Association of neighbourhood food availability with the consumption of processed and ultra-processed food products by children in a city of Brazil: a multilevel analysis.

OBJECTIVE: To investigate the association between neighbourhood food availability and the consumption of ready-to-consume products (RCP), either processed or ultra-processed, and unprocessed/minimally processed foods (UF-MPF) by children. DESIGN: Cross-sectional. 24 h Dietary recalls were collected from children from January 2010 to June 2011. Neighbourhood food availability data were collected from 672 food stores located within 500 m of participants' homes, using an adapted and validated instrument. Neighbourhood-level socio-economic status (SES) was obtained by calculating the mean years of household head's education level in each census tract covered by 500 m buffers. Foods that were consumed by children and/or available in the food stores were classified based on their degree of industrial processing. Multilevel random-effect models examined the association between neighbourhood food availability and children's diets. SETTING: Santos, Brazil. SUBJECTS: Children (n 513) under 10 years old (292 aged <6 years, 221 aged ≥6 years). RESULTS: The availability of RCP in food stores was associated with increased RCP consumption (P<0·001) and decreased UF-MPF consumption (P<0·001). The consumption of UF-MPF was positively associated with neighbourhood-level SES (P<0·01), but not with the availability of UF-MPF in the neighbourhood. CONCLUSIONS: Results suggest that food policies and interventions that aim to reduce RCP consumption in Santos and similar settings should focus on reducing the availability in food stores. The results also suggest that interventions should not only increase the availability of UF-MPF in lower-SES neighbourhoods, but should strive to make UF-MPF accessible within these environments.

Are campus food environments healthy? A novel perspective for qualitatively evaluating the nutritional quality of food sold at foodservice facilities at a Brazilian university.

AIMS: The purpose of this novel study was to evaluate the food environment at a Brazilian university, encompassing 6 restaurants and 13 snack bars. The investigation uniquely analyses the food environment (barriers, facilitators, type of foods and prices). This was a food-based analysis of the nutritional quality of the products sold on campus. METHODS: A cross-sectional descriptive design was used, applying the classic Nutrition Environment Measures Survey-Restaurants (NEMS-R) adapted for Brazil and an original methodology to evaluate and classify qualitatively the nutritional quality and characteristics of the food. A census of all campus food environments was applied. RESULTS: The main results show most food and beverage products were made with processed ingredients and had a lower nutritional quality and price when compared with similar products made on premises, that is, processed iced tea compared with fresh tea ( p < .001), fried refined flour salgados compared with baked wholegrain flour salgados ( p < .001) and refined flour biscuits compared with those made with whole grains ( p = .028). Only 16% of the outlets provided food ingredients or nutritional information of products available. CONCLUSION: The overall options for healthy food choices and good nutritional quality on campus were mostly limited by the availability and higher prices of products. These findings could be used to develop new policy perspectives for the offering of healthy food items and to facilitate better food choices among students in a healthier food environment.

Conflitos de interesses nas estratégias da indústria alimentícia para aumento do consumo de alimentos ultraprocessados e os efeitos sobre a saúde da população brasileira / Conflicts of interest of the strategy of food industry to increase the consumption of ultraprocessed foods and the health effects of the Brazilian population

As doenças crônicas não transmissíveis, em 2010, foram responsáveis por mais de 18 milhões de mortes no mundo; em 2014, a prevalência do excesso de peso representou 2,1 bilhões. No Brasil, o excesso de peso afeta 51% da população. Existem muitas evidências de que os alimentos ultraprocessados (biscoitos recheados, salgadinhos de pacote, refrigerantes e fast food) colaboram para essa epidemia por apresentarem combinações de ingredientes que os tornam altamente palatáveis (açúcar, sal, gordura e aditivos químicos) e que prejudicam os mecanismos de controle do apetite. Os principais fatores que contribuíram para o aumento no consumo desses alimentos foram o fortalecimento da economia, elevação do poder de compra, campanhas de marketing, bem como comodidade, conveniência e seu menor custo. A indústria de alimentos tem utilizado estratégias de formação de opinião, como a exposição no espaço midiático com campanhas maciças para a promoção desses produtos e ações com foco em profissionais da saúde por meio do patrocínio de eventos científicos e de organizações não governamentais. Os conflitos de interesse na produção científica são crescentes e a análise de estudos financiados pela indústria tem mostrado que os desfechos são muito frequentemente favoráveis ao patrocinador do estudo. Este ensaio tem o objetivo de discutir a influência da indústria alimentícia no aumento do consumo de alimentos ultraprocessados e o efeito sobre a saúde da população brasileira. Pretende-se contribuir para o processo de transformação de práticas e princípios, bem como para uma ampliação dessa discussão com transparência e equidade, a fim de manter o interesse da população brasileira em primeiro lugar.(AU)

Noncommunicable chronic diseases in 2010, accounted for over 18 million deaths worldwide; in 2014, the prevalence of overweight represented 2.1 billion. In Brazil, overweight affects 51% of the population. Ultra-processed foods as sandwich cookies, pack snacks, soft drinks and fast food, collaborate to this epidemic by presenting combinations of ingredients that make them highly palatable (sugar, salt, fat and chemical additives) and damage mechanisms of control of appetite. The main factors that contributed to the increase in the consumption of these foods were the strengthening of the economy, the increase in purchasing power, marketing campaigns, as well as the comfort, convenience and its lower cost. The food industry has used opinion formation strategies, such as exposure in the media with massive campaigns to promote these products and initiatives focused on health professionals through sponsorship of scientific events and non-governmental organizations. Conflicts of interest in scientific production are increasing and analysis of studies funded by industry has shown that the outcomes are favorable to the study sponsor. This trial aimed to discuss the influence of the food industry in the increased consumption of ultra-processed food and the effects on health of the Brazilian population. Thus, ther may be a contribution to the process in the transformation of practices and principles, as well as an extension of this discussion with transparent and fair discussion, keeping the interest of the Brazilian population first..(AU)

Family meals and eating practices among mothers in Santos, Brazil: A population-based study.

This study investigates family meals among mothers and explores associations between eating with family and sociodemographic characteristics, body mass index, and eating practices. A population-based cross-sectional study, using complex cluster-sampling, was conducted in the city of Santos, Brazil with 439 mothers. Frequency of family meals was assessed by asking if mothers did or did not usually have a) breakfast, b) lunch, and c) dinner with family. Linear regression analyses were conducted for the number of meals eaten with family per day and each of the potential explanatory variables, adjusting for the mother's age. Poisson regression with robust variance was used to analyze each factor associated with eating with family as classified categorically: a) sharing meals with family, b) not eating any meals with family. Only 16.4% (n = 72) of participants did not eat any meals with family. From the 83.6% (n = 367) of mothers that had at least one family meal per day, 69.70% (n = 306) ate dinner with their families. Mothers aged ≥40 years reported significantly fewer meals eaten with family compared to mothers aged 30-39 years (ß: -0.26, p = 0.04). Having family meals was 54% more prevalent among mothers with ≥12 years of education (PR for no meals eaten with family: 0.54, 95% CI: 0.30; 0.96, p = 0.03), when compared to mothers with less than nine years of education. Eating no meals with family was 85% more prevalent among mothers who reported that eating was one of the biggest pleasures in their lives (PR: 1.85, 95% CI: 1.21; 2.82, p = 0.004). We suggest the need for further research investigating the effects of family meals on mothers' health through nutritional and phenomenological approaches.

Atenção nutricional no pré-natal e no puerpério: percepção dos gestores da Atenção Básica à Saúde / The nutritional care during the prenatal and postpartum: Perceptions of managers of Primary Health Care

RESUMO Objetivo: Avaliar a percepção dos gestores quanto à atenção nutricional ao pré-natal e ao puerpério na rede básica de município da Baixada Santista, São Paulo, segundo estrutura e processo. Métodos: Realizou-se censo das 28 unidades básicas da área insular por meio de entrevistas com gestores. Avaliou-se a atenção nutricional segundo infraestrutura, processo de trabalho e vigilância alimentar e nutricional. Resultados: A inserção do nutricionista foi o principal componente insuficiente da dimensão estrutura, interferindo negativamente na atenção nutricional para 60% dos gestores. Encontrou-se baixa conformidade para as seguintes variáveis da dimensão processo: cálculo do índice de massa corporal (35%), acompanhamento do estado nutricional na curva índice de massa corporal/semana gestacional (46%) e realização de aconselhamento nutricional individualizado no pré-natal (14%). Conclusão: A atenção nutricional pré-natal e puerperal é insatisfatória para alcançar a integralidade do cuidado. Faz-se necessário sensibilizar gestores locais e capacitar equipes de saúde para assegurar a efetividade de tais ações em Santos.

ABSTRACT Objective: To evaluate the perception of managers regarding the nutritional care to prenatal and postpartum in Primary Health Units in Southern,São Paulo, Brazil. Methods: It was conducted a census of 28 Primary Health Units from the insular area, using interviews with managers. The nutritional care was assessed according to infrastructure, work process and food and nutrition surveillance. Results: The insertion of dietitians was the main insufficient component of dimension structure, interfering negatively on nutritional care for 60% of managers. It was founded low compliance for the following variables of the process dimension: calculate the body mass index (35%), monitoring of nutritional status in body mass index/gestational week curve (46%) and conducting individualized nutritional counseling in antenatal (14%). Conclusion: Prenatal and postpartum nutritional care is unsatisfactory to achieve comprehensive care. It is necessary to sensitize local manager's awareness and qualify the health teams to ensure the effectiveness of such actions in Santos.

Factors associated with abdominal obesity in children / Fatores associados ao acúmulo de gordura abdominal em crianças

Objective: To identify the association of dietary, socioeconomic factors, sedentary behaviors and maternal nutritional status with abdominal obesity in children. Methods: A cross-sectional study with household-based survey, in 36 randomly selected census tracts in the city of Santos, SP. 357 families were interviewed and questionnaires and anthropometric measurements were applied in mothers and their 3-10 years-old children. Assessment of abdominal obesity was made by maternal and child's waist circumference measurement; for classification used cut-off points proposed by World Health Organization (1998) and Taylor et al. (2000) were applied. The association between variables was performed by multiple logistic regression analysis. Results: 30.5% of children had abdominal obesity. Associations with children's and maternal nutritional status and high socioeconomic status were shown in the univariate analysis. In the regression model, children's body mass index for age (OR=93.7; 95%CI 39.3-223.3), female gender (OR=4.1; 95%CI 1.8-9.3) and maternal abdominal obesity (OR=2.7; 95%CI 1.2-6.0) were significantly associated with children's abdominal obesity, regardless of the socioeconomic status. Conclusions: Abdominal obesity in children seems to be associated with maternal nutritional status, other indicators of their own nutritional status and female gender. Intervention programs for control of childhood obesity and prevention of metabolic syndrome should consider the interaction of the nutritional status of mothers and their children.

Objetivo: Identificar fatores individuais (dietéticos, comportamento sedentário) e familiares (estado nutricional materno e nível socioeconômico) associados com o acúmulo de gordura abdominal de crianças. Métodos: Estudo de delineamento transversal de base domiciliar, em 36 setores censitários sorteados aleatoriamente na cidade de Santos/SP. Foram entrevistadas 357 famílias para aplicação de questionários e aferição de medidas antropométricas em mães e crianças de 3-10 anos. A avaliação do acúmulo de gordura abdominal foi feita pela medida da circunferência da cintura de mães e crianças com o uso da recomendação da Organização Mundial da Saúde (1998) e a proposta de Taylor et al. (2000), respectivamente. A associação entre as variáveis foi verificada por meio de regressão logística múltipla. Resultados: Verificou-se que 30,5% das crianças apresentaram acúmulo de gordura abdominal. Na análise univariada, o acúmulo de gordura abdominal esteve associado ao estado nutricional materno e da criança e ao nível socioeconômico elevado. Na análise multivariada, foram observadas associações com excesso de peso pelo índice de massa corporal para idade (OR=93,7; IC95% 39,3-23,3); ser do sexo feminino (OR=4,1; IC95% 1,8-9,3) e acúmulo de gordura abdominal materno (OR=2,7; IC95% 1,2-6); independentemente do nível socioeconômico. Conclusões: O acúmulo de gordura abdominal em crianças mostrou-se associado ao estado nutricional materno, aos indicadores de seu próprio estado nutricional e ao sexo feminino. Programas de intervenção para controle da obesidade infantil e prevenção da síndrome metabólica relacionada ao acúmulo de gordura abdominal devem levar em consideração a interação do estado nutricional de mães e seus filhos.

Food environment and fruit and vegetable intake in a urban population: a multilevel analysis.

BACKGROUND: Environmental, social and individual factors influence eating patterns, which in turn affect the risk of many chronic diseases. This study aimed to estimate associations between environmental factors and the consumption of fruit and vegetables among adults in a Brazilian urban context. METHODS: Data from the surveillance system for risk factors for chronic diseases (VIGITEL) of Brazilian Ministry of Health were used. A cross-sectional telephone survey (VIGITEL - 2008-2010) was carried out with 5826 adults in the urban area of Belo Horizonte. Individual variables were collected. The frequency of fruit and vegetables consumption was assessed from number of servings, weekly frequency and an intake score was calculated. Georeferenced variables were used to characterize the food environment. The density of healthy food outlets (stores specialized in selling fruit and vegetables), unhealthy food outlets (bars, snack bars and food trucks/trailers) and the neighborhood family income were investigated and associated with fruit and vegetables intake score. Weighted multilevel linear regression was used to evaluate the associations between the environment variables and the fruit and vegetables intake score. RESULTS: Higher fruit and vegetables intake scores were observed in neighborhoods with higher density of healthy food outlets and higher income. Lower scores were observed in neighborhood with higher density of unhealthy food outlets. These associations were adjusted by individual variables such as gender, age, physical activity, sugar sweetened beverages consumption, education level and smoking. DISCUSSION: The food environment might explain some of the socioeconomic disparities with respect to healthy food intake and health outcomes. Healthy food stores are less common in socially disadvantaged neighborhoods, and therefore, healthy foods such as fruits and vegetables are less available or are of a lower quality in lower income areas. CONCLUSION: Food environment characteristics and neighborhood socioeconomic level had significant associations with fruit and vegetable intake score. These are initial findings that require further investigation within the middle income world populations and the role of the environment with respect to both healthy and unhealthy food acquisition and intake.

Patterns of Food Consumption are Associated with Obesity, Self-Reported Diabetes and Cardiovascular Disease in Five American Indian Communities.

The relationship between dietary patterns and chronic disease is underexplored in indigenous populations. We assessed diets of 424 American Indian (AI) adults living in 5 rural AI communities. We identified four food patterns. Increased prevalence for cardiovascular disease was highly associated with the consumption of unhealthy snacks and high fat-food patterns (OR 3.6, CI=1.06, 12.3; and OR 6.0, CI=1.63, 22.1), respectively. Moreover, the food-consumption pattern appeared to be different by community setting (p<.05). We recommend culturally appropriate community-intervention programs to promote healthy behavior and to prevent diet-related chronic diseases in this high-risk population.

Regional food dishes in the Brazilian National School Food Program: Acceptability and nutritional composition / Preparações regionais no Programa Nacional de Alimentação Escolar: aceitabilidade e composição nutricional

Objective: the objective of this study was to evaluate the nutritional composition and describe the acceptability of regional culinary dishes served to students from public schools of rural and urban areas. Methods: Ten Brazilian regional dishes were evaluated for acceptability and nutritional composition. the survey was conducted in schools located in rural and urban areas of two cities in the state of São Paulo. Dish acceptability was evaluated using leftover analysis and a 5-point facial hedonic scale. the adherence index was calculated and used as an indirect measure of acceptance, and the nutritional composition was calculated based on the technical files of each dish. Results: A total of 2,384 students from 20 schools participated in the study and 1,174 tasted and evaluated the dishes. the test using the 5-point facial hedonic scale demonstrated that five dishes (Caldo verde soup, persimmon jelly, chicken with okra, puréed cornmeal with spinach, and arugula pizza) had an acceptability rate above 85.0%. the mean adherence indices were 57.3% and 55.6% in urban and rural environments, respectively. Analysis of the nutritional composition of regional dishes indicates that these dishes can partially meet macronutrient recommendations. Conclusion: the tested dishes can become part of school menus as they were accepted or partly accepted by the students regardless of school location, whether rural or urban. the cultural heritage is an important resource for the food sovereignty of a country and should be constantly encouraged. .

Objetivo: Avaliar a composição nutricional e descrever a aceitabilidade de preparações regionais servidas aos estudantes de escolas públicas de áreas rurais e urbanas. Métodos: Dez preparações regionais brasileiras foram avaliadas quanto à aceitabilidade e à composição nutricional. A pesquisa foi realizada em escolas localizadas em áreas rurais e urbanas de duas cidades no estado de São Paulo. A aceitabilidade dos alimentos foi avaliada por meio da análise de restos e da escala hedônica facial de 5 pontos. O índice de adesão foi calculado e utilizado como medida indireta da aceitação. A composição nutricional foi calculada com base nas fichas técnicas de cada prato. Resultados: Participaram do estudo 2 384 estudantes de 20 escolas públicas; destes, 1 174 provaram e avaliaram os pratos. A avaliação por meio da escala hedônica facial de 5 pontos demonstrou que cinco pratos (caldo verde, geleia de caqui, frango com quiabo, angu com espinafre e pizza de rúcula) tiveram um percentual de aceitabilidade acima de 85,0%. O percentual médio de adesão à alimentação escolar foi de 57,3% e 55,6% em escolas urbanas e rurais respectivamente. A análise da composição nutricional das preparações regionais indicou que os pratos testados podem ser fontes de vários micronutrientes e atender parcialmente as recomendações de macronutrientes exigidas pela legislação. Conclusão: Os pratos testados podem tornar-se parte do cardápio escolar, pois foram aceitos ou parcialmente aceitos pelos alunos, independentemente da localidade da escola. O patrimônio cultural é um recurso importante para a soberania alimentar de um país e deve ser constantemente estimulado. .

Eating practices and habitus in mothers. A Brazilian population-based survey.

A population-based cross-sectional study was conducted with mothers living in the city of Santos, Brazil, in order to investigate their eating practices, and the interface between those practices and the concept of habitus. From a cluster analysis of the scores for dietary pattern and for food preparation and consumption, the mothers were categorised into five clusters of eating practices: practical mothers (19.8%), symbiotic mothers (3.2%), health-conscious hedonists (17.3%), traditionalists (34.6%), and family cooks (25.1%). To access the habitus of the eating-practice clusters, the following variables were compared: location of residence, profession, socioeconomic status, weight-loss practices, risk behaviours for eating disorders, disordered eating attitudes, body dissatisfaction, and cultural and technological consumption. For all the groups, the observed eating practices were permeated by responsibility for the family's diet, but with different manifestations. For symbiotic mothers, practical mothers, and family cooks, the primary function of their relation with food was to nourish their families, with little expression of their own tastes and preferences. The traditionalists and the health-conscious hedonists, on the other hand, manifested their role as mothers by providing food considered 'nutritionally proper' to their family members. Furthermore, aspects of contemporary lifestyles, such as little time for food, individualisation of meals, and consumption of processed foods, were found to coexist with the valorisation and maintenance of the traditional meals within some groups. The variety of eating practices could not be understood as a linear association between economic and cultural capitals; however, eating practices seemed to interact with those capitals, composing a habitus.

Changing the Food Environment for Obesity Prevention: Key Gaps and Future Directions.

The food environment has a great impact on the nutritional health of the population. Food environment interventions have become a popular strategy to address the obesity epidemic. However, there are still significant gaps in our understanding of the most effective strategies to modify the food environment to improve health. In this review, we examine key gaps in the food environment intervention literature, including the need for: developing appropriate formative research plans when addressing the food environment; methods for selecting intervention domains and components; incorporating food producers and distributors in intervention strategies; strengthening evaluation of environmental interventions; building the evidence base for food environment interventions in diverse settings; engaging policy makers in the process of modifying the food environment; and creating systems science models to examine the costs and benefits of a potential program or policy on the food environment prior to implementation. In addition, we outline the need for strategies for addressing these issues including conducting additional pilot interventions, developing additional methodologies, and embracing the use of simulation models.

Prática de atividade física e perfil nutricional de mães com filhos de até 10 anos de idade residentes na área urbana do município de Santos-SP / Physical activity and nutritional status of mothers with children under 10 years old residents of an urban area in Santos, Brazil

In this study, we aimed to describe the physical activity level and nutritional status of mothers with children under 10 years old living in different socioeconomic areas in the municipality of Santos, Sao Paulo state, Brazil. To this end, we used a cross-sectional design and collected data on physical activity level, means of transportation, anthropometric measures, and socioeconomic status through home-based interviews in a sample of 538 mothers. The physical activity level of individuals was assessed by a short version of the International Physical Activity Question¬naire (IPAQ). We used the Chi-square ande Kruskal-Wallis tests to assess the difference in physical activity level among various socioeconomic areas of the city and evaluate the association between this outcome and the nutritional status of women. We found a high prevalence of women with little activity (43.7%) and a high frequency of women who do not practice leisure-time physical activity (79.2%). When practice occurs, the most common exercises are walking (10.4%) and working out (9.1%). We also found a high prevalence of excess body fat (74.3%) and overweight (52%) among this population. A higher prevalence of leisure-time physical activity was found among participants from high-income areas. Thus, we recommend that new strategies to promote physical activity should take into account socioeconomic inequalities and cultural differences that can affect the physical activity level of the population.

Describir la práctica de actividad física y el perfil nutricional de la población de madres con hijos de hasta 10 años de edad, residentes en diferentes regiones socioeconómicas del municipio de Santos. El estudio tuvo un diseño transversal y los datos se recogieron por medio de encuestas domiciliarias con una muestra de 538 madres. Se preguntó sobre nivel de actividad física, medios de transporte utilizados, medidas antropométricas y datos socioeconómicos. El nivel de actividad física se evaluó por medio del instrumento International Physical Activity Questionnaire (IPAQ ? versión breve). Se evaluó la diferencia en el nivel de actividad física entre las regiones de la ciudad y se asoció dicha variable con el estado nutricional de las mujeres, por medio de los tests de Kruskal-Wallis y Chi-cuadrado. Se encontró una alta prevalencia de mujeres poco activas (43,7%) y una alta frecuencia de mujeres que no practican actividad física en su tiempo libre (79,2%). Las actividades de tiempo libre más frecuentes fueron caminatas (10,4%) y musculación (9,1%). También se encontró una alta prevalencia en el exceso de grasa corporal (74,3%) y sobrepeso (52%) en esta población. Se encontraron diferencias en el perfil de actividad física de la población, dependiendo, éstas, de la región de residencia. Se pudo verificar una mayor prevalencia de actividad física en el tiempo libre entre los residentes de las regiones de mayor nivel socioeconómico. Por lo tanto, se recomienda que las nuevas estrategias de incentivo a la actividad física tengan en cuenta las desigualdades socioeconómicas y culturales que influyen en el nivel de actividad física.

Descrever a prática de atividade física e o perfil nutricional da população de mães com filhos de até 10 anos de idade, residentes nas diferentes regiões socioeconômicas do município de Santos-SP. O estudo teve delineamento transversal e os dados foram coletados por meio de entrevistas domiciliares com uma amostra de 538 mães. Foram investigadas questões sobre o nível de atividade física, os meios de transporte utilizados, as medidas antropométricas e os dados socioeconômicos. O nível de atividade física foi avaliado por meio do instrumento International Physical Activity Questionnaire (IPAQ - versão curta). Foi avaliada a diferença no nível de atividade física entre as regiões da cidade e a associação dessa variável com o estado nutricional das mulheres, por meio dos testes de Kruskal-Wallis e Qui-quadrado. Foi observada alta prevalência de mulheres pouco ativas (43,7%) e alta frequência de inatividade física no lazer (79,2%). As atividades de lazer mais praticadas foram caminhada (10,4%) e musculação (9,1%). Encontrou-se também uma alta prevalência de excesso de gordura corporal (74,3%) e excesso de peso (52%) nesta população. Diferenças no perfil de atividade física da população apareceram de acordo com a região de moradia. Foi possível verificar maior prevalência de atividade física no domínio do lazer entre os residentes das regiões de maior nível socioeconômico. Recomenda-se que novas estratégias de incentivo à atividade física considerem as disparidades socioeconômicas e culturais que influenciam o nível de atividade física.

A importância do tratamento em hospital-dia para a criança com subnutrição primária / The importance of treatment in day hospitals for children with primary malnutrition

Avaliou-se o impacto de fatores socioeconômicos, maternos, frequência ao tratamento e frequência de infecções, parasitoses e anemia no incremento de estatura para idade (E/I) em crianças (< 5 anos) submetidas a tratamento em hospital-dia no Centro de Recuperação e Educação Nutricional (n = 57). Doenças respiratórias superiores foram as mais frequentes com associação positiva com a gravidade da subnutrição (p = 0,035) e a idade na admissão (p = 0,001). Em análise de regressão múltipla a gravidade da subnutrição, o baixo nível de hemoglobina, menor renda familiar e frequência no serviço foram fatores preditivos (p < 0,05) para maior incremento de E/I. Os achados mostram a importância do tratamento em hospital-dia para o tratamento de crianças subnutridas.

Availability of processed foods in the perimeter of public schools in urban areas.

OBJECTIVES: To assess the availability of food in relation to their degree of industrial processing and the types of food stores in the perimeters of elementary schools. METHODS: This is a cross-sectional study. 82 food stores located within a 500 m radius buffer of three public schools located in three distinct regions with different socioeconomic levels in the municipality of Santos, state of São Paulo, Brazil, were assessed. All streets within a 500-meter radius of the schools were covered, geographic coordinates were recorded and information about the stores and food items available were collected by direct observation and interview with store managers. Available food items were classified in relation to their degree of industrial processing as ultra-processed foods and minimally processed foods. Kernel's density maps were used to assess the degree of agglomeration of stores near the schools. RESULTS: The stores that offered mostly ultra-processed foods were significantly closer to schools than those who offered mostly minimally processed foods. There was a significant difference between the availability of processed food in different types of stores and between the three regions assessed. CONCLUSIONS: The data found by this work evidence that children who attend the three public schools assessed are exposed to an environment that encourages the consumption of ultra-processed foods through easier access of these products in the studied stores.

Oferta de alimentos processados no entorno de escolas públicas em área urbana / Availability of processed foods in the perimeter of public schools in urban areas

OBJETIVO: Avaliar a disponibilidade de alimentos comercializados em relação ao seu grau de processamento industrial e os tipos de comércios existentes nos perímetros de escolas de ensino fundamental. MÉTODOS: O estudo teve delineamento transversal, e foram avaliados 82 comércios localizados a um raio de 500 metros de três escolas públicas situadas em regiões distintas do município de Santos, que apresentam diferentes níveis socioeconômicos. Foram percorridas todas as ruas existentes nos perímetros das escolas, considerando-se um raio de 500 metros para delimitação da área, tendo sido registradas as coordenadas geográficas e coletadas informações sobre os pontos de venda e sobre os alimentos comercializados, por meio de observação e entrevista com os responsáveis pelo estabelecimento. Os alimentos encontrados foram classificados, em relação ao seu grau de processamento industrial, em: alimentos ultraprocessados e alimentos minimamente processados. Para a avaliação do grau de aglomeração dos estabelecimentos nos perímetros das escolas, foram utilizados mapas de densidade de Kernel. RESULTADOS: Os pontos de vendas que ofertavam, em sua maioria, alimentos ultraprocessados estavam significativamente mais próximos das escolas do que aqueles que ofertavam maioria de alimentos com menor grau de processamento. Observou-se diferença estatisticamente significativa entre a oferta desses alimentos nas diferentes categorias de comércios e entre as três regiões avaliadas. CONCLUSÕES: Os dados existentes neste trabalho evidenciam que as crianças que frequentam as três escolas públicas avaliadas estão expostas a um ambiente que incentiva o consumo de alimentos ultraprocessados por meio de um acesso facilitado nos comércios investigados.

OBJECTIVE: To assess the availability of food in relation to their degree of industrial processing and the types of food stores in the perimeters of elementary schools. METHOD: This is a cross-sectional study. 82 food stores located within a 500 m radius buffer of three public schools located in three distinct regions with different socioeconomic levels in the municipality of Santos, state of São Paulo, Brazil, were assessed. All streets within a 500-meter radius of the schools were covered, geographic coordinates were recorded and information about the stores and food items available were collected by direct observation and interview with store managers. Available food items were classified in relation to their degree of industrial processing as ultra-processed foods and minimally processed foods. Kernel's density maps were used to assess the degree of agglomeration of stores near the schools. RESULTS: The stores that offered mostly ultra-processed foods were significantly closer to schools than those who offered mostly minimally processed foods. There was a significant difference between the availability of processed food in different types of stores and between the three regions assessed. CONCLUSIONS: The data found by this work evidences that children who attend the three public schools assessed are exposed to an environment that encourages the consumption of ultra-processed foods through easier access of these products in the studied stores.

Factors associated with overweight in children living in the neighbourhoods of an urban area of Brazil.

OBJECTIVE: The present study aimed to investigate the individual and family determinants of being overweight among children younger than 10 years of age. DESIGN: Cross-sectional survey. Direct data on children's age, food intake, physical activity, type of transportation used and anthropometric measurements, as well as the education level of the mothers, were collected by trained interviewers. SETTING: Population-based study in the city of Santos, Brazil. SUBJECTS: A total of 531 children under 10 years of age (302 aged <6 years, 229 aged ≥6 years), living in the city of Santos. RESULTS: The overall prevalence of overweight and obesity (BMI-for-age Z-score >1) was 35·4 % for children under 6 years and 38·9 % for children aged 6-10 years. The socio-economic status of the family was associated with being overweight for both age groups. Logistic regression analysis showed that the lower the socio-economic status, the higher the likelihood of being overweight, among both younger children (OR = 7·73; P = 0·02) and older children (OR = 1·98; P = 0·04). The use of active transportation was associated with a lower likelihood of being overweight, but only among younger children (OR = 1·70; P = 0·05). CONCLUSIONS: Socio-economic status seems to be an important individual-level determinant of overweight in children. Public policies should consider promoting the use of active transportation, as the results showed it to have a positive effect on reducing overweight issues. The high prevalence of overweight in younger children suggests that this age group should be a priority in health-promoting interventions.

Insatisfação corporal, prática de dietas e comportamentos de risco para transtornos alimentares em mães residentes em Santos / Body dissatisfaction, dieting and risk behaviors for eating disorders among mothers living in Santos

OBJETIVO: Avaliar a insatisfação corporal, a prática de dietas e os comportamentos de risco para transtornos alimentares em uma amostra de mães residentes no município de Santos. MÉTODOS: Foi realizado um estudo transversal, de base populacional, com 453 mães de filhos com até 10 anos de idade. As mães responderam ao Teste de Atitudes Alimentares (EAT-26), à Escala de Figuras de Stunkard e a uma questão sobre a prática atual de dietas. RESULTADOS: Das mães, 29,9% apresentaram escore positivo para os comportamentos de risco para transtornos alimentares e 21,8% estavam fazendo dieta para emagrecer no momento da entrevista. No tocante à imagem corporal, 17,5% das mães estavam satisfeitas com o seu tamanho corporal, 71,5% gostariam de diminuir seu tamanho corporal e 11,0% gostariam de aumentá-lo. Os comportamentos de risco para transtornos alimentares foram mais frequentes nas mães insatisfeitas com seus tamanhos corporais (p < 0,0001). CONCLUSÃO: A maioria das mães investigadas estava insatisfeita com os seus tamanhos corporais. A frequência de mães que praticavam dietas ou tinham comportamentos de risco para transtornos alimentares foi similar ou superior aos demais estudos nacionais, conduzidos, em sua maioria, com populações consideradas de risco, como meninas adolescentes e jovens universitárias.

OBJECTIVE: To evaluate body dissatisfaction, dieting and risk behaviors for eating disorders among a sample of mothers living in the city of Santos. METHODS: It was conducted a cross-sectional population-based study with 453 mothers of children aged until 10 years old. The mothers answered to the Eating Attitudes Test (EAT-26), the Stunkard's Figure Scale and a question about being currently dieting. RESULTS: 29.9% presented a positive score for risk behaviors for eating disorders and 21.8% were currently dieting. Regarding body image, 17.5% of the mothers were satisfied with their current body size, 71.5% would like to decrease their body sizes and 11.0% would like to increase it. The risk behaviors for eating disorders were more frequent among the body-dissatisfied mothers (p < 0.0001). CONCLUSION: Most of the mothers were dissatisfied with their body sizes. The frequency of mothers who practiced diets or presented risk behaviors for eating disorders was similar or superior to the rest of the national studies, conducted, at large, with populations considered at risk, such as adolescent girls or young college women.

A dinâmica do aleitamento materno entre famílias em vulnerabilidade social: o que revela o sistema de busca ativa / Breastfeeding dynamics among families on social vulnerability: findings of active search system

OBJETIVO: Descrever as práticas de amamentação em grupos vulneráveis residentes na área de cobertura do Distrito Noroeste de Campinas. Métodos: Foi realizado um estudo transversal, utilizando levantamento de caráter censitário, denominado busca ativa, em visitas a todos os domicílios da área estudada. Foi feito um estudo exploratório das práticas de aleitamento materno em população moradora de região urbana periférica em vulnerabilidade social, com aproximadamente 165 mil habitantes, atendidos por três unidades básicas de saúde. RESULTADOS: Foram encontradas 1.139 crianças com até seis anos de idade, com 72,6 por cento das famílias abaixo da linha de pobreza. A amamentação ocorreu em 93,3 por cento dos casos, com mediana de aleitamento materno de 8 meses (IC 95 por cento 7,0 - 8,9 meses), tempo de aleitamento materno exclusivo com mediana de 4 meses (IC 95 por cento 3,9 - 4,1 meses), sendo que mais de 20 por cento das crianças recebiam outros alimentos já no primeiro mês. Grande parte das famílias referiu não ter recebido orientação sobre o aleitamento materno nas unidades básicas de saúde. CONCLUSÃO: O tempo de aleitamento materno e de aleitamento materno exclusivo na área do estudo, encontrado por busca ativa, foi superior à média nacional e também ao observado em populações com características socioeconômicas semelhantes, o que reforça a importância da incorporação dessa estratégia pela Atenção Básica, nas ações de promoção do aleitamento materno.

OBJECTIVE: This study describes the breastfeeding practices of vulnerable groups living in an area covered by the Northwest Health District of Campinas (SP), Brazil. METHODS: A cross-sectional study was done by visiting all families in the studied area and performing a census-like survey called active search. An exploratory study was done of the breastfeeding practices of a socially vulnerable population living in the outskirts of Campinas. This area has approximately 165,000 inhabitants and three primary healthcare facilities. RESULTS: The survey found 1,139 children under six years of age and 72.6 percent of the families were below the poverty line; 93.3 percent of the children were breastfeed for a median of 8 months (CI 95 percent 7.0 - 8.9 months); exclusive breastfeeding lasts a median of 4 months (CI 95 percent 3.9 - 4.1 months), and more than 20 percent of the children were given other foods during their first month of life. Most of the families reported that the primary healthcare facilities gave them no information on breastfeeding. CONCLUSION: Breastfeeding and exclusive breastfeeding in the studied area found by active search lasted longer than the national average and longer than those of families with similar socioeconomic characteristics. This reinforces the importance of primary healthcare incorporating this strategy in actions that promote breastfeeding.

Estado nutricional de crianças atendidas na rede pública de saúde do município de Santos / Nutritional status of children assisted in public health care settings of the city of Santos, São Paulo, Brazil

OBJETIVO:Caracterizar o perfil nutricional de crianças de 6 a 24 meses de idade frequentadoras de Unidades Básicas de Saúde do município de Santos e sua relação com condições socioeconômicas, de saúde, nutrição e alimentação. MÉTODOS: Foram avaliadas 95 crianças em cinco Unidades Básicas de Saúde de diferentes regiões do município de Santos, em rotina normal de atendimento em Pediatria. Foram feitas medidas de peso e comprimento e aplicou-se um questionário às mães/responsáveis com perguntas sobre identificação, alimentação e nutrição, saúde e situação socioeconômica da criança. O estado nutricional foi avaliado pelas seguintes curvas de referência: National Center for Health Statistics (NCHS, 1977), Centers for Disease Control and Prevention (CDC, 2000) e o padrão de crescimento da Organização Mundial da Saúde do ano 2006 (OMS, 2006). Analisaram-se os índices: peso para idade (P/I), estatura para idade (E/I) e peso para estatura (P/E), medidos em escores Z. Consideraram-se como desnutrição os valores P/I, E/I e P/E menores que -2 escores Z e sobrepeso, valores de P/E maiores que +2 escores Z. RESULTADOS: Entre as crianças estudadas, foram observadas frequências de desnutrição para P/I em 4,2 por cento, 9,5 por cento e 3,2 por cento, para E/I em 2,1 por cento, 2,1 por cento e 4,2 por cento e para P/E, em 2,1 por cento, 4,2 por cento e 1,0 por cento das crianças, respectivamente para as curvas NCHS (1977), CDC (2000) e OMS (2006). Com relação ao sobrepeso, as frequências foram 4,2 por cento, 3,2 por cento e 5,3 por cento, respectivamente para as curvas NCHS (1977), CDC (2000) e OMS (2006). CONCLUSÕES: Notou-se baixa frequência de desnutrição. A curva da OMS identificou menor proporção de déficits nutricionais.

OBJECTIVE: Evaluate the nutritional status of children with 6 to 24 months of age assisted by the public health service in the city of Santos, Brazil, and its relation with socioeconomic status, health and nutritional conditions. METHODS: This cross-sectional study enrolled 95 children who attended regular pediatric visits in 5 units of public primary health centers. Weight and height were measured and parents were requested to answer a questionnaire with health, nutrition and socioeconomic information of their children. Nutritional status was assessed by the NCHS (1977), CDC (2000) and WHO (2006) child growth standard curves. Weight for age, height for age and weight for height Z scores were calculated. Values of the these indices below -2.0 Z score defined malnutrition and values of weight for height above +2.0 Z score defined overweight. RESULTS: The frequency of malnutrition according to the different indices were: weight for age 4.2 percent, 9.5 percent and 3.2 percent; height for age 2.1 percent, 2.1 percent and 4.2 percent, and weight for age 2.1 percent, 4.2 percent and 1.0 percent, respectively, according to the NCHS (1977), CDC (2000) and WHO (2006) reference curves. Overweight was found in 4.2 percent, 3.2 percent and 5.3 percent by the NCHS (1977), CDC (2000) and WHO (2006) reference curves, respectively. CONCLUSIONS: There was a low frequency of malnutrition. The WHO curve detected less patients with nutritional deficits than the other NCHS (1977) and CDC (2000) curves.