Avaliação do conteúdo de sal em refeições escolares
Palavras-chave:
Promoção da saúde, Alimentação escolar, Cloreto de sódio, Percepção gustatóriaResumo
Objetivo
Considerando que a pressão arterial elevada constitui um dos maiores fatores de risco para as doenças cardiovasculares e sua associação ao consumo elevado de sal, bem como o fato de as escolas serem considerados ambientes de excelência para fomentar a aquisição de bons hábitos alimentares e promover a saúde, o objetivo deste estudo foi avaliar o conteúdo de sal presente nas refeições escolares e a percepção dos consumidores sobre o sabor salgado.
Métodos
Foram recolhidas refeições nas cantinas das escolas, analisando-se todos os seus componentes (pão, sopa e prato principal). A quantificação de sal foi realizada com um medidor de sal portátil. Para a avaliar a percepção dos consumidores foi desenvolvido e aplicado um questionário aos alunos das escolas preparatórias e secundárias.
Resultados
Foram analisados 798 componentes de refeições. O pão apresentou o valor mais elevado de sal, com média de 1,35 g/100 g (SD=0.12). O conteúdo de sal nas sopas apresentou média de 0,72 g/100 g a 0,80 g/100 g (p=0,05) e, nos pratos principais, de 0,71 g/100 a 0,97 g/100 g (p=0,05). Em média, as refeições escolares disponibilizaram entre 2,83 e 3,82 g de sal por porção servida, o que representa de duas a cinco vezes mais em relação à dose diária recomendada para crianças e jovens. Para a maioria dos estudantes, o sabor das refeições foi percebido como sendo nem salgado nem insosso, o que parece demonstrar adaptação à intensidade/quantidade de sal consumida.
Conclusão
Escolhas alimentares saudáveis e adequadas só são possíveis se sustentadas por um ambiente que as facilite. Considerando o impacto que o consumo de sal tem na saúde, em particular nas doenças crônicas, a implementação de estratégias de redução de sal - nas indústrias, serviços de catering e restaurantes -, é imperativa, em particular direcionada para o público mais jovem.
Referências
World Health Organization, Food and Agriculture Organization. Diet nutrition and the prevention of chronic diseases; 2003 [cited 2008 Apr 12]. Available from: http://whqlibdoc.who.int/trs/ who_trs_916.pdf
World Health Organization. The european health report 2002: WHO regional publications. Copenhagen: WHO; 2002 [cited 2008 Apr 12]. Available from: http://www.euro.who.int/__data/ assets/pdf_file/0007/98296/E76907.pdf
World Health Organization. Deaths from CVD and diabetes. Geneva: WHO; 2012 [cited 2012 Oct 23]. Available from: http://www.who.int/gho/ncd/ mortality_morbidity/cvd/en/index.html
Beaglehole R, Ebrahim S, Reddy S, Voute J, Leeder S, Chronic Disease Action Group. Prevention of chronic diseases: A call to action. Lancet. 2008; 370(9605):2152-7.
World Health Organization. Global health risks: Mortality and burden of disease attributable to selected major risks. Geneva: WHO; 2009 [cited 2012 Oct 1]. Available from: http://www.who.int/ healthinfo/global_burden_disease/GlobalHealth Risks_report_full.pdf
Polónia J, Maldonado J, Ramos R, Bertoquini S, Duro M, Almeida C, et al. Estimation of salt intake by urinary sodium excretion in a portuguese adult population and its relationship to arterial stiffness. Rev Port Cardiol. 2006; 25(9):801-17.
Instituto Nacional de Estatística. Dados Estatísticos. Lisboa: Instituto Nacional de Estatística; 2011 [acesso 2012 nov 11]. Disponível em: http:// www.ine.pt/xportal/xmain?xpid=INE&xpgid= ine_base_dados
Espiga M, Macedo MJL, Silva AO, Alcântara P, Ramalhinho V, Carmona J. Prevalência, conheci mento, tratamento e controlo da hipertensão em portugal. Estudo PAP [2]. Rev Port Cardiol. 2007; 26(1):21-39.
Forte JG, Miguel JM, Miguel MJ, Pádua F, Rose G. Salt and blood pressure: A community trial. J Hum Hypertens. 1989; 3(3):179-84.
Stamler J. The INTERSALT study: Background, methods, findings, and implications. Am J Clin Nutr. 1997; 65(2 Suppl):626S-42S.
Elliott P, Walker LL, Little MP, Blair-West JR, Shade RE, Lee DR, et al. Change in salt intake affects blood pressure of chimpanzees: Implications for humanpopulations. Circulation. 2007; 116(14):1563-8. http://dx.doi.org/10.1161/CIRCULATIONAHA.10 6.675579
Denton D, Weisinger R, Mundy NI, Wickings EJ, Dixson A, Moisson P, et al. The effect of increased salt intake on blood pressure of chimpanzees. Nat Med. 1995; 1(10):1009-16.
Vollmer WM, Sacks FM, Svetkey LP. New insights into the effects on blood pressure of diets low in salt and high in fruits and vegetables and low-fat dairy products. Curr Control Trials Cardiovasc Med. 2001; 2(2):71-4.
Shay CM, Stamler J, Dyer AR, Brown IJ, Chan Q, Elliott P, et al. Nutrient and food intakes of middle aged adults at low risk of cardiovascular disease: The international study of macro-/micronutrients and blood pressure (INTERMAP). Eur J Nutr. 2011; 51(8):917-26. http://dx.doi.org/10.1007/s00394-0 11-0268-2
Cook NR, Cutler JA, Obarzanek E, Buring JE, Rexrode KM, Kumanyika SK, et al. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: Observational follow-up of the Trials of Hypertension Prevention (TOHP). BMJ. 2007; 334(7599):885-8. http://dx.doi.org/10.1 136/bmj.39147.604896.55
Khaw KT, Bingham S, Welch A, Luben R, O’Brien E, Wareham N, et al. Blood pressure and urinary sodium in men and women: The norfolk cohort of the european prospective investigation into cancer (epic-norfolk). Am J Clin Nutr. 2004; 80(5):1397-403.
Tuomilehto J, Jousilahti P, Rastenyte D, Moltchanov V, Tanskanen A, Pietinen P, et al. Urinary sodium excretion and cardiovascular mortality in finland: A prospective study. Lancet. 2001; 357(9259): 848-51. http://dx.doi.org/10.1016/S0140-6736 (00)04199-4
Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium collaborative research group. N Engl J Med. 2001; 344(1):3-10. http://dx.doi.org/ 10.1056/NEJM200 101043440101
MacGregor GA, Markandu ND, Sagnella GA, Singer DR, Cappuccio FP. Double-blind study of three sodium intakes and long-term effects of sodium restriction in essential hypertension. Lancet. 1989; 2(8674):1244-7.
He FJ, Marrero NM, Macgregor GA. Salt and blood pressure in children and adolescents. J Hum Hypertens. 2008; 22(1):4-11. http://dx.doi.org/ 10.1038/sj.jhh.1002268
Geleijnse JM, Hofman A, Witteman JC, Hazebroek AA, Valkenburg HA, Grobbee DE. Long-term effects of neonatal sodium restriction on blood pressure. Hypertension. 1997; 29(4):913-7.
Frisoli TM, Schmieder RE, Grodzicki T, Messerli FH. Salt and hypertension: Is salt dietary reduction worth the effort? Am J Med. 2012; 125(5):433-9. http://dx.doi.org/10.1016/j.amjmed.2011.10.023
Webster J, Dunford E, Huxley R, Li N, Nowson CA, Neal B. The development of a national salt reduction strategy for Australia. Asia Pac J Clin Nutr. 2009; 18(3):303-9.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: Analysis of worldwide data. Lancet. 2005; 365(9455):217-23. http://dx.doi.org/10.1016/ S0140-6736(05)17741-1
Kawada T, Suzuki S. Attention of salt awareness to prevent hypertension in the young. J Clin Hypertens. 2011; 13(12):933-4. http://dx.doi.org/ 10.1111/j.1751-7176.2011.00555.x
Spagnolo A, Giussani M, Ambruzzi AM, Bianchetti M, Maringhini S, Matteucci MC, et al. Focus on prevention, diagnosis and treatment of hypertension in children and adolescents. Ital J Pediatr. 2013; 39:20. http://dx.doi.org/10.1186/ 1824-7288-39-20
Freeman DA, Petitti DB. Commentary: Salt, blood pressure and public policy. Int J Epidemiol. 2002; 31(2):319-20.
Dötsch M, Busch J, Batenburg M, Liem G, Tareilus E, Mueller R, et al. Strategies to reduce sodium consumption: A food industry perspective. Crit Rev Food Sci Nutr. 2009; 49(10):841-51. http://dx. doi.org/10.1080/10408390903044297
Morris MJ, Na ES, Johnson AK. Salt craving: The psychobiology of pathogenic sodium intake. Physiol Behav. 2008; 94(5):709-21. http://dx.doi.org/ 10.1016/j.physbeh.2008.04.008 30. Food and Nutrition Board, Institute of Medicine, National Academies. Dietary Reference Intakes (DRIs): Estimated Average Requirements. Washington (DC): Institute of Medicine [cited 2012 Nov 11]. Available from: http://www.iom.edu/ Activities/Nutrition/SummaryDRIs/~/media/Files/ Activity%20Files/Nutrition/DRIs/5_Summary %20Table%20Tables%201-4.pdf
Food Safety Authority of Ireland. Salt and health: Review of the scientific evidence and recommendations for public policy in Ireland. Dublin: Food Safety Authority of Ireland; 2005 [cited 2007 May 11]. Available from: http:// www.fsai.ie/uploadedFiles/Science_and_Health/ salt_report-1.pdf
Stokols D. Establishing and maintaining healthy environments. Toward a social ecology of health promotion. Am Psychol. 1992; 47(1):6-22.
Hill JO. Understanding and addressing the epidemic of obesity: An energy balance perspective. Endocr Rev. 2006; 27(7):750-61. http://dx.doi.org/10.12 10/er.2006-0032
Hill O. Environmental contributions to the obesity epidemic. Science. 1998; 280(5368):1371-4. http:// dx.doi.org/10.1126/science.280.5368.1371
World Health Organization. Promoting health through schools: Report of a Who Expert Committee on Comprehensive School Health Education and Promotion. Geneva: WHO; 1997 [cited 2008 Apr 12]. Available from: http:// whqlibdoc.who.int/trs/WHO_TRS_870.pdf
Gross SM, Cinelli B. Coordinated school health program and dietetics professionals: Partners in promoting healthful eating. J Am Diet Assoc. 2004; 104(5):793-8. http://dx.doi.org/10.1016/j.jada. 2004.02.024
ATAGO. Products/Digital Salt-meter-saltmeter, PAL ES2, PAL-ES3, ES-421. Japão: ATAGO; 2012 [cited 2012 Nov 14]. Available from http://www.atago. net/english/products_salt.php
Krouwer JS, Monti KL. A simple, graphical method to evaluate laboratory assays. Eur J Clin Chem Clin Biochem. 1995; 33(8):525-28.
Altman DG, Bland JM. Measurement in medicine: The analysis of method comparison studies. The Statistician. 1983; 32:307-17.
Olstad DL, Downs SM, Raine KD, Berry TR, McCargar LJ. Improving children’s nutrition environments: A survey of adoption and implementation of nutrition guidelines in recreational facilities. BMC Public Health. 2011; 11:423. http://dx.doi.org/10.1186/ 1471-2458-11-423.
Timperio A, Ball K, Roberts R, Campbell K, Andrianopoulos N, Crawford D. Children’s fruit and vegetable intake: Associations with the neighbourhood food environment. Prev Med. 2008; 46(4):331-5. http://dx.doi.org/10.1016/ j.ypmed.2007.11.011
Pettinger C, Holdsworth M, Gerber M. Meal patterns and cooking practices in southern france and central england. Public Health Nutr. 2007; 9(08):1020-6. http://dx.doi.org/10.1017/PHN2006 945
Venables WN, Smith DM, Core Team R. An introduction to R: Notes on R: A programming environment for data analysis and graphics. Wien: Wirtschaftsuniversität Wien; 2008.
He FJ, MacGregor GA. Importance of salt in determining blood pressure in children: Meta analysis of controlled trials. Hypertension. 2006; 48(5):861-9. http://dx.doi.org/10.1161/01.HYP.00 00245672.27270.4a
Conselho Nacional de Alimentação e Nutrição. Recomendações para a educação alimentar da população portuguesa. Lisboa: Instituto Nacional de Saúde Dr. Ricardo Jorge; 1997.
Cruz JAA, Pereira A, Miguel JMP, Conselho Nacional de Alimentação e Nutrição. Contribuição para uma política alimentar e nutricional em portugal: situação alimentar e nutricional portuguesa, reco mendações do CNAN para a melhoria da situação existente. Lisboa: Conselho Nacional de Alimen tação e Nutrição; 1989.
He FJ, Markandu ND, MacGregor GA. Modest salt reduction lowers blood pressure in isolated systolic hypertension and combined hypertension. Hypertension. 2005; 46(1):66-70. http://dx.doi.org/ 10.1161/01.HYP.0000171474.84969.7a
He FJ, MacGregor GA. How far should salt intake be reduced? Hypertension. 2003; 42(6):1093-9. http://dx.doi.org/10.1161/01.HYP.000010286 4.05174.E8
Hoption Cann SA. Salt in food. Lancet. 2005; 365(9462):845-6. http://dx.doi.org/10.1016/S0 140-6736(05)71038-2
Sellen DW. Evolution of infant and young child feeding: Implications for contemporary public health. Annu Rev Nutr. 2007; 27:123-48. http:// dx.doi.org/10.1146/annurev.nutr.25.050304.0 92557
van Trijp HC, van der Lans IA. Consumer perceptions of nutrition and health claims. Appetite. 2007; 48(3):305-24. http://dx.doi.org/10.1016/j.appet.20 06.09.011
Cowburn G, Stockley L. Consumer understanding and use of nutrition labelling: A systematic review. Public Health Nutr. 2005; 8(1):21-8. http://dx. doi.org/10.1079/PHN2004666
Lai Yeung WL. Gender perspectives on adolescent eating behaviors: A study on the eating attitudes and behaviors of junior secondary students in hong kong. J Nutr Educ Behav. 2010; 42(4):250-8. http:// dx.doi.org/10.1016/j.jneb.2009.05.008
Clark JE. Taste and flavour: Their importance in food choice and acceptance. Proc Nutr Soc. 1998; 57(4):639-43.
Shannon C, Story M, Fulkerson JA, French SA. Factors in the school cafeteria influencing food choices by high school students. J Sch Health. 2002; 72(6):229-34.
Croll JK, Neumark-Sztainer D, Story M. Healthy eating: What does it mean to adolescents? J Nutr Educ. 2001; 33(4):193-8.
Story M, Kaphingst KM, Robinson-O’Brien R, Glanz K. Creating healthy food and eating environments: Policy and environmental approaches. Annu Rev Public Health. 2008; 29:253-72. http://dx.doi.org/ 10.1146/annurev.publhealth.29.020907.090926
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2023 Cláudia Alexandra Colaço Lourenço VIEGAS, Jorge TORGAL, Pedro GRAÇA, Maria do Rosário Oliveira MARTINS
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.