Absence of symbolic and sustainable aspects in recommendations for healthy eating: a qualitative analysis of food-based dietary guidelines
Palavras-chave:Culture, Diet, food, and nutrition, Food guide, Food habits, Sustainable development
Was analyzed the contents of the main messages of food-based dietary guidelines to promote healthy eating, identifying nutritional, symbolic, and sustainable recommendations.
Food-based dietary guidelines from 90 different countries were analyzed. These guidelines were selected from the United Nations Food and Agriculture Organization database. For data extraction, all messages were exported to the Nvivo software and, after repeated readings, were grouped into predefined categories and corresponding dimensions based on the literature. The categories were created according to the mixed model, that is, they were created before data analysis was performed, but modified if necessary.
Was identified 1,982 messages grouped into the following dimensions: nutritional (n=73.9%); sustainable (3.2%); symbolic (3.3%), and others (19.7%). All food-based dietary guidelines addressed nutritional aspects, and the most frequent recommendation was regarding the consumption of fats, followed by the consumption of salt and vegetables and fruits, cited by at least 75 food-based dietary guidelines. Less than half (n=40) of the food-based dietary guidelines addressed sustainable or symbolic aspects of food and 13 of the food-based dietary guidelines addressed both aspects. However, these messages represented only 6.5% of the total messages in the documents.
The recommendations for healthy eating in the food-based dietary guidelines are incipient in terms of sustainable and symbolic issues. Recommendations for adopting healthy diets need to consider the completeness of the food and its various combinations, dietary patterns, and the factors associated with their consumption, as well as the individual’s relations with food, environment, and society.
Frison EA; IPES-Food. From uniformity to diversity: a paradigm shift from industrial agriculture to diversified agroecological systems. Louvain-la-Neuve (Belgium): IPES; 2016.
Thomas K, Karl-Heinz E, Helmut H. Rapid growth in agricultural trade: effects on global area efficiency and the role of management. Environ Res Lett. 2014;9:034015. https://doi.org/10.1088/1748-9326/9/3/034015
Poulain JP. Sociologia da alimentação: os comedores e o espaço social alimentar. Florianópolis: EDUFSC; 2012.
Food and Agriculture Organization. Sustainable diets and biodiversity. Rome (Italy): Food; 2010.
Popkin BM. Relationship between shifts in food system dynamics and acceleration of the global nutrition transition. Nutr Rev. 2017;75:73-82. https://doi.org/10.1093/nutrit/nuw064
Imamura F, Micha R, Khatibzadeh S, Fahimi S, Shi P, Powles J, et al. Dietary quality among men and women in 187 countries in 1990 and 2010: a systematic assessment. Lancet Glob Health. 2015;3:e132-42. https://doi.org/10.1016/s2214-109x(14)70381-x
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.
Johnston JL, Fanzo JC, Cogill B. Understanding sustainable diets: a descriptive analysis of the determinants and processes that influence diets and their impact on health, food security, and environmental sustainability. Adv Nutr. 2014;5:418-29. https://doi.org/10.3945/an.113.005553
Nogueira JP, Hatjiathanassiadou M, Souza SRG, Strasburg VJ, Rolim PM, Seabra LMJ. Sustainable perspective in public educational institutions restaurants: from foodstuffs purchase to meal offer. Sustainability (Switzerland). 2020;12:4340.
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
Auestad N, Fulgoni III, VL. What current literature tells us about sustainable diets: Emerging research linking dietary patterns, environmental sustainability, and economics. Adv Nutr. 2015;6:19-36. https://doi.org/10.3945/an.114.005694
Meybeck A, Gitz V. Sustainable diets within sustainable food systems. Proc Nutr Soc. 2017;76:1-11. https://doi.org/10.1017/S0029665116000653
Menal-Puey S, Marques-Lopes I. Development of criteria for incorporating occasionally consumed foods into a national dietary guideline: a practical approach adapted to the spanish population. Nutrients. 2019;11(1):458. https://doi.org/10.3390/nu11010058
Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, Bogard JR, et al. The global syndemic of obesity, undernutrition, and climate change. Lancet. 2019;393:791-846. https://doi.org/10.1016/S0140-6736(18)32822-8
Hawkes C, Popkin BM. Can the sustainable development goals reduce the burden of nutrition-related noncommunicable diseases without truly addressing major food system reforms? BMC Med. 2015;13:143. https://doi.org/10.1186/s12916-015-0383-7
Fardet A, Rock E. Perspective: reductionist nutrition research has meaning only within the framework of holistic and ethical thinking. Adv Nutr. 2018;9:655-70. https://doi.org/10.1093/advances/nmy044
Menezes MFG, Maldonado LA. Do nutricionismo à comida: a culinária como estratégia metodológica de educação alimentar e nutricional. Rev Hosp Univ Pedro Ernesto. 2015;14(3):82-90. https://doi.org/https://doi.org/10.12957/rhupe.2015.19950
Scrinis G. On the ideology of nutritionism. London: Bloomsbury Academic; 2014.
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
Jennings HM, Thompson JL, Merrell J, Bogin B, Heinrich M. Food, home and health: the meanings of food amongst Bengali women in London. J Ethnobiol Ethnomed. 2014;10:44. https://doi.org/10.1186/1746-4269-10-44
Jacobs Jr DR, Tapsell LC. Food, not nutrients, is the fundamental unit in nutrition. Nutr Rev. 2007;65:439-50. https://doi.org/10.1111/j.1753-4887.2007.tb00269.x
Gil Á, Ruiz-López MD, Fernández-González M, Victoria EM. The finut healthy lifestyles guide: beyond the food pyramid. Nutr Hosp. 2015;31:2313-23. https://doi.org/10.3305/nh.2015.31.5.8803
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
Sachs I. Desenvolvimento: includente, sustentável, sustentado. Rio de Janeiro: Garamond; 2004.
Food and Agriculture Organization. Food-based dietary guidelines. Rome: Organization; 2020 [cited 2020 Aug 2]. Available from: http://www.fao.org/nutrition/education/food-dietary-guidelines/background/en/
Martins KA, Freire MCM. Guias alimentares para populações: aspectos históricos e conceituais. Brasília Méd. 2008;45(4):291-302.
Freire MCM, Balbo PL, Amador MA, Sardinha LMV. Guias alimentares para a população brasileira: implicações para a Política Nacional de Saúde Bucal. Cad Saúde Pública. 2012;28(Suppl):s20-s9. https://doi.org/10.1590/S0102-311X2012001300004
Food and Agriculture Organization. Food-based dietary guidelines. Rome: Organization; 2020 [cited 2020 Sept 5]. Available from: http://www.fao.org/nutrition/education/food-dietary-guidelines/home/en/.
Food and Agriculture Organization. Plates, pyramids, planet: developments in national healthy and sustainable dietary guidelines: a state of play assessment. Rome: Organization; 2016.
Montagnese C, Santarpia L, Buonifacio M, Nardelli A, Caldara AR, Silvestri E, et al. European food-based dietary guidelines: a comparison and update. Nutrition. 2015;31:908-15. https://doi.org/10.1016/j.nut.2015.01.002
Herforth A, Arimond M, Álvarez-Sánchez C, Coates J, Christianson K, Muehlhoff E. A global review of food-based dietary guidelines. Adv Nutr. 2019;10:590-605. https://doi.org/10.1093/advances/nmy130
Rizk MT, Treat TA. Perceptions of food healthiness among free-living women. Appetite. 2015;95:390-8. https://doi.org/10.1016/j.appet.2015.08.003
Food and Agriculture Organization. Food-based dietary guidelines. Rome: Organization; 2017 [cited 2017 Mar 2]. Available from: http://www.fao.org/nutrition/education/food-based-dietary-guidelines/en/
Ferrari R. Writing narrative style literature reviews. Medical Writ. 2015;24:230-5. https://doi.org/10.1179/2047480615Z.000000000329
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
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
World Health Organization. Healthy diet: fact sheet n°394 updated august 2018. Rome: Organization; 2018.
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
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
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
Belloir C, Neiers F, Briand L. Sweeteners and sweetness enhancers. Curr Opin Clin Nutr Metab Care. 2017;20:279-85.
Proença RPC, Sousa AA, Veiros MB, Hering B. Qualidade nutricional e sensorial na produção de refeições. Santa Catarina: Universidade Federal de Santa Catarina; 2005.
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
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
Ministério da Saúde (Brasil). Guia alimentar para a população brasileira: promovendo a alimentação saudável. Brasília: Ministério; 2006.
Montanari M. Food is culture. New York: Columbia University Press; 2006.
Brillat-Savarin J-A. A fisiologia do gosto. São Paulo: Cia das Letras; 1995.
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
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
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
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
United Nations. Transforming our world: the 2030 Agenda for Sustainable Development: General Assembley 70 session. New York: Department of Economic and Social Affairs; 2015.
Food and Agriculture Organization. Agroecology knowledge hub: overview. Rome: Organization; 2020 [cited 2020 May 22]. Available from: http://www.fao.org/agroecology/overview/en/
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.
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 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.
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
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
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
Altieri MA, Nicholls CI, Henao A, Lana MA. Agroecology and the design of climate change-resilient farming systems. Agron Sustain Dev. 2015;35:869-90. https://doi.org/10.1007/s13593-015-0285-2
Brunori G, Galli F, Barjolle D, Van Broekhuizen R, Colombo L, Giampietro M, et al. Are local food chains more sustainable than global food chains? Considerations for assessment. Sustainability. 2016;8:1-27. https://doi.org/10.3390/su8050449
Shukla PR, Skea J, Calvo Buendia E, Masson-Delmotte V, Pörtner H-O, Roberts DC, et al. IPCC: Climate Change and Land: an IPCC special report on climate change, desertification, land degradation, sustainable land management, food security, and greenhouse gas fluxes in terrestrial ecosystems. Geneva: Intergovernmental Panel on Climate Change; ©2019.
Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277-88. https://doi.org/10.1177/1049732305276687
QSR International. NVivo: version 11. Melbourne: QSR International; 2015 [cited 2020. Aug 5]. Available from: https://www.qsrinternational.com/nvivo-qualitative-data-analysis-software/home
Buckton CH, Lean ME, Combet E. Language is the source of misunderstandings: impact of terminology on public perceptions of health promotion messages. BMC Public Health. 2015;15:579. https://doi.org/10.1186/s12889-015-1884-1
King JC. An evidence-based approach for establishing dietary guidelines. J Nutr. 2007;137:480-3. https://doi.org/10.1093/jn/137.2.480
Bosi MLM. A nutriçäo na concepçäo científica moderna: em busca de um novo paradigma. Rev Nutr. 1994:32-47.
Bisogni CA, Jastran M, Seligson M, Thompson A. How people interpret healthy eating: contributions of qualitative research. J Nutr Educ Behav. 2012;44:282-301. https://doi.org/https://doi.org/10.1016/j.jneb.2011.11.009
Perignon M, Masset G, Ferrari G, Barré T, Vieux F, Maillot M, et al. How low can dietary greenhouse gas emissions be reduced without impairing nutritional adequacy, affordability and acceptability of the diet? A modelling study to guide sustainable food choices. Public Health Nutr. 2016;19:2662-74. https://doi.org/10.1017/s1368980016000653
Girardi MW, Fabri RK, Bianchini VU, Martinelli SS, Cavalli SB. Oferta de preparações culinárias e alimentos regionais e da sociobiodiversidade na alimentação escolar: um estudo na Região Sul do Brasil. Segur Alim Nutr. 2018;25. https://doi.org/10.20396/san.v25i3.8652261
Food and Agriculture Organization. Family farming and sustainable development at the CPLP. Portugal: Organizaton; 2019.
Aschemann-Witzel J. Consumer perception and trends about health and sustainability: trade-offs and synergies of two pivotal issues. Curr Opin Food Sci. 2015;3:6-10. https://doi.org/https://doi.org/10.1016/j.cofs.2014.08.002
Brink E, Van Rossum C, Postma-Smeets A, Stafleu A, Wolvers D, Van Dooren C, et al. Development of healthy and sustainable food-based dietary guidelines for the Netherlands. Public Health Nutr. 2019;22:2419-35. https://doi.org/10.1017/S1368980019001435
Feil AA, Cyrne CCS, Sindelar FCW, Barden JE, Dalmoro M. Profiles of sustainable food consumption: Consumer behavior toward organic food in southern region of Brazil. J Clean Prod. 2020;258:120690. https://doi.org/https://doi.org/10.1016/j.jclepro.2020.120690
Verbeke W, Guerrero L, Almli VL, Vanhonacker F, Hersleth M. European consumers’ definition and perception of traditional foods. In: Kristbergsson K, Oliveira J, editors. Traditional foods: general and consumer aspects. Boston: Springer; 2016.
Oliveira MSS, Santos LA. Guias alimentares para a população brasileira: uma análise a partir das dimensões culturais e sociais da alimentação. Ciênc Saúde Coletiva. 2018.
Ministério da Saúde (Brasil). Guia Alimentar para a população brasileira. 2a. ed. Brasília: Ministério; 2014.
Martinelli SS, Cavalli SB. Alimentação saudável e sustentável: uma revisão narrativa sobre desafios e perspectivas. Ciênc Saúde Coletiva. 2019;24:4251-62.
Copyright (c) 2022 Rafaela Karen FABRI, Suellen Secchi MARTINELLI, Maria Angela PERITO, Andrea FANTINI, Suzi Barletto CAVALLI
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.