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Conteúdo (article):

BARRIERS TO ORGANIZING FOOD AND NUTRITION SURVEILLANCE IN PRIMARY HEALTH CARE: SCOPING REVIEW

AUTHORS
Andréia Silva de Oliveira
Graduate Program in Gerontology, Universidade Federal de Santa Maria, nutriandreiars@gmail.com, ORCID 0000-0003-0199-5620

Laura Virgilli Claro
Graduate Program in Gerontology, Universidade Federal de Santa Maria, lauravirgili05@gmail.com, ORCID 0000-0001-6016-6692

Eliza Sella Battisti
Graduate Program in Gerontology, Universidade Federal de Santa Maria, sella_eliza@yahoo.com.br, ORCID 0000-0001-5235-1521

Marília Alessandra Bick
Graduate Program in Nursing, Universidade Federal de Santa Maria, mariliabick@gmail.com, ORCID 0000-0002-8744-7790

Silvia Eugênia Oliveira Valença
Graduate Program in Nutrition Sciences, Universidade Federal de Sergipe,
silviavalenca1@gmail.com, ORCID 0000-0003-3592-9867

Greisse Viero da Silva Leal
Graduate Program in Gerontology, Universidade Federal de Santa Maria, greisseleal@gmail.com, ORCID 0000-0002-1204-0080

Cristiane Cardoso de Paula
Graduate Program in Nursing, Universidade Federal de Santa Maria, cristiane.paula@ufsm.br, ORCID 0000-0003-4122-5161

Vanessa Ramos Kirsten
Graduate Program in Gerontology, Universidade Federal de Santa Maria, kirstenvr@gmail.com, ORCID 0000-0002-6737-1039

RESUMO
Objetivo: mapear as barreiras para a organização da Vigilância Alimentar e Nutricional enfrentadas por profissionais de saúde nos serviços de Atenção Primária à Saúde no Brasil. Método: revisão de escopo no método do JBI. A busca ocorreu em agosto de 2021 nas bases de dados da BVS, Scopus, Web of Science, CINAHL, ScienceDirect, CAB Abstract, Embase, com filtro de tempo (2008 a 2021). Foram incluídos estudos primários, de opinião, de caso e de relato. Para a extração de dados utilizou-se o instrumento padrão do JBI. A análise de conteúdo qualitativa básica categorizou os dados segundo as fases do Ciclo de Gestão e Produção do Cuidado da Vigilância Alimentar e Nutricional. Resultados: foram selecionados 23 estudos. As principais barreiras mapeadas referiram-se à coleta e produção de informações. A análise, decisão e ação ocorreram aquém do esperado e não houve abordagem inerente à avaliação. Outras barreiras identificadas relacionaram-se aos recursos humanos, materiais/físicos e à falta de recursos financeiros. Considerações finais: As fases de coleta e registro de dados são priorizadas nos serviços de Atenção Primária à Saúde no Brasil por estarem atreladas principalmente a condicionalidades de programas intersetoriais. As fases de avaliação e ação demarcam lacunas da literatura.

ABSTRACT
Objective: to map the barriers to the organization of Food and Nutrition Surveillance faced by health professionals in Primary Health Care services in Brazil. Method: A scoping review using the JBI methodology. The search was conducted in August 2021 in the following databases: BVS, Scopus, Web of Science, CINAHL, ScienceDirect, CAB Abstract, and Embase, with a time filter (2008 to 2021). Primary studies, opinion pieces, case studies, and reports were included. Data extraction was performed using the JBI\'s standard tool. Basic qualitative content analysis categorized the data according to the phases of the Food and Nutrition Surveillance Care Management and Production Cycle. Results: A total of 23 studies were selected. The main barriers identified were related to data collection and information production. Analysis, decision-making, and action fell short of expectations, and there was no inherent approach to evaluation. Additional barriers identified were related to human resources, material/physical resources, and lack of financial resources. Final considerations: The data collection and recording phases are prioritized in Primary Health Care services in Brazil due to their ties to the conditionalities of intersectoral programs. The evaluation and action phases highlight gaps in the literature.

Palavras-chave: Vigilância Alimentar e Nutricional. Atenção Primária à Saúde.

Keywords: Food and Nutrition Surveillance. Primary Health Care.

INTRODUCTION
Food and Nutrition Surveillance (FNS) is defined as the continuous process of monitoring the population\'s food and nutrition conditions, considered strategic for the organization of nutritional care at the primary health care level1 and a priority basis for supporting health professionals and managers in decision-making in the field of nutritional care2.
FNS is one of the guidelines of the National Food and Nutrition Policy (PNAN), and must be organized through the Care Management and Production Cycle (CMPC) at individual or collective levels3. This Cycle begins with the collection of anthropometric and food consumption data, which must be recorded by Primary Health Care (PHC) teams, preferably in the Health Information Systems (HIS) of the Ministry of Health. These allow FNS information to be validated and integrated into the Food and Nutrition Surveillance System (Sisvan-Web), which generates information that can be used to diagnose the nutritional situation of the population and establish public policies through public reports, conferring the second stage of the CMPC, which is analysis and decision2,3,4,5. This stage takes into account the human, material, physical, and financial resources to conduct the subsequent stage (action). The action aims to conduct interventions based on the results found, and their evaluation is essential to understand the effects of what was done and to provide helpful support for planning the next steps3.
Despite the growing trend in data recording in the HIS, coverage of the nutritional status and food consumption of the Brazilian population remains below ideal in all regions of the country6,7,8,9,10. The information is not used to its full potential for planning, managing, and evaluating food and nutrition (FN) actions within the scope of PHC11,12, as professionals and managers face barriers to consolidating the Food and Nutrition Surveillance Care Management and Production Cycle in the daily routine of services. The fragmentation of work or rework in the collection, typing, and entering of data on different platforms, the lack of structure in health teams and the non-use of FNS information for service planning11,13, as well as the low qualification of professionals and managers to use this system14 are some examples of the barriers described in some primary studies.
When the review was planned, a preliminary search was conducted in Publisher Medline (Pubmed), the Cochrane Database of Systematic Reviews, JBI Evidence Synthesis, International Prospective Register of Systematic Reviews (PROSPERO), and Opens Science Framework (OSF), which resulted in a single scoping review protocol regarding the implementation of children\'s FNS systems, which does not address operationalization by professionals15. Other reviews have analyzed aspects of FNS in health information systems in other countries16,17,18,19.
The relevance of mapping barriers that impact the organization of FNS within the scope of PHC is highlighted as a strategy to help management and professionals recognize these difficulties in planning and operationalization, strengthening not only the monitoring of the food and nutritional situation, but above all the implementation of actions that enable the improvement of the food, nutrition, and health conditions of the population. Given these findings, this scoping review aims to map the barriers to the organization of Food and Nutrition Surveillance by health professionals in Primary Health Care services in Brazil.

MATERIALS AND METHODS
This proposed scoping review was conducted according to the JBI method 20 and followed the recommendation for quality and transparency of reporting (PRISMA-ScR) 21. The study protocol was registered with OSF Registries under DOI https://doi.org/10.17605/OSF.IO/KSWRT.
The methodological details were deposited in the SciELO Data repository, under the DOI https://doi.org/10.48331/scielodata.9GYMTG.

Eligibility Criteria
The eligibility criteria followed the structure of the acronym PCC (P = population; C = concept; C = context). For the population, studies involving health teams/professionals (health managers, nurses, nursing technicians, nutritionists, physicians, and community health agents) who were involved in the organization of FNS were selected. To be included, the study needed to have information about the practice of these professionals in the mentioned area. Studies that presented only secondary data from these records, such as coverage of the nutritional status of a given location without describing the particularities of these records, were excluded.
Regarding the concept, the inclusion criterion was that the study addressed FNS, which involves the continuous description of food and nutrition conditions (including anthropometry and food consumption) of the population. The barriers to its implementation were all determining factors for its organization, according to the CMPC3,4. This included studies that described information on the organization of professionals in the collection, production, analysis, and evaluation of data (weight, height, and food consumption) of PHC users and/or assistance programs, and the development of actions linked to the CMPC, as well as the human, material/physical, and financial resources necessary for this organization. The concept encompassed an expanded approach that incorporated FNS into health services and the integration of information derived from health information systems2.
Regarding the context, that is, the place where FNS takes place, studies developed in the Brazilian PHC were included, covering schools, homes, community groups, health academies, Basic Health Units, and Family Health Strategies.
Regarding the type of study, observational designs with a quantitative approach (descriptive, cross-sectional, and longitudinal), qualitative, opinion studies, case studies, and experience reports were included. The research was not limited by language and included studies published between 2008 and 2021, since 2008 was the year Sisvan-Web was launched, with the incorporation of the World Health Organization (WHO) growth curves and the inclusion of tools for the assessment of food consumption markers for all stages of the life course3,4.

Data collection
The search was developed in the following information sources: LILACS/BVS-BIREME, BDENF/BVS/BIREME, BVS Public Health, MEDLINE/PUBMED, Scopus/ELSEVIER, Web of Science Core Collection/Clarivate Analytics, CINAHL/EBSCO, ScienceDirect/ELSEVIER, CAB Abstract/CABI, Embase (Elsevier), and gray literature (dissertations and theses from Capes). The references of the included studies were also searched. It was not necessary to contact the authors.
The search strategy was developed in three stages 20, by a team composed of a researcher with expertise in the topic, a consultant (JBI-certified trainer), and two reviewers (both experienced in the topic). The first step was to map the terms according to the PCC acronym. Regarding the P element, the mapping showed that the articles on the topic do not use terms that inform surveillance participants, neither in the descriptors nor in the words (title/abstract); therefore, they did not compose the strategy so as not to limit it. In the second stage, the mapped terms of the concept (C – Food and Nutrition Surveillance) and context (C – Primary Health Care) elements were used to develop the final search strategy applied to MEDLINE/PUBMED and used in the other databases: ((((((("nutritional surveillance"[Text Word]) OR ("nutritional surveillance system"[Text Word])) OR ("nutritional surveillance systems"[Text Word])) OR (sisvan[Text Word])) OR ("sisvan web"[Text Word])) OR ("sisvanweb"[Text Word])) OR ("sisvan web coverage"[Text Word])) AND ((((((((("primary health care"[MeSH Terms])) OR ("primary health care"[Text Word])) OR ("primary healthcare"[Text Word])) OR ("primary care"[Text Word])) OR ("primary health care"[Text Word])) OR ("unified health system"[Text Word])) OR ("family health strategy"[Text Word])) OR ("brazilian unified national health system"[Text Word])). The strategy used in the gray literature was “food and nutritional surveillance” OR “nutritional surveillance” OR “SISVAN”. The strategy was reviewed by the JBI librarian, who has expertise in the health area and the method, at a regular meeting of JBI Brazil, where the protocol for this review was presented and discussed. This stage occurred on August 5, 2021, in the information sources. In the third stage, the reference lists of the included articles were checked to select additional studies.
After the searches, all identified references were grouped and entered into the Mendeley Desktop software version 1.19.8 and duplicate citations were checked. A pilot study was conducted with all researchers during the screening of the first 25 titles and abstracts to standardize the eligibility criteria. After this phase, the titles and abstracts were selected according to previously established criteria. The team discussed the discrepancies and adjusted the eligibility criteria. When 75% (or more) agreement was reached, independent double screening began, with reviewers 1 and 2, in addition to being previously trained for this review, having prior experience in the topic of FNS. After screening, the full text of potentially eligible studies was retrieved and read in full to determine eligibility in detail by two independent reviewers. The third reviewer, with prior experience in the FNS topic and with the advice of a researcher experienced in scoping reviews, resolved any disagreements that arose between the reviewers. It was not necessary to contact the authors to retrieve additional information.
A standard JBI instrument (Appendix II) was used, with multiphase data extraction. This instrument was organized in an Excel spreadsheet consisting of two tabs, one for each phase. Phase 1 included the characterization data: year of publication, location of data production (municipality/state), type of study, and population. Phase 2 included the following data: use of public food and nutrition policies at different stages of the life course (children, adolescents, adults, older adults and pregnant women, and/or assistance programs); barriers to data collection (weight, height, and food consumption), recording (health systems used and frequency), data analysis (nutritional status and food consumption), and actions linked to the CMPC; and demands on human resources (professional profile), material/physical resources, and financial resources.
The results extraction instrument was tested in the first five articles, and adjusted for objectivity in collecting information and consistency with the review question, in order to refine the mapping. The reviewers (both experienced in the subject) were trained in data extraction by the consultant. This stage occurred in a double-independent manner. The third reviewer (with expertise in the topic) resolved the disagreements, and the consensus version was reviewed by a panel of researchers composed of the third reviewer, another researcher with experience in the review topic, and the consultant. At this stage there was also no need to contact the authors.

Data analysis
An analysis with descriptive statistics of the data extracted in phase 1 was developed and the studies were characterized according to temporal trend, regional distribution, and type of study (Table 1). In most cases, there is no need for scoping reviews to go beyond basic descriptive analysis. Still, sometimes it may be appropriate to use basic qualitative content analysis, for example, when identifying factors related to a concept22. Hence, this descriptive analysis approach was developed, which involves an open coding process to allocate characteristics into general categories, following a deductive approach that considers the predetermination of the analytical framework by the phases of the Food and Nutrition Surveillance Care Management and Production Cycle: data collection and information production, analysis and decision, and action and evaluation. The reviewers developed the analysis and, again, the consensus version was reviewed by a panel of researchers composed of the third reviewer and the consultant.
The extracted data were grouped and summarized. A narrative summary of the results was created, and the presentation of the data on the characterization and mapping of barriers to the organization of FNS was presented in both diagrammatic and tabular forms. The findings were discussed with regard to the organization of FNS in PHC in Brazil. Gaps and limitations in the current literature were identified.

RESULTS
The PCC strategy was applied to 8 databases, which resulted in the identification of 306 records. Of these, 91 were removed because they were duplicates. In total, 215 records were eligible for the screening process by reading the title/abstract of the articles. Initially, a pilot test was conducted with the first 25 articles, whose titles/abstracts did not meet the eligibility criteria, resulting in their exclusion. Next, the remaining eligible articles (190) were screened, and of these, 37 were excluded because they did not meet the eligibility criteria. In total, the screening of titles/abstracts resulted in 153 articles read in full, with the inclusion of 23 studies. The process of selecting studies for this review is presented in the Prisma Flowchart (Figure 1).
The included studies were developed in all geographic regions of the country. The Southeast provided 11 of 23 publications, with emphasis on Minas Gerais and São Paulo (6 and 5 publications, respectively) 11,23,24,25,26,27,28,29,30,31,32. The peak of publications occurred between 2017 and 2021 (n=9) 30,31,,32,33,34,35,36,37,38. Experience reports (n=5), cross-sectional studies (n=4), and descriptive studies (n=4) predominated23,26,28,29,34,35,39,40,41 (Table 1).
Regarding the activity of professionals in the context of FNS (n=20), the studies identified 13 categories, with emphasis on nurses11,23,26,28,30,33,35,37,39,42,41, nursing assistants23,30,43, nursing technicians11,23,39, community health agents23,26,30,37,39,44, physicians11,23,30,37,4, nutritionists11,31,32,37, and managers27,30,35,38. The publications mainly covered the maternal and child audience27,29,31,33,34,35,38,40,41,43,44, and the programs and policies included in the surveillance actions were concentrated at the federal level11,28,29,31,35,37,38,40,40,42,43.
Barriers to “data collection and information production” from FNS were addressed in 14 publications. Among these, the following stood out: the prioritization of the collection of anthropometric data from beneficiaries of the Bolsa Família Program (PBF) and the maternal-child life cycle11,31,34, the lack of standardization of anthropometric techniques related to weight and height measurement techniques in accordance with official standards of the Ministry of Health (MS) 23,32,43 and the occurrence of technical errors in the measurement of these measurements24,30,35,43 (Table 2).
Regarding “the production of information” from FNS, publications revealed that the recording of (anthropometric) data occurs in printed documents such as FNS Forms, Child Handbooks, and physical medical records24,25,30,33,36,38. As with data collection, the studies highlighted the prioritization of recording information inherent to Social Programs and the maternal-child life cycle30,35,40 (Table 2).
Twelve publications provided information regarding the “analysis and decision” of FNS and pointed out that the analysis of nutritional status is not performed or is below the recommended level in PHC services11,23,28,30,36,37,38,41 due to factors such as underutilization of Sisvan-Web reports28,34,38 and low compliance in relation to the analysis27,35,43,44 (Table 2). The “action” stage was covered in 9 publications. There was an insufficiency of actions aimed at individualized (nutritional counseling)11,33,38,41 and collective monitoring 27,35,36,38 (Table 2). No study mentioned the evaluation of actions.
The low supply/lack of training in the theoretical field of FNS 11,27,28,32,38,41,43,44 and the overload of professionals and managers of UBS/ESF (nurse, nutritionist, and typist), who are responsible for the execution/management of multiple programs and activities in health services 11,25,28,31,37,40,44, were the most cited barriers regarding human resources in a total of 20 publications (Table 3). A lack of knowledge among professionals and managers on topics related to FNS was identified, including nutritional care and the information system itself23,29,34,32,44. The lack of a complete team of professionals, temporary hiring, professionals with unstable employment relationships, and high turnover of members11,28,33,34,44 were also recurring information. The absence of a nutritionist in the UBS/ESF teams was perceived as a significant obstacle to organizing the FNS11,26,27,39,41 (Table 3).
Barriers related to material and physical resources were addressed in 18 publications, with emphasis on insufficiency, unavailability, and/or lack of adequate maintenance of anthropometric equipment (scales and stadiometers) 11,24,27,28,30,31,32,33,34,36,38,41,43,44, lack of computers and difficulties in accessing the internet 11,25,28,31,42 and the lack of a suitable place to practice anthropometry and carry out group activities27,32,43 (Table 4).
In 5 publications, barriers were mentioned regarding the understanding that there is a lack of resources for FNS actions11,28,31. Within this logic of financial resources, one study highlighted a high level of knowledge deficiency among UBS professionals and managers responsible for Sisvan-Web regarding the availability of federal funding for FNS 11 actions (Table 4).
DISCUSSION
The results show that the CMPC is not carried out in its entirety, as there is prioritization of the data collection and recording phases. Furthermore, the studies evaluated in this review demonstrated a predominance of recording anthropometric data (weight and height) over recording food consumption data. This can be justified by the fact that the assessment of nutritional status is a criterion for compliance with health conditions or actions provided for in the PBF and the School Health Program (PSE), which is not observed for the assessment of food consumption, currently recommended only within the scope of the Healthy Growth Program 45,46,47. Furthermore, it was observed that data collection and information recording are linked to the maternal and child public, while official documents guide their execution for all life cycles 3,4.
Few studies cited the use of the e-SUS strategy for recording information, which is defined as the priority system for recording FNS information. It is essential to highlight that the low data recording makes it impossible to increase coverage, limiting the representativeness of Sisvan-Web reports with regard to the interpretation of the nutritional status generated 2,3.
Conducting the initial stages of the cycle is a strategic objective of FNS to detect and predict food and nutritional risk situations, as well as their temporal trends, and thereby enabling immediate intervention in the nutritional problems of the population3,48. They are considered strategic tools for management at all levels, contributing to the planning of actions, programs, and policies that are consistent with the profile of the population assigned to the territory48.
The results of this study indicate that the use of Sisvan-Web reports to support nutritional care actions for planning, managing, and evaluating food and nutrition actions at the individual and collective levels of territories and municipalities is not a practice in health services, compromising data analysis and decision-making 49,50. This creates a high chance that the actions (linked to the penultimate stage of the CMPC) conducted will not provide solutions to the problems found in the territory.
The actions are mentioned in a small number of publications, focusing particularly on the lack of monitoring of users with nutritional deviations and without highlighting the health education topics that should be prioritized51. It is worth highlighting that the Promotion of Adequate and Healthy Food (PAHF) is a PNAN guideline that intersects with various health and/or intersectoral policies and programs3,2 and is a strategic axis of health promotion that should be conducted by the teams. In 2019, only 26.9% of the collective activities conducted in the PHC and registered in e-SUS PC addressed the topic of FN47.
No article mentioned the evaluation of actions, the last phase of the CMPC. Evaluations of food and nutrition programs and actions have historically been less frequent compared to other types of research. And when they do happen, they are focused on effectiveness and impact and not on the work process53. However, this phase is of utmost importance, as it enables everyone involved in the planning to identify the effects being produced, the results being used, and the changes that can be effective in improving the health of individuals, the community, and society.
The barriers inherent to human resources affect all phases of the CMPC, as they are related not only to the execution of the FNS but also to its management, drawing particular attention to the low level of knowledge and/or lack of training on this PNAN guideline. It is clear that the FNS theme is important to be included in the context of Continuing Education in Health (EPS)54,55, with investment in continuing education processes on Food and Nutrition (FN) topics for care and management professionals being one of the recommendations for strengthening FN guidelines in the SUS. A specialization course contributed to the work of nurses in caring for overweight people in primary care, equipping them to practice food and nutritional surveillance, use health information systems, and conduct individual, collective, and intersectoral activities 56. Furthermore, the low presence of nutritionists in PHC was seen as an obstacle to the operationalization of FNS because, despite being a common responsibility of all PHC professionals, the nutritionist must be responsible for its coordination2,57.
In the same logic, the barriers related to physical/material resources seem to be associated with the lack of knowledge or non-use of federal funding for structuring the FNS, such as the guarantee of transfer for the acquisition of anthropometric equipment58 and for the organization of the FNS through the Financing of Food and Nutrition Actions (FNA)59,60.

CONCLUSION
The mapping developed in this review study responded to a gap in the literature that existed until then, as it highlighted barriers to the organization of FNS related to all stages of the CMPC, especially its initial phases (data collection and recording), which tend to be prioritized in PHC services because they are linked to conditionalities of intersectoral policies and programs. The barriers mapped were prioritization of children and social programs, lack of standardization of techniques, errors in reading measurements, and in the use of equipment. The evaluation and action phases highlighted gaps in the literature.
Barriers related to human resources highlighted low knowledge and training on the topic, overload of professionals, and the absence of a nutritionist on the team. Material barriers revealed insufficient maintenance of anthropometric equipment and computers, and the absence of suitable locations for anthropometry. Financial barriers also marked gaps in the literature.

ACKNOWLEDGEMENTS
To the Brazilian Center for Evidence-Based Healthcare: JBI Brazil Center of Excellence for the training offered in the CSRTP Course and for the analysis of the Scope Review Protocol at the Ordinary Scientific Meeting. To librarian Juliana Takahashi for her support in developing the search strategy and defining the search sources.

FINANCING
To the Research Support Foundation in Rio Grande do Sul – PPSUS Notice (Process 21/2551-0000127-5) and to the Research Improvement Coordination for financing the Research Project “Qualification of Food and Nutrition Surveillance: a proposal for permanent education to improve the quality of health care in the municipalities of RS”.

CONFLICTS OF INTEREST
The authors declare that they have no conflicts of interest.




REFERENCES

1. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Política Nacional de Alimentação e Nutrição. Brasília; 2013. 84 p.

2. Brasil. Marco de Referência da Vigilância Alimentar e Nutricional na Atenção Básica. Ministério. Brasília; 2015.

3. Brasil. Ministério da Saúde. Guia para a organização da Vigilância Alimentar e Nutricional na Atenção Primária à Saúde. Ministério da Saúde. Universidade Federal de Sergipe. Brasília; 2022. 51 p.

4. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Matriz para Organização dos Cuidados em Alimentação e Nutrição na Atenção Primária à Saúde. Brasília; 2022. 95 p.

5. Coutinho JG. et al. A organização da Vigilância Alimentar e Nutricional no Sistema Único de Saúde: histórico e desafios atuais. Revista Brasileira de Epidemiologia [periódico na Internet]. 2009 [acessado 2022 Out]; 12(4): [cerca de 11 p.]. Disponível em: https://www.scielo.br/j/rbepid/a/Rnrhq4vjpQMFmc3TGr3hhJB/

6. Gonçalves I SA. et al. Nutritional status coverage trend registered in the SISVAN web in seven municipalities of the Zona da Mata Mineira, Brazil, from 2008 to 2017, and its association with socio-economic, demographic and organization of health system variables. Journal of Nutritional Science [serial on the Internet]. 2020 [cited 2022 Out 21]; 9: [about 7 p.]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6984122/

7. Nascimento FA do, Silva SA da, Jaime PC. Coverage of food intake assessment in the Brazilian Food and Nutrition Surveillance System: 2008 to 2013. Rev Bras Epidemiol [periódico na Internet]. 2019 [acessado 2022 Out 13]; 22. Disponível em: https://www.scielo.br/j/rbepid/a/MpVdDCs5QjWnSvxNsjCBQrh/?format=pdf&lang=en

8. Nascimento FA do, Silva SA da, Jaime PC. Coverage of assessment of nutritional status in the Brazilian Food and Nutritional Surveillance System, 2008-2013 . Cad Saúde Pública [periódico na Internet] . 2017 [acessado 2022 Out 11]; 33(12). Disponível em: https://www.scielo.br/j/csp/a/p8MCGwRtvvBQMyvx5RZkXmR/?lang=pt&format=pdf

9. Borges LKS, Nascimento FF, Mascarenhas MDM, Rodrigues MTP. Cobertura de avaliação do consumo alimentar em crianças participantes do Programa Crescer Saudável - Brasil, 2015-2018. Ciênc. saúde coletiva [periódico na Internet]. 2022 Mai./Jun [acessado 2022 Out 20]; 27(06). Disponível em: https://www.scielosp.org/article/csc/2022.v27n6/2317-2324/

10. Silva RPC. et al. Sistema de Vigilância Alimentar e Nutricional: tendência temporal da cobertura e estado nutricional de adultos registrados, 2008-2019. Epidemiol. Serv. Saúde [periódico na Internet]. 2022 Abr [acessado 2022 Out 21]; 31(1). Disponível em: https://www.scielo.br/j/ress/a/rQyYg8DVPLyjxhVZMCJrgqM/

11. Rolim MD, Lima SML, Barros DC de, Andrade CLT de. Evaluation of the Food and Nutrition Surveillance System (SISVAN) in food and nutritional management services in the State of Minas Gerais, Brazil. Cien Saude Colet. [periódico na Internet]. 2015 [acessado 2021 Aug 05]; 20(8): [cerca de 10 p.]. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S141381232015000802359&lng=pt&tlng=pt

12 Vitorino SAS, Cruz MM, Barros DC. Validação do modelo lógico teórico da vigilância alimentar e nutricional na atenção primária em saúde. Cad. Saúde Pública [periódico na Internet] . 2017 [acessado 2022 Dez 5]; 33(12). Disponível em: https://www.scielo.br/j/csp/a/XN3fsrVDFWSPYfmNCYR9WHs/

13. Ferreira CS, Rodrigues LA, Bento IC, Villela MPC, Cherchiglia ML, César CC. Factors associated with Sisvan Web coverage for children under 5 years of age, in the municipalities of the Regional Health Inspectorate of Belo Horizonte, Brazil. Cien Saude Coletiva [periódico na Internet]. 2018 [acessado 2022 Set 06]; 23(9): [cerca de 9 p.]. Disponível em: https://www.scielo.br/j/csc/a/8Fz3tgFS7MF75GzNY3VSsWL/abstract/?lang=pt

14. Campos DS; Fonseca P C. A vigilância alimentar e nutricional em 20 anos
da Política Nacional de Alimentação e Nutrição. Cad. Saúde Pública [periódico na Internet]. 2021 [acessado 2022 Nov 25]; (37). Disponível em: https://www.scielo.br/j/csp/a/8NcbkvZQW9LDPpdXzhL4JQC/

15. Sadeghi M, Langarizadeh M, Olang B, Seddighi H, Sheikhtaheri A. A Survey of implementation status of child nutrition surveillance systems, registry systems and information systems: a scoping literature review protocol. BMJ Paediatr Open [serial on the Internet]. 2021 Aug [acessado 2021 Jun 17]; 5(1). Available from: https://bmjpaedsopen.bmj.com/lookup/doi/10.1136/bmjpo-2021-001164

16. Ahluwalia N, Dwyer J, Terry A, Moshfegh A, Johnson C. Update on NHANES Dietary Data: Focus on Collection, Release, Analytical Considerations, and Uses to Inform Public Policy. Adv Nutr. [serial on the Internet]. 2016 Jan [cited 2021 Jun 17]; 7(1): [about 13 p.]. Available from: https://academic.oup.com/advances/article/7/1/121/4524042

17. Lachat C, Dehenauw S, van Camp J, Matthys C, Larondelle Y, Kolsteren P. [A review of the nutritional management plans in the member states of the European Union]. Verh K Acad Geneeskd Belg [serial on the Internet]. 2006 [cited 2021 Jun 17]; 68(1): [about 21 p.]. Available from: https://pubmed.ncbi.nlm.nih.gov/16610423/

18. Mohammed SH, POUR ARAM H, Djazayery A. Enhancing nutrition surveillance in Africa: a systematic review of strategies to strengthen data quality and information use. PROSPERO [serial on the Internet]. 2017 [cited 2021 Jun 17]. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=64243

19. Lee KW, Park K, Lee S-M, Lim H, Shin M-J. Dietary Issues and Challenges on Cardiometabolic Health in Korea: From a Viewpoint of a National Nutrition Surveillance System. Clin Nutr Res [serial on the Internet] . 2017 Jan [cited 2021 Jun 17]; 6(1):1–6. Available from: https://e-cnr.org/DOIx.php?id=10.7762/cnr.2017.6.1.1

20. Peters M, Godfrey C, McInerney P, Munn Z, Tricco A, Khalil H. Chapter 11: Scoping Reviews (2020 version). In: JBI, editor. JBI Manual for Evidence Synthesis [serial on the Internet]. 2020 [cited 2021 Jun 17]. Available from: https://synthesismanual.jbi.global

21. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med [serial on the Internet]. 2018 [acessado 2021 Jun 17]; 169(7): [about 6 p.]. Available from: https://doi.org/10.7326/M18-0850

22. Pollock D, Peters MDJ, Khalil H, McInerney P, Alexander L, Tricco AC, Evans C, de Moraes ÉB, Godfrey CM, Pieper D, Saran A, Stern C, Munn Z. Recommendations for the extraction, analysis, and presentation of results in scoping reviews. JBI Evid Synth. 2023 Mar 1;21(3):520-532. doi: 10.11124/JBIES-22-00123.


23. Camargo AA, Oliveira MRM, Renosto RV, Vieira CM. Promotion and evaluation of the Nutritional Surveillance in Primary Care of the Piracicaba-Capivari watersheds. Segurança Alimentar e Nutricional [periódico na Internet]. 2010 [acessado 2021 Aug 5]; 17(2): [about 13 p.]. Disponível em: https://repositorio.unesp.br/handle/11449/133618

24. Ferreira MCS, Detregiachi CRP, Oliveira, MRM. Qualidade das medidas de peso produzidas em unidades de atenção básica à saúde da região de Botucatu-SP, Brasil. Nutrire Rev. Soc. Bras. Aliment. Nutr [periódico na Internet]. 2011 [acessado 2021 Aug 5]; 36(3). Disponível em: http://sban.cloudpainel.com.br/files/revistas_publicacoes/337.pdf

25. Jesus MCP, Santos SMR, Goulart TP, Martins NA, Peres RB, Coelho VS. Atualização dos dados nos sistemas de informação em saúde. Rev. enferm. UER. [periódico na Internet]. 2012 [acessado 2021 Aug 5]; 20: [cerca de 6 p.]. Disponível em: http://www.facenf.uerj.br/v20nesp2/v20e2a17.pdf

26. Alves ICR, Souza TF, Pinho L. Operacionalização do sistema de vigilância alimentar e nutricional: relato de experiência. Rev. APS [periódico na Internet]. 2015 [acessado 2021 Aug 5]; 18(3). Disponível em: https://aps.ufjf.emnuvens.com.br/aps/article/view/2455/903

27. Pinfildi ASCL, Zangirolani LTO, Spina N, Martins PA, Medeiros MAT. Atenção nutricional no pré-natal e no puerpério: percepção dos gestores da Atenção Básica à Saúde. Rev. Nutr. [periódico na Internet]. 2016 [acessado 2021 Aug 5]; 29(1): [cerca de 14 p.] Disponível em: https://doi.org/10.1590/1678-98652016000100011

28. Vitorino SAS, Siqueira RLPMC, Bezerra OMPA, Cruz MM, Silva CAM. Estrutura da vigilância alimentar e nutricional na atenção básica em saúde no estado de Minas Gerais. Rev. APS . 2016 [acessado 2021 Aug 5]; 19(2), 230–244. Disponível em: https://aps.ufjf.emnuvens.com.br/aps/article/view/2531/970

29 Pinfildi ASC, Medeiros MAT. Nutritional care during prenatal and postpartum periods: A report of experiences in a city on São Paulo’s coast. Rev. Nutr [periódico na Internet]. 2016 [acessado 2021 Aug 5]; 29(6): [cerca de 14 p.]. Disponível em: https://doi.org/10.1590/1678-98652016000600016

30. Hunger R, Costa DN, Faria AL, Rodrigues AM. Monitoramento da avaliação antropométrica no contexto do sistema de vigilância alimentar e nutricional na atenção primária à saúde. Rev. APS [periódico na Internet]. 2017 [acessado 2021 Aug 5]; 20(2), [cerca de 8 p.]. Disponível em: https://aps.ufjf.emnuvens.com.br/aps/article/view/2602/1080

31. Bento IC, Lana DV. Influência do projeto de fortalecimento da vigilância em saúde na cobertura. Rev. APS [periódico na Internet]. 2017 [acessado 2021 Aug 5]; 20(3); cerca de 6 p.]. Disponível em: https://aps.ufjf.emnuvens.com.br/aps/article/view/2921/1119

32. Gonçalves I DSA, Donateli CP, Cotta RMM, Moreira TR, Costa GDD. Perception of the Food and Nutrition Surveillance System in the Zona da Mata Mineira region of Brazil: A qualitative approach. Science Progress [serial on the Internet]. 2021 [acessado 2021 Aug 5]; 104(4). Available from: https://doi.org/10.1177/00368504211043365

33. Pedraza DF, Santos IS. Avaliação da vigilância do crescimento nas consultas de puericultura na Estratégia Saúde da Família em dois municípios do estado da Paraíba, Brasil. Epidemiol. serv. Saúde. 2017 [acessado 2021 Aug 5]; 26(4), 847–855. Disponível em: https://www.scielo.br/j/ress/a/nLgQXQ58v98WtZGxfsxmBkw/

34. Soares LE, Mezadri T, Nunes P. Operacionalização do Sistema de Vigilância Alimentar e Nutricional (SISVAN) no município de Balneário Piçarras: relato de experiência Rev. Bras. Promoç. Saúde (Impr.) [periódico na Internet]. 2017 [acessado 2021 Aug 5]; 30(2), [cerca de 4 p.]. Disponível em: https://doi.org/10.5020/18061230.2017.p283

35. Pedraza DF. Food and nutrition surveillance system in municipalities of paraíba: data reliability, coverage and management’s perception. Rev. Fac. Nac. Salud Pública [periódico na Internet]. 2017; 35(3): [cerca de 8 p.]. Disponível em: https://doi.org/10.17533/udea.rfnsp.v35n3a02

36. Brandão AL, Reis EC dos, Silva CVC da, Seixas CM, Casemiro JP. Estrutura e adequação dos processos de trabalhos no cuidado à obesidade na Atenção Básica brasileira. Saúde Debate [periódico na Internet]. 2020 [acessado 2021 Aug 5]; 44(126): [cerca de 15 p.]. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-11042020000300678&tlng=pt

37. Damião J J, Lobato E, Silva JP, Silva CVC, Castro LMC, Maldonado LA, Ribeiro AA. Condicionalidades de saúde no Programa Bolsa Família e a vigilância alimentar e nutricional: narrativas de profissionais da atenção primária à saúde. Cad. Saúde Pública (Online) [periódico na Internet]. 2021 [acessado 2021 Aug 5]; 37(10). Disponível em: https://doi.org/10.1590/0102-311x00249120

38. Pedraza, D. F. Estratégia Saúde da Família: contribuições das equipes de saúde no cuidado nutricional da criança. Cien Saude Colet [periódico na Internet]. 2021 [acessado 2021 Aug 5]; 26(5): [cerca de 13 p.]. Disponível em: https://doi.org/10.1590/1413-81232021265.04622021

39. Pereira SMPD, Brito LAMH, Palácio MAV, Monteiro M PA. Operacionalização do sistema de vigilância alimentar e nutricional em Juazeiro do Norte, Ceará. Rev. baiana saúde pública [periódico na Internet]. 2012 [acessado 2021 Aug 5]; 36(2). Disponível em: http://files.bvs.br/upload/S/0100-0233/2012/v36n2/a3256.pdf

40. Silva DI, Gonçalves JB, Plucheg VC, Mazza VA, Slomp Junior H. Reorganização da atenção a saúde da criança em Colombo, Paraná, Brasil. Rev. baiana saúde pública [periódico na Internet]. 2012 [acessado 2021 Aug 5]; 36(1). Disponível em: http://files.bvs.br/upload/S/0100-0233/2012/v36n1/a3013.pdf

41. Rocha ACD, Pedraza DF. Acompanhamento do crescimento infantil em unidades básicas de saúde da família do município de Queimadas, Paraíba, Brasil. Texto & contexto enferm. [periódico na Internet]. 2013 [acessado 2021 Aug 5]; 22(4): [cerca de 9 p.] Disponível em: https://doi.org/10.1590/S0104-07072013000400036

42. Siniak AMPS, Munhoz GMA. Structure of children’s basic health units: descriptive study. Online Brazilian Journal of Nursing [periódico na Internet]. 2013 [acessado 2021 Aug 5]; 12(3), 471–481. Disponível em: https://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=104138873&lang=pt-br&site=ehost-live&scope=site

43 Lima MAA, Oliveira MA, Ferreira HS. Reliability of anthropometric data obtained in children seen at the primary public healthcare service network in Alagoas, Brazil. Revista Brasileira de Epidemiologia [periódico na Internet]. 2010 [acessado 2021 Aug 5]; 13(1): [about 13 p.]. Disponível em: https://www.embase.com/search/results?subaction=viewrecord&id=L359043195&from=export

44. Silva LBA, Silva CA, Rezende FAC. Fragilidades da atuação do agente comunitário de saúde na vigilância alimentar e nutricional de crianças. Rev. enferm. atenção saúde [periódico na Internet]. 2015 [acessado 2021 Aug 5]; 4(1): [cerca de 7 p.]. Disponível em: http://seer.uftm.edu.br/revistaeletronica/index.php/enfer/article/view/1268/1139

45. Brasil. LEI nº 14284, de 29 de dezembro de 2021. Institui o Programa Auxílio Brasil e o Programa Alimenta Brasil; define metas para taxas de pobreza; altera a Lei nº 8.742, de 7 de dezembro de 1993; revoga a Lei nº 10.836, de 9 de janeiro de 2004, e dispositivos das Leis nos 10.696, de 2 de julho de 2003, 12.512, de 14 de outubro de 2011, e 12.722, de 3 de outubro de 2012; e dá outras providências. Brasília: Presidência da República; 2021.

46. Brasil. DECRETO nº 6.286, de 05 de dezembro de 2007. Institui o Programa Saúde na Escola - PSE, e dá outras providências. Brasília: Presidência da República; 2007.

47. Brasil. Ministério da Saúde. Secretaria de Atenção Primária à Saúde. Instrutivo Programa Crescer Saudável (2019/2020). Brasília; 2019. 21 p.

48. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Orientações para avaliação de marcadores de consumo alimentar na atenção básica Brasília: Ministério da Saúde; 2015. 33 p.

49. Fagundes AA, Damião JJ, Ribeiro RCL. Reflexões sobre os processos de descentralização da Política Nacional de Alimentação e Nutrição nos seus 20 anos. Cad. Saúde Pública [periódico na Internet]. 2021 [acessado 2022 Nov 25]; (37): [cerca de 1 p.]. Disponível em: https://www.scielo.br/j/csp/a/yrLKtKS5npfv3LrH6sHBWQM/

50. Campos DS; Fonseca P C. A vigilância alimentar e nutricional em 20 anos
da Política Nacional de Alimentação e Nutrição. Cad. Saúde Pública [periódico na Internet]. 2021 [acessado 2022 Nov 25]; (37). Disponível em: https://www.scielo.br/j/csp/a/8NcbkvZQW9LDPpdXzhL4JQC/

51 Brandão AL, Casemiro JP, dos Reis EC, Vitorino SAS, de Oliveira ASB, Bortolini GA. Recomendações para o fortalecimento da atenção nutricional na atenção primária à saúde brasileira. Rev Panam Salud Publica. 2022; 46:e119.
https://doi.org/10.26633/RPSP.2022.119

53. Cruz MM, Barros DC, Vitorino SAS. Avaliação das políticas de alimentação e nutrição: contribuições teóricas e práticas. Rio de Janeiro: Editora Fiocruz, 2023.

54. Cecccin RB. Educação Permanente em Saúde: desafio ambicioso e necessário. Debates Interface (Botucatu) [periódico na Internet]. 2005 Fev; 9(16). Disponível em: https://www.scielo.br/j/icse/a/jC4gdtHC8RPLWSW3WG8Nr5k/

55. Brasil. Ministério da Saúde. Secretaria de Gestão do Trabalho e da Educação na Saúde. Departamento de Gestão da Educação em Saúde. Política Nacional de Educação Permanente em Saúde. Brasília; 2009. 63p.

56. Lindner SR, Coelho EBS, Campos DA de, Warmling D, Faust SB, Conceição TB, et al. NURSING CARE FOR INDIVIDUALS WITH OVERWEIGHT AND OBESITY: CONTRIBUTIONS OF A REMOTE SPECIALIZATION COURSE. Texto contexto - enferm [Internet]. 2024;33:e20230297. Available from: https://doi.org/10.1590/1980-265X-TCE-2023-0297en

57. Portaria nº 2.246, de 18 de outubro de 2004. Institui e divulga orientações básicas para a implementação das Ações de Vigilância Alimentar e Nutricional, no âmbito das ações básicas de saúde do Sistema Único de Saúde - SUS, em todo o território nacional.Brasília: Ministério da Saúde; 2004.

58. Portaria nº 2.975, de 14 de dezembro de 2011. Apoiar financeiramente a estruturação da Vigilância Alimentar e Nutricional. Brasília: Ministério da Saúde; 2011.

59. Portaria nº 1.738, de 19 de agosto de 2013. Estabelece incentivo de custeio para estruturação e implementação de ações de alimentação e nutrição pelas Secretarias Estaduais e Municipais de Saúde com base na Política Nacional de Alimentação e Nutrição. Brasília: Ministério da Saúde; 2013.

60. Portaria nº 55, de 06 de janeiro de 2017. Estabelece incentivo de custeio para a estruturação e implementação de ações de alimentação e nutrição pelas Secretarias de Saúde dos municípios que possuem população entre 30.000 e 149.999 habitantes (IBGE) e do Distrito Federal, com base na Política Nacional de Alimentação e Nutrição (PNAN). Brasília: Ministério da Saúde; 2017.