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- Childhood Obesity Surveillance Initiative: COSI Portugal 2022Publication . Rito, Ana; Mendes, Sofia; Figueira, Inês; Faria, Maria do Carmo; Carvalho, Rita; Santos, Teresa; Cardoso, Susana; Feliciano, Elsa; Silvério, Rosa; Sancho, Teresa Sofia; Dinis, Ana; Rascôa, Carla Lacerda; Batista, Catarina; Cruz, Rachel; Marques, CarlaO Childhood Obesity Surveillance Initiative (COSI)/Organização Mundial da Saúde (OMS) é o sistema europeu de vigilância nutricional infantil coordenado pelo Gabinete Regional Europeu da OMS. Tem como principal objetivo criar uma rede sistemática de recolha, análise, interpretação e divulgação de informação descritiva sobre as caraterísticas do estado nutricional infantil de crianças dos 6 aos 8 anos, que se traduz num sistema de vigilância que produz dados comparáveis entre países da Europa e que permite a monitorização da obesidade infantil a cada 2-3 anos. O presente relatório divulga e analisa os dados de prevalência de excesso e obesidade infantil da 6.ª ronda do COSI Portugal, realizada no ano letivo 2021/2022 numa amostra representativa nacional de escolas públicas do 1.º ciclo do Ensino Básico (EB) português.
- Childhood Obesity Surveillance Initiative: COSI Portugal 2019Publication . Rito, Ana; Mendes, Sofia; Baleia, Joana; Gregório, Maria JoãoO Childhood Obesity Surveillance Initiative (COSI)/Organização Mundial da Saúde (OMS) é o sistema europeu de vigilância nutricional infantil coordenado pelo Gabinete Regional Europeu da OMS. Tem como principal objetivo criar uma rede sistemática de recolha, análise, interpretação e divulgação de informação descritiva sobre as caraterísticas do estado nutricional infantil de crianças dos 6 aos 8 anos, que se traduz num sistema de vigilância que produz dados comparáveis entre países da Europa e que permite a monitorização da obesidade infantil a cada 2-3 anos. O presente relatório divulga e analisa, em detalhe, os resultados da 5ª ronda do Sistema Nacional de Vigilância Nutricional Infantil – COSI Portugal, que decorreu maioritariamente no ano de 2019 e tem como objetivo principal caracterizar o estado nutricional infantil das crianças portuguesas dos 6 aos 8 anos de uma amostra representativa das escolas do 1º Ciclo do Ensino Básico das sete regiões de Portugal.
- Avaliação da qualidade proteica de alimentos de origem vegetal consumidos em PortugalPublication . Diniz, Dalila; Tavares, Nelson; Motta, CarlaCom base no crescimento das preocupações com a sustentabilidade ambiental e alimentar associada à saúde, verifica-se uma mudança recente e gradual do paradigma alimentar português. De acordo com a Pesquisa Nacional de Alimentação, Nutrição e Atividade Física, aumentaram as opções de alimentação vegetariana como alternativa ao consumo de produtos de origem animal. Objetivo: Este estudo visa definir a qualidade proteica de 58 diferentes alimentos de origem vegetal pertencentes a seis grupos nutricionais distintos, consumidos pela população portuguesa. Para isso, foi realizada a análise das proteínas e do perfil de aminoácidos, mais especificamente dos aminoácidos essenciais. Material e Métodos: A amostra do estudo foi organizada por grupos nutricionais, a saber, cereais e tubérculos, hortícolas, frutas, leguminosas, substitutos de proteína animal e algas. O perfil de aminoácidos foi determinado por cromatografia líquida de ultra-eficiência com detetor de foto-diodos (UPLC / PDA). A quantificação dos aminoácidos essenciais foi realizada para avaliar a qualidade da proteína de cada amostra. O score dos aminoácidos de cada grupo nutricional foi calculado com base nas porções de ingestão recomendadas, de acordo com a roda dos alimentos, base de referência na alimentação portuguesa. Resultados: Os scores dos grupos de alimentos analisados apresentam alta variabilidade nos diferentes aminoácidos. Em relação a todos os aminoácidos essenciais, a histidina apresenta os níveis mais elevados, especialmente em frutas, como banana e manga (pontuações entre 6 e 2) e cereais, como arroz (pontuação > 1,6). Comparando os scores nos grupos de alimentos testados, observamos uma tendência semelhante. Os aminoácidos aromáticos e a histidina apresentam scores superiores a 1 em todos os grupos de alimentos, enquanto a lisina, valina, isoleucina e leucina apresentaram scores inferiores a 1, representando, dessa forma, os aminoácidos limitantes nos vegetais. Conclusões: Os resultados obtidos demonstram a importância de uma ingestão variada, mas corretamente ponderada, de alimentos de diferentes grupos nutricionais. Para garantir a 12 complementaridade dos níveis diários de proteína, uma combinação de diferentes grupos alimentares, como por exemplo cereais e leguminosas, deve ser levada em consideração. A combinação correta de porções de diferentes grupos nutricionais pode ser uma forma eficaz de obter os aminoácidos essenciais necessários para uma alimentação equilibrada.
- HBM4EU - Deliverable Report D 5.5: Human biomonitoring in risk assessment: 2nd set of examples on the use of HBM in risk assessments of HBM4EU priority chemicalsPublication . Santonen, Tiina; Mahiout, Selma; Bessems, J.; Buekers, J.; Baken, K.; Schoeters, G.; Woutersen, M.; Vermeire, T.; Bil, W.; Ougier, E.; Rousselle, C.; Šömen Joksić, A.; Kirinčič, S.; Louro, Henriqueta; Silva, Maria João; Assunção, Ricardo; Vinggaard, A. M.; Viegas, S.; Huuskonen, P.; Porras, S.; Kiilunen, M.; Uhl, M.; Hartmann, C.; Hauzenberger, I.; Losert, A.; Tratnik, J. Snoj; Horvat, M.; Schaddelee-Scholten, B.; Buist, H.; Westerhout, J.; Fletcher, T.; Rauscher-Gabernig, E.; Plichta, V.; Abraham, K.; Borges, T.; Kadikis, N.The aim of this work was to exemplify the inclusion of human biomonitoring (HBM) data in risk assessment (RA) and health impact assessment (HIA) strategies. RA was performed for six compound groups on HBM4EU’s first list of priority substances: anilines, cadmium/chromium, flame retardants, PAHs, PFAS and phthalates. In addition, burden of disease (BoD) calculations were made for cadmium. The general approach used included: 1) identification of an existing RA for the substance, 2) identification of possible existing biological limit or guidance values or biological equivalents (BEs), or if lacking, existing health based limit values for external exposure, 3) identification of relevant biomonitoring data to be used in the RA, 4) in case no existing biological limit or guidance values or BEs existed, identification of approaches for reverse/forward calculation, including the use of PBPK modelling or calculation of BE values based on one-compartment modelling, 5) RA or BoD calculation based on HBM data, 6) analysing the benefits and challenges of using HBM data in RA compared to the use of external exposure data. The overall result of the work was that HBM can be included in RA even when relatively few data are available, and its inclusion generally benefits the RA. Several methods exist, and a tiered approach is suggested, based on the amount and quality of data available. The recommended 1st tier method is a one-compartment modelling based derivation of BE values or reverse calculation of external exposure based on biomarker levels. This approach is simple and rough, and uses only very basic parameters. However, in many cases this approach can be considered sufficient, especially when conservative assumptions have been used for the FUE, and the calculated RCRs remain well below 1, indicating a low risk. Also, in cases in which risk assessment using this approach supports the RA made based on external exposure estimates, it is often a sufficient approach. Nevertheless, in some cases e.g. where the RCR is close to 1, a more detailed approach may be needed to refine the RA. For the 2nd tier, PBPK modelling is recommended. For the most robust, 3rd tier approach, measured data on correlations between external exposure and internal doses from well controlled studies would be needed. Certain cases were identified where inclusion of HBM would be particularly important for performing RA: for compounds, for which several exposure routes may contribute to the body burden and the health effects, as HBM reflects the total body burden, and cumulative compounds. For cumulative compounds, HBM could also be useful for hazard assessment in addition to exposure assessment. One of the major challenges for the inclusion of HBM into RA is the often limited data available on toxicokinetics. In addition, in some cases, there is an urgent need for more specific biomarkers or more sensitive analytic methods than currently available. It should be noted that these risk assessments were performed purely to determine how HBM data can contribute to the risk assessment of chemicals, and they have no regulatory implications. Overall for the substances on the HBM4EU’s first list of priority substances, more HBM data are needed. This work is ongoing in WP8, and the RAs presented here will be updated when new data become available.
- Pilot study: Reduction of salt (sodium) in bread and its contribution to the decrease of cardiovascular diseases Health Impact Assessment of the introduction of new legislation - Terms of referencePublication . Caldas de Almeida, Teresa; Costa, Luciana; Costa, Alexandra; Santos, Joana; Braz, Paula; Coelho, Mariana; Brazão, Roberto; Assunção, Ricardo; Alves, Joana; Lopes, Isabel; Guerreiro, Ana CristinaIntroduction: The Health Impact Assessment (HIA) is a combination of essential procedures, methods, and tools to assess the potential effects of policies, programs or projects on the health of a population, contributing to the decision making for health protection and equity. Within the scope of the Biennial Collaborative Agreement (BCA) between the World Health Organization (WHO) and the Ministry of Health, the Health Impact Assessment Workshop was held in November 2017 at National Institute of Health Dr. Ricardo Jorge (INSA, I.P.). This workshop presented the methodologies of health impact studies, as well as established working groups to carry out an exercise of application of the addressed contents, focusing on concrete cases where the HIA showed relevance. This working group intends to study the health impact of the gradual reduction of salt content in bread consumed in Portugal, in line with the goals identified in the protocol recently established between the Directorate-General for Health (DGS), INSA I.P., and Portuguese bakery associations. This exercise intends, on the one hand, to put into practice the methodology to carry out HIA (delivered in the workshop) in a "Learning by Doing" approach, on the other hand, to reinforce the importance of reducing the salt content in the occurrence of cardiovascular diseases with a special focus on the reduction of arterial hypertension. The working group includes member of the Departments of Health Promotion and Prevention of Non-Communicable Diseases (DPS), Food and Nutrition (DAN) and Epidemiology (DEP) of INSA, I.P. as well as representatives of the Regional Health Administration of Algarve (ARS Algarve) and Directorate-General for Education (DGE). In order to carry out this study, national data from projects in which INSA, I.P. is/was coordinator entity or participant will be used, such as INSEF - National Health Survey with Physical Examination and IAN-AF - National Food and Physical Activity Survey. All activities carried out in this field have been accompanied by the WHO international experts who participated in the Health Impact Assessment Workshop.
- Pilot study: Reduction of salt (sodium) in bread and its contribution to the decrease of cardiovascular diseases Health Impact Assessment of the introduction of new legislation - Screening reportPublication . Caldas de Almeida, Teresa; Costa, Luciana; Costa, Alexandra; Santos, Joana; Braz, Paula; Coelho, Mariana; Brazão, Roberto; Assunção, Ricardo; Lopes, Isabel; Guerreiro, Ana CristinaIntroduction: The importance of using a Health Impact Assessment (HIA) methodology to evaluate a new policy, program or project resides in the possibility of using the results to increase knowledge about the proposal, inform decision makers and affected population, and minimize potential effects and maximize the positive effects on health and well-being. The methodology of HIA is thus an essential tool in assessing the potential effects of interventions on the health of a population by its contribution to decision making for health and equity protection. In Portugal there is a growing interest in understanding the extent to which health interventions and policies in other sectors have an impact on health and equity. The new Public Health Law (Number49 / XIII) which is being discussed in the special field in Parliament, defines the competences of public health services and proposes to carry out at national level studies to assess the impact on health, from a "whole of government" perspective. Following this Law, a model is being developed to guide the implementation of health impact studies at the national, regional and local levels. In this way, the initiatives that promote technical training in this field are of particular importance, particularly to the National Institute of Health Doctor Ricardo Jorge, IP (INSA, IP) regarding its mission. It is therefore important to develop technical skills, tools and methodologies for impact assessment from a "whole of society" perspective. In this sense, within the scope of the Biennial Collaborative Agreement between the World Health Organization (WHO) and the Ministry of Health of Portugal, INSA, IP is implementing in collaboration with technical experts from WHO a "capacity building HIA training program”. In this context, a Workshop on HIA was held in November 2017 in Lisbon. This Workshop included a Policy Dialogue, with the main objective of training health professionals and other sectors to develop health impact studies and discuss strategies for implementing HIA as a tool to support a "Health in all policies" approach. This strategy is considered essential for governance in health and for equity and well-being, not only for other sectors to recognize their responsibility in Health, but also for Health to recognize the impact of its interventions in other sectors. Following this initiative, three stakeholder groups were organized for the implementation of three pilot studies on HIA, with WHO expert follow-up. Online meetings and seminars based on a "Learning by doing" program, were organized and supported by "Screening" and "Scooping" tools described in the HIA Guidance of the Institute of Public Health in Ireland [1] intending in the end to build from the case studies a guide to the national context. This report concerns to one of the studies carried out in this context, and serves to present the preliminary results of the study “Reduction of salt (sodium) in bread and its contribution to the decrease of cardiovascular diseases Health Impact Assessment of the introduction of new legislation”.
- Risk Benefit for EU - Partnering to strengthen the risk-benefit assessment within EU using a holistic approach: mid-term reportPublication . Alvito, Paula; Assunção, Ricardo; Fernandes, P.; Boué, Géraldine; Membré, Jeanne-Marie; Pires, Sara; Carvalho, Catarina; Torres, D.RiskBenefit4EU – Partnering to strengthen the risk-benefit assessment within EU using a holistic approach (RB4EU) is a project funded by European Food Safety Authority (EFSA) under Partnering Grants (GP/EFSA/AFSCO/2017/01) and was launched on the 17th January 2018, at a kick-off meeting in the EFSA’s premises, Parma, Italy. With the focus on the capacity building, it aims to develop a strategy to strengthen the EU capacity to assess and integrate food risks and benefits in the areas of microbiological, nutritional and chemical components through the development of a harmonized framework that will be available to EU member states organizations. Within the 1st year of the project, several deliverables and expected outputs were attained, including: two submitted manuscripts, eight communications in national and international conferences, one mid-report, two training activities, one harmonized risk-benefit assessment (RBA) framework on RBA capacity building, one flyer, a project website and one international workshop and the respective abstracts book. In order to answer to specific project and team member’s needs, some adjustments concerning the team composition and the budget allocated to travels and missions were performed, all in agreement with EFSA. RB4EU allowed to gather, for the first time, a multidisciplinary team to develop a capacity building framework on RBA in foods. After the first year of the project, the team and the capacity building framework on RBA in foods are consolidated, allowing to progress on the Portuguese case-study involving data at national level on nutritional, toxicological and microbiological areas. A close collaboration between team members and EFSA have been developed promoting an important support for the project progress.
- Notificação da ocorrência de microrganismos patogénicos detetados em géneros alimentícios prontos a comer no retalho em 2016, em Portugal, reportados ao portal PortFIRPublication . Viegas, SilviaEste relatório apresenta análise da informação notificada para o PortFIR, referente a resultados laboratoriais de pesquisa/quantificação de Salmonella spp., Listeria monocytogenes e Escherichia coli produtora de “Shiga toxin” (STEC), realizados em géneros alimentícios prontos a comer, a nível do retalho, realizados em 2016, no âmbito de monitorização, vigilância e autocontrolo para prevenção e controlo da higiene e segurança dos géneros alimentícios.
- Scientific update on the iodine content of Portuguese foodsPublication . Delgado, Inês; Coelho, Inês; Castanheira, Isabel; Calhau, Maria Antónia; Albuquerque, José Maria; Breda, JoãoIodine is an essential trace element in human and animal diets. However, mild to moderate iodine deficiency has been reported in several countries. Food is the natural source of iodine. Detectable analytical values, expressed in SI units (µg/kg), are required to guarantee reliable measurement results used to estimate iodine intake over time at national and international level. The aim of this work, conducted as an activity of the WHO Collaborating Centre for Nutrition and Childhood Obesity, was to develop a database of the iodine content of foods in order to predict nutritional adequacy of dietary intake. This database may be used as a tool to promote iodine intake through consumption of foods rich in iodine. The specific objective of this report is to provide updated data on the iodine content of Portuguese foods as consumed within, and as representative of, the Portuguese diet. The methodology selected for quantification of this nutrient was inductively coupled plasma mass spectrometry (ICP-MS) assisted by microwave after alkaline digestion.Eight groups of food were analysed: (1) meat; (2) fish and seafood; (3) milk and milk products, eggs; (4) fruit; (5) vegetables and pulses; (6) sweets and beverages; (7) cereals and tubers; and (8) meals. These foods were collected on the basis of consumption patterns drawn from national food consumption surveys (Fabrice Elegbede et al., 2017). The proportion of samples beyond the limit of detection (LoD) ranged between 0% in fish, seafood and dairy products to 81.3% in fruit. The food samples with detectable iodine content showed a wide variation: 2.4–7.8 µ g/100 g for meat; 2.8–289.3 µ g/100 g for fish and seafood; 15.8–39.4 µ g/100 g for milk, milk products and eggs; 3.3–26.6 µ g/100 g for fruit; 0.3–6.5 µ g/100 g for vegetables and pulses; 0.3–22.7 µ g/100 g for sweets and beverages; 0.9–4.7 µ g/100 g for cereals and tubers; and 0.7–56.8 µ g/100 g for meals. The results showed that in Portugal a diet rich in fish, seafood and dairy products supplies the recommended daily intake of iodine for a healthy adult.
- Inquérito Alimentar Nacional e de Atividade Física, IAN-AF 2015-2016: relatório de resultadosPublication . Lopes, Carla; Torres, Duarte; Oliveira, Andreia; Severo, Milton; Alarcão, Violeta; Guiomar, Sofia; Mota, Jorge; Teixeira, Pedro; Rodrigues, Sara; Lobato, Liliane; Magalhães, Vânia; Correia, Daniela; Carvalho, Catarina; Pizarro, Andreia; Marques, Adilson; Vilela, Sofia; Oliveira, Luísa; Nicola, Paulo; Soares, Simão; Ramos, ElisabeteEste relatório foi realizado com informação recolhida no âmbito do Inquérito Alimentar Nacional e de Atividade Física (IAN-AF 2015-2016), desenvolvido por um Consórcio que tem como Promotor a Universidade do Porto. O IAN-AF recebeu financiamento do Espaço Económico Europeu concedido pela Islândia, Liechtenstein e Noruega através do Programa EEA Grants - Iniciativas de Saúde Pública, área dos Sistemas de Informação em Saúde (PT06 - 000088SI3). O IAN-AF teve o apoio institucional da Direção-Geral da Saúde, da Administração Central do Sistema de Saúde, das Administrações Regionais de Saúde, das Secretarias Regionais de Saúde dos Açores e da Madeira e da Autoridade Europeia para a Segurança dos Alimentos.