de refrigerantes e doces (9,2% dos adolescentes); “saudável” — maior consumo de feijão, vegetais e frutas (27,1%); e “monótono” — maior consumo de feijão (63,7%). Alta adesão à alimentação escolar (todos os dias) e adesão insatisfatória (1–4 vezes/semana) foram positivamente associadas ao padrão saudável, mesmo após ajuste para possíveis fatores de confusão (OR 1,37, IC95% 1,23–1,52; OR 1,20, IC95% 1,10–1,30, respectivamente). Conclusão: Os resultados mostraram que o consumo das refeições escolares oferecidas pelo Programa Nacional de Alimentação Escolar pode contribuir para hábitos alimentares saudáveis entre os adolescentes brasileiros.

ABSTRACT Objective: This study aimed to verify the association between adherence to school meals provided by the National School Feeding Program and dietary patterns in adolescents from Brazilian public schools. Methods: Data from the 2019 National School Health Survey were used, with a nationally representative sample of Brazilian school adolescents (n=53,477; 13–17 years old). Food consumption of healthy and unhealthy food markers was obtained from a food consumption questionnaire. Regular consumption was considered ≥5 times/week. Latent class analysis was used to identify dietary patterns whose association with adherence to school meals was evaluated by multinomial logistic regression models, with adjustment for sociodemographic and eating behavior variables. Results: Three dietary patterns were identified: “unhealthy” — higher consumption of soft drinks and sweets (9.2% of adolescents); “healthy” — higher consumption of beans, vegetables, and fruits (27.1%); and “monotonous” — higher consumption of beans (63.7%). High adherence to school meals (every day) and unsatisfactory adherence (1–4 times/week) were positively associated with the healthy pattern even after adjustment for possible potential confounders (OR 1.37, 95%CI 1.23–1.52; OR 1.20, 95%CI 1.10–1.30, respectively). Conclusion: The results showed that the consumption of school meals offered by the National School Feeding Program can contribute to healthy eating habits among Brazilian adolescents.

RESUMO Objetivo: Este estudo teve como objetivo verificar a associação entre a adesão à alimentação escolar fornecida pelo Programa Nacional de Alimentação Escolar e os padrões alimentares em adolescentes de escolas públicas brasileiras. Métodos: Foram utilizados dados da Pesquisa Nacional de Saúde Escolar de 2019, com uma amostra nacionalmente representativa de adolescentes brasileiros (n=53.477; 13–17 anos). O consumo de alimentos marcadores saudáveis e não saudáveis foi obtido a partir de um questionário de consumo alimentar. O consumo regular foi considerado ≥5 vezes/semana. A análise de classes latente foi utilizada para identificar padrões alimentares cuja associação com a adesão à alimentação escolar foi avaliada por modelos de regressão logística multinomial, com ajuste para variáveis sociodemográficas e de comportamento alimentar. Resultados: Foram identificados três padrões alimentares: “não saudável” — maior consumo de refrigerantes e doces (9,2% dos adolescentes); “saudável” — maior consumo de feijão, vegetais e frutas (27,1%); e “monótono” — maior consumo de feijão (63,7%). Alta adesão à alimentação escolar (todos os dias) e adesão insatisfatória (1–4 vezes/semana) foram positivamente associadas ao padrão saudável, mesmo após ajuste para possíveis fatores de confusão (OR 1,37, IC95% 1,23–1,52; OR 1,20, IC95% 1,10–1,30, respectivamente). Conclusão: Os resultados mostraram que o consumo das refeições escolares oferecidas pelo Programa Nacional de Alimentação Escolar pode contribuir para hábitos alimentares saudáveis entre os adolescentes brasileiros. Objetivo brasileiras Métodos 2019 n=53.477 n53477 n 53 477 (n=53.477 1317 13 17 13–1 anos. anos . anos) alimentar 5 ≥ vezessemana vezes semana vezes/semana multinomial Resultados saudável 9,2% 92 9 2 (9,2 adolescentes) “saudável 27,1% 271 27 1 (27,1%) monótono “monótono 63,7%. 637 63,7% 63 7 (63,7%) todos dias 1–4 14 4 (1– 137 37 1,37 IC95 IC 1,23–1,52 123152 23 52 120 20 1,20 110130 10 30 1,10–1,30 respectivamente. respectivamente respectivamente) Conclusão 201 n=53.47 n5347 47 (n=53.47 131 13– 9,2 (9, 27,1 (27,1% 63,7 6 (63,7% 1– (1 3 1,3 IC9 1,23–1,5 12315 12 1,2 11013 1,10–1,3 n=53.4 n534 (n=53.4 9, (9 27, (27,1 63, (63,7 ( 1, 1,23–1, 1231 1101 1,10–1, n=53. n53 (n=53. (27, (63, 1,23–1 123 110 1,10–1 n=53 n5 (n=53 (27 (63 1,23– 11 1,10– n=5 (n=5 (2 (6 1,23 1,10 n= (n= 1,1 (n

ABSTRACT Objective: This study aimed to verify the association between adherence to school meals provided by the National School Feeding Program and dietary patterns in adolescents from Brazilian public schools. Methods: Data from the 2019 National School Health Survey were used, with a nationally representative sample of Brazilian school adolescents (n=53,477; 13–17 years old). Food consumption of healthy and unhealthy food markers was obtained from a food consumption questionnaire. Regular consumption was considered ≥5 times/week. Latent class analysis was used to identify dietary patterns whose association with adherence to school meals was evaluated by multinomial logistic regression models, with adjustment for sociodemographic and eating behavior variables. Results: Three dietary patterns were identified: “unhealthy” — higher consumption of soft drinks and sweets (9.2% of adolescents); “healthy” — higher consumption of beans, vegetables, and fruits (27.1%); and “monotonous” — higher consumption of beans (63.7%). High adherence to school meals (every day) and unsatisfactory adherence (1–4 times/week) were positively associated with the healthy pattern even after adjustment for possible potential confounders (OR 1.37, 95%CI 1.23–1.52; OR 1.20, 95%CI 1.10–1.30, respectively). Conclusion: The results showed that the consumption of school meals offered by the National School Feeding Program can contribute to healthy eating habits among Brazilian adolescents. Objective schools Methods 201 n=53,477 n53477 n 53 477 (n=53,477 1317 13 17 13–1 old. old . old) questionnaire 5 ≥ timesweek times week times/week models variables Results identified “unhealthy 9.2% 92 9 2 (9.2 adolescents) “healthy vegetables 27.1% 271 27 1 (27.1%) monotonous “monotonous 63.7%. 637 63.7% 63 7 (63.7%) every day 1–4 14 4 (1– 137 37 1.37 95CI CI 95 1.23–1.52 123152 23 52 120 20 1.20 110130 10 30 1.10–1.30 respectively. respectively respectively) Conclusion n=53,47 n5347 47 (n=53,47 131 13– 9.2 (9. 27.1 (27.1% 63.7 6 (63.7% 1– (1 3 1.3 1.23–1.5 12315 12 1.2 11013 1.10–1.3 n=53,4 n534 (n=53,4 9. (9 27. (27.1 63. (63.7 ( 1. 1.23–1. 1231 1101 1.10–1. n=53, n53 (n=53, (27. (63. 1.23–1 123 110 1.10–1 n=53 n5 (n=53 (27 (63 1.23– 11 1.10– n=5 (n=5 (2 (6 1.23 1.10 n= (n= 1.1 (n

Objective. Consumption of water may help promote health and prevent obesity in children by decreasing consumption of sugar-sweetened beverages. This study used evidence-based strategies to increase water consumption in Mexican-American and Mexican children. Materials and methods. In 2012, two schools in San Diego, USA and two other in Tlaltizapan, Mexico were recruited to Agua para Niños (Water for Kids), a program designed to promote water consumption among elementary grade students. Guided by operant psychology, the intervention focused on school and classroom activities to encourage water consumption. One control and one intervention school in each country were included. Results. Agua para Niños resulted in increases in observed water consumption and bottle possession among US and Mexican students. Teacher receptivity to the program was very positive in both countries. Conclusions. Agua para Niños yielded sufficiently positive behavioral changes to be used in a future fully randomized design, and to contribute to school nutrition policy changes.

Objetivo. Explorar cómo el consumo de agua proporciona salud y previene la obesidad en los niños al disminuir el consumo de bebidas endulzadas con azúcar, a partir del empleo de estrategias basadas en la evidencia para aumentar el consumo de agua en niños mexicanos y mexicano-estadounidenses. Material y métodos. En 2012, se eligieron dos escuelas en San Diego, EU y otras dos en Tlaltizapán, Morelos, México para implementar el programa Agua para Niños (Water for Kids), diseñado para promover el consumo de agua en los niños de nivel primaria. Bajo el enfoque de la psicología operante, la intervención se centró en las actividades escolares en general y dentro del aula para fomentar el consumo de agua. Resultados. Agua para Niños logró un aumento en el consumo de agua y la utilización personal de una botella con este líquido entre los estudiantes mexicano-estadounidenses y mexicanos. La receptividad del programa por parte de los maestros fue bastante positiva en ambos países. Conclusiones. Agua para Niños produjo cambios conductuales suficientemente positivos, lo que la hace una estrategia que puede utilizarse en futuros estudios aleatorizados que contribuyan a lograr cambios en las políticas escolares de nutrición.

Objective. Consumption of water may help promote health and prevent obesity in children by decreasing consumption of sugar-sweetened beverages. This study used evidence-based strategies to increase water consumption in Mexican-American and Mexican children. Materials and methods. In 2012, two schools in San Diego, USA and two other in Tlaltizapan, Mexico were recruited to Agua para Niños (Water for Kids), a program designed to promote water consumption among elementary grade students. Guided by operant psychology, the intervention focused on school and classroom activities to encourage water consumption. One control and one intervention school in each country were included. Results. Agua para Niños resulted in increases in observed water consumption and bottle possession among US and Mexican students. Teacher receptivity to the program was very positive in both countries. Conclusions. Agua para Niños yielded sufficiently positive behavioral changes to be used in a future fully randomized design, and to contribute to school nutrition policy changes.

Objetivo. Explorar cómo el consumo de agua proporciona salud y previene la obesidad en los niños al disminuir el consumo de bebidas endulzadas con azúcar, a partir del empleo de estrategias basadas en la evidencia para aumentar el consumo de agua en niños mexicanos y mexicano-estadounidenses. Material y métodos. En 2012, se eligieron dos escuelas en San Diego, EU y otras dos en Tlaltizapán, Morelos, México para implementar el programa Agua para Niños (Water for Kids), diseñado para promover el consumo de agua en los niños de nivel primaria. Bajo el enfoque de la psicología operante, la intervención se centró en las actividades escolares en general y dentro del aula para fomentar el consumo de agua. Resultados. Agua para Niños logró un aumento en el consumo de agua y la utilización personal de una botella con este líquido entre los estudiantes mexicano-estadounidenses y mexicanos. La receptividad del programa por parte de los maestros fue bastante positiva en ambos países. Conclusiones. Agua para Niños produjo cambios conductuales suficientemente positivos, lo que la hace una estrategia que puede utilizarse en futuros estudios aleatorizados que contribuyan a lograr cambios en las políticas escolares de nutrición.

Objective. The purpose of the present study was to conduct a systematic literature review of obesity interventions that focused on increasing physical activity and healthy eating among overweight and obese children in Mexico. Materials and methods. Data was taken from a larger literature review focused on obesity interventions for Latinos in Latin America and the United States. Study design suitability, quality of execution, and effect size were assessed for a subset of these articles. Results. There were six intervention studies included in the present review. Five studies showed reductions in obesity-related outcomes, while one study reported gains in body mass index (BMI). Conclusions. Physical activity and healthy eating remain constant components in obesity treatment interventions, which highlights the importance of understanding evidence-based strategies to guide future research to reduce childhood obesity in Mexico.

Objetivo. El propósito del presente estudio fue realizar una revisión sistemática de la literatura en intervenciones relacionadas con la obesidad enfocadas en incrementar la actividad física y alimentación saludable en niños mexicanos con obesidad y sobrepeso. Material y métodos. La información forma parte de una revisión sistemática de la literatura enfocada en intervenciones para prevenir o tratar la obesidad en población latina habitante de Latinoamérica y Estados Unidos. La adecuación del diseño del estudio, la calidad de ejecución y el efecto de la muestra fueron evaluados para una submuestra de estos artículos. Resultados. Se incluyeron seis estudios dentro de la revisión. Cinco estudios encontraron una reducción en los resultados relacionados con la obesidad, mientras que un estudio encontró ganancias en el índice de masa corporal (IMC). Conclusiones. La actividad física y alimentación saludables fueron componentes constantes de las intervenciones para tratamiento de la obesidad. Esto resalta la importancia de entender las estrategias basadas en evidencia para guiar futuras investigaciones en la reducción de la obesidad infantil en México.

Objective. The objective of this systematic literature review was to identify evidence-based strategies associated with effective healthcare interventions for prevention or treatment of childhood obesity in Latin America. Materials and methods. A systematic review of peer-reviewed, obesity-related interventions implemented in the healthcare setting was conducted. Inclusion criteria included: implementation in Latin America, aimed at overweight or obese children and evaluation of at least one obesity-related outcome (e.g., body mass index (BMI), z-score, weight, and waist circumference, and body fat). Results. Five interventions in the healthcare setting targeting obese children in Latin America were identified. All five studies showed significant changes in BMI, and the majority produced sufficient to large effect sizes through emphasizing physical activity and health eating. Conclusion. Despite the limited number of intervention studies that treat obesity in the healthcare setting, there is evidence that interventions in this setting can be effective in creating positive anthropometric changes in overweight and obese children.

Objetivo. El objetivo de esta revisión sistemática de la literatura fue identificar estrategias basadas en evidencia asociadas con intervenciones en salud efectivas para la prevención y el tratamiento de la obesidad infantil en Latinoamérica. Material y métodos. Se realizó una revisión sistemática por pares de intervenciones relacionadas con la obesidad, que fueron llevadas a cabo en clínicas de atención para la salud. Criterios de inclusión: implementadas en Latinoamérica, dirigidas a niños con obesidad y sobrepeso y evaluación de por lo menos un resultado relacionado con obesidad (ej. índice de masa corporal (IMC), puntaje Z, peso, circunferencia de cintura o grasa corporal). Resultados. Se identificaron cinco intervenciones dirigidas a niños obesos en clínicas de salud en Latinoamérica. Todas las intervenciones mostraron cambios significativos en IMC y la mayoría obtuvo un tamaño del efecto grande a través de la promoción de actividad física y alimentación saludable. Conclusión. A pesar del número limitado de estudios de intervención para tratar la obesidad en clínicas de salud, existe evidencia que las intervenciones en estos lugares pueden ser efectivas en alcanzar cambios antropométricos positivos en los niños con obesidad y sobrepeso.

Objective. The objective of this systematic literature review was to identify evidence-based strategies associated with effective healthcare interventions for prevention or treatment of childhood obesity in Latin America. Materials and methods. A systematic review of peer-reviewed, obesity-related interventions implemented in the healthcare setting was conducted. Inclusion criteria included: implementation in Latin America, aimed at overweight or obese children and evaluation of at least one obesity-related outcome (e.g., body mass index (BMI), z-score, weight, and waist circumference, and body fat). Results. Five interventions in the healthcare setting targeting obese children in Latin America were identified. All five studies showed significant changes in BMI, and the majority produced sufficient to large effect sizes through emphasizing physical activity and health eating. Conclusion. Despite the limited number of intervention studies that treat obesity in the healthcare setting, there is evidence that interventions in this setting can be effective in creating positive anthropometric changes in overweight and obese children.

Objetivo. El objetivo de esta revisión sistemática de la literatura fue identificar estrategias basadas en evidencia asociadas con intervenciones en salud efectivas para la prevención y el tratamiento de la obesidad infantil en Latinoamérica. Material y métodos. Se realizó una revisión sistemática por pares de intervenciones relacionadas con la obesidad, que fueron llevadas a cabo en clínicas de atención para la salud. Criterios de inclusión: implementadas en Latinoamérica, dirigidas a niños con obesidad y sobrepeso y evaluación de por lo menos un resultado relacionado con obesidad (ej. índice de masa corporal (IMC), puntaje Z, peso, circunferencia de cintura o grasa corporal). Resultados. Se identificaron cinco intervenciones dirigidas a niños obesos en clínicas de salud en Latinoamérica. Todas las intervenciones mostraron cambios significativos en IMC y la mayoría obtuvo un tamaño del efecto grande a través de la promoción de actividad física y alimentación saludable. Conclusión. A pesar del número limitado de estudios de intervención para tratar la obesidad en clínicas de salud, existe evidencia que las intervenciones en estos lugares pueden ser efectivas en alcanzar cambios antropométricos positivos en los niños con obesidad y sobrepeso.

Objective. The purpose of the present study was to conduct a systematic literature review of obesity interventions that focused on increasing physical activity and healthy eating among overweight and obese children in Mexico. Materials and methods. Data was taken from a larger literature review focused on obesity interventions for Latinos in Latin America and the United States. Study design suitability, quality of execution, and effect size were assessed for a subset of these articles. Results. There were six intervention studies included in the present review. Five studies showed reductions in obesity-related outcomes, while one study reported gains in body mass index (BMI). Conclusions. Physical activity and healthy eating remain constant components in obesity treatment interventions, which highlights the importance of understanding evidence-based strategies to guide future research to reduce childhood obesity in Mexico.

Objetivo. El propósito del presente estudio fue realizar una revisión sistemática de la literatura en intervenciones relacionadas con la obesidad enfocadas en incrementar la actividad física y alimentación saludable en niños mexicanos con obesidad y sobrepeso. Material y métodos. La información forma parte de una revisión sistemática de la literatura enfocada en intervenciones para prevenir o tratar la obesidad en población latina habitante de Latinoamérica y Estados Unidos. La adecuación del diseño del estudio, la calidad de ejecución y el efecto de la muestra fueron evaluados para una submuestra de estos artículos. Resultados. Se incluyeron seis estudios dentro de la revisión. Cinco estudios encontraron una reducción en los resultados relacionados con la obesidad, mientras que un estudio encontró ganancias en el índice de masa corporal (IMC). Conclusiones. La actividad física y alimentación saludables fueron componentes constantes de las intervenciones para tratamiento de la obesidad. Esto resalta la importancia de entender las estrategias basadas en evidencia para guiar futuras investigaciones en la reducción de la obesidad infantil en México.