Building training capacity for addressing the obesity epidemic

in the Americas

June 6th 2013

Building strong post graduate nutrition programs: The case of

Brazil

Gilberto Kac50.nutr@capes.gov.com.br

gilberto.kac@gmail.com

Presentation outline

1. Obesity and overweight profile in Brazil

2. The role of CAPES and CNPq agencies

3. Important indicators of the Brazilian science

4. Building training capacity in nutrition/obesity

Part I

Obesity and overweight profile in Brazil

Brazilian Nutritional Scenario

National surveys since (1970, 1980, 1990, 2003, 2006 & 2009)

ENDEF 1974-75; PNSN 1989; PNDS 1996 e 2006; POF 2008-2009; VIGITEL 2006 a 2009.

Overweight

Undernutrition

Déficit de altura para a idade

Excesso de peso Déficit de peso para a idade

0

2

4

6

8

10

12

14

16

13.4

7.3

2.5

6.8 7.4

1.6

19962006

Stunting wasting overweight

Nutritional status – children under 5 years Demographic Health Survey (DHS, 1996-

2006)

Trends of overweight – children and adolescents

(1974 – 2009)Children 5 to 9 years Adolescents

Stunting ObesityOverweight

boys girls boys girls boys girls

Overweight ObesityUndernutritionboys girls boys girls boys girls

Trends of overweight and obesity among adults (1974 – 2009)

Undernutrition Overweight Obesity

Male Female Male Female Male Female

masculino feminino total masculino feminino totalexcesso de peso obesidade

47.2

38.542.7

11.4 11.4 11.4

52.144.3

48.1

14.4 15.5 15

2006 2007 2008 2009 2010

Obesity and excessive weight (>= 18years) Vigitel 2006-2010.

Excessive weight: average population increase 1.08%/yrObesity: average population increase 0.72%/yr

Prevalence of overweight and obesity – beneficiaries from “Bolsa Família” Brazilian cash transfer program

(Brasil - SISVAN, 2010)

Meninas Meninos Meninas Meninos Feminino FemininoMenores de 5 anos 5 a 9 anos Adolescentes Adultos

16.2 18.1

23.527.2

17.3

45.0

8.1 9.5 9.913.0

4.0

15.7

Excesso de peso Obesidade

girls boys girls boys female femaleUnder 5 years 5 – 9 years adolescents adults

overweight obesity

Part II

The role of CAPES and CNPq agencies

Capes

is a foundation linked to the Ministry of Education whose mission is to build capacity in higher education and support the training and development of teachers of Basic Education

Main actions/mission

• Evaluation of the Brazilian Post Graduate system

• Fostering human resources qualification of high level in Brazil and abroad

• Initial and continuing training of Basic Education Teachers

Main actions/mission

• Promotion of international scientific cooperation/internationalization

• Access and dissemination of scientific information: Journals Portal

CNPq – National Council of scientific and technology development

Mission: Focused on research and scientists funding

• To promote the development of scientific and technologic research on all knowledge areas

• To promote and foment technologic innovation

CNPq – National Council of scientific and technology development

• To promote agreements, protocols, programs and interchange projects of technology among public and private, national and international institutions

Part III

Important indicators of the Brazilian science

CAPES – Brazilian Coordination Body for the Training of University Level

Personnel

Capes Geo system

1. Provides information on selected indicators year by year

2. http://geocapes.capes.gov.br/geocapesds/

Coordination of personnel for graduate studies – CAPES indicators

1. Number of post graduate scholarships (master and doctoral)

2. Number of post graduate programs

3. Number of professors of post graduate programs

4. Number of post graduate students

Concepts

• A program includes both a master and a doctoral

• A course includes only a master

CNPq – National Council of scientific and technology development

Brazil’s scientific trends

Dados ISI Web of Science cu=Brazil AND Document Type=(Article)

0,6% da prod. global

2% da prod. global

Scientific Production 2010All areas

Medicine 2010All categories

34

Scientific Production 2010

6

Parasitology Dentistry

Beauchesne scientific collaboration map

11,4 mil doutores titulados em 2009

38,8 mil mestres* titulados em 2009

Masters and PhD degrees granted by Brazilian institutions

38,800 masters in 2009

11,4 mil Phd’s in 2009

Investigators per million inhabitants

Baseado em dados do UNESCO Report, 2010

20022007

A low researcher per labor force ratio

Scientific specialization, 2008

Phd frequency and and HDI. Brazilian states

Dados de 2005

Part IV

Building training capacity in nutrition

How to evaluate capacity building

Indicators and sources

1. Number of post graduate programs in nutrition in Brazil

1.1 how many we are (map)1.2 how we are distributed across the country

2.1 CAPES thesis database

2.1.1 Number of thesis on obesity (1987-2012)

2.1.2 Number of thesis on childhood obesity (1987-2012)

Indicators/sources

2.1 CAPES thesis database

2.1.3 Number of dissertations on obesity (1987-2012)

2.1.4 Number of dissertations on childhood obesity (1987-2012)

3. Disciplines on obesity or correlated areas

4. Research lines and projects on obesity or correlated areas

5. Publications

Number of graduate programs in nutrition, how many we are and

how we are distributed

Decade 70 – 1 Program

UFPE (1971)

Decade 80 – 2 Programs

UFPE (1971)

UFRJ (1985)

Decade 90 – 5 programs

UFPE (1971)

UFRJ (1985)

UFPB (1995)

USP (1991)

UNIFESP (1991)

Decade 2000 (until 2006) – 11 Programs

UFPE (1971)

UFRJ (1985)

UFPB (1995)

USP (1991)UNIFESP (1991)

UNB (2000)UFV (2001)

UFSC (2002)

UFRN (2001)

UFBA (2005)

UFAL (2005)

Decade 2000 (until 2008) – 15 Programs

UFG (2008)

UFPE (2008)(Campus Avançado)

UERJ (2007)

UFMT (2008)

UFPE (1971)

UFRJ (1985)

UFPB (1995)

USP (1991)UNIFESP (1991)

UNB (2000)UFV (2001)

UFSC (2002)

UFRN (2001)

UFBA (2005)

UFAL (2005)

Decade 2000 (until 2009) – 17 Programs

UFPEL

UFOPUFG

UFPE(Campus Avançado)

UERJ

UFMT

UFPE (1971)

UFRJ (1985)

UFPB (1995)

USP (1991)UNIFESP (1991)

UNB (2000)UFV (2001)

UFSC (2002)

UFRN (2001)

UFBA (2005)

UFAL (2005)

23 graduate programs (2013)

UFMG

UFPR

UFRN

UFPEL

UFOPUFG

UFPE(Campus Avançado)

UERJ

UFMT

UFPE (1971)

UFRJ (1985)

UFPB (1995)

USP (1991)UNIFESP (1991)

UNB (2000)UFV (2001)

UFSC (2002)

UFRN (2001)

UFBA (2005)

UFAL (2005)

UECE

Comments

1. History of graduate programs in Brazil1. First master course was inaugurated only in 19712. Second course opened only in 1985 (14 years apart)

2. Recent increase on the number of programs (from 2000 on)

3. Network among coordinators

4. New area in CAPES. Very important issue

Number of professors, thesis, dissertations and papers according

programs

Total number of professors

181

Total number of thesis

154

Total number of dissertations

670

CAPES thesis database

Masters dissertations

• Nutrition

Masters dissertations

• Obesity

CAPES thesis database (examples of master’s dissertations on

obesity)

1. Evaluation of markers of inflammation and vitamin in obese patients with and without bariatric surgery indication.

2. The influence of obesity and body fat location in cardiovascular risk factors among adolescents in the central region in Juiz de Fora.

Masters dissertations

• Childhood obesity

CAPES thesis database (examples)

1. The exclusive breastfeeding until 6 months, as a protective factor in the development of childhood obesity;

2. Childhood Obesity: Prevalence, Environmental Influences, Metabolic Alterations and Quality of Life in School from Pontal do Araguaia

Doctorate thesis

• Nutrition

Doctorate thesis

• Obesity

CAPES thesis database (examples)

1. Relationship between physical activity and nutritional status and biochemical markers in adolescents from public schools in Piracicaba, São Paulo;

2. Overweight and Metabolic Syndrome in teens: prevalence and associated factors

Doctorate thesis

• Childhood obesity

CAPES thesis database (examples)

1. Study of body image, stress and food preferences in adolescents and their caregivers;

2. Effect of nutrition education based on the adequacy of the portioning of food, change in body composition in obese adolescents treated in an outpatient clinic.

Disciplines tought

1. Nutritional epidemiology

2. Nutrition and health in different life cycles

3. Genetics of obesity

4. Obesity across the life-course

Research lines

1. Epidemiology of nutritional problems

2. Descriptive epidemiology of health, food and nutritional problems

3. Nutrition epidemiology

4. Epidemiology of the nutritional problems

Projetcs

1. Metabolic Syndrome and Childhood Obesity

2. Eating and Nutritional Disorders: the Polarization Between the New and the Old Evils in the Context of the Epidemiological Transition

3. Fatty acid concentrations during pregnancy and excessive weight gain

Programs - Bibliographic production

• Ten-year increase in the prevalence of obesity and reduction of fat intake in brazilian women 35 years and older. Journal of Epidemiology and Community Health (1979), V. 64, 3, 252-254

Programs - Bibliographic production

• Short stature of mothers from an area endemic for undernutrition is associated with obesity, hypertension and stunted children: a population-based study in the semi-arid region of Alagoas, Northeast Brazil. British Journal of Nutrition. 12-18.

Programs - Bibliographic production

• Perinatal undernutrition-induced obesity is independent of the developmental programming of feeding. Physiology & Behavior. 96:481-492

Developing leadership programs

• A comprehensive approach to capacity building is required.

– This needs to recognise the importance of workforce development,

– Leadership development – Academic institutional strengthening– Organisational development and partnerships

Developing leadership programs

• There is merit in developing international competency standards specific to public health nutrition workforce development that recognise different workforce tiers (frontline, manager, specialist) and different practice contexts (under- and overnutrition).

Developing leadership programs

• There is considerable overlap in the competencies needed by a public health nutritionist in dealing with over- or under nutrition. A core set of competencies are equally valid in either setting, with different emphases depending on the context.

Profile of potential lidearships

• Broad vision of nutrition (there is no need to be a specialist on all aspects on nutrition, but know well the complex determination)

• Sense of opportunity,

• Capacity of dialogue with several fields of kwnoledge (scientific, popular and traditional)

• Ability to connect the different stakeholders

Conclusions1. Overweight and obesity are important epidemiologic

problems in Brazil

2. Brazilian agencies such as Capes and Cnpq play a very important role on the recent positive trends of indicators such as number of masters and phds granted, scientific papers published, grants and others

3. There is a lack of a program of leadership on capacity building either on nutrition or obesity

Gilberto Kac Professor Titular

gilberto.kac@gmail.com

Observatório de Epidemiologia Nutricional

Universidade Federal do Rio de Janeiro