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1.
Public Health Nutr ; 27(1): e187, 2024 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-39360471

RESUMEN

OBJECTIVE: Evaluate the 5-year changes in the consumers' food environment in the area of a health promotion service in Brazilian primary health care. Our hypothesis is that the consumers' food environment in the areas with primary healthcare services has changes that may favour healthy eating habits over time. DESIGN: Longitudinal study. SETTING: The territory around the primary healthcare services in Belo Horizonte, Minas Gerais, Brazil. PARTICIPANTS: All food stores and open-air food markets that sell fruits and vegetables around the primary healthcare services in 2013 (n 272) and in 2018 (n 265). RESULTS: Fruit diversity increased by 13·4 % (P < 0·001) and vegetables variety and quality by 16·1 % (P = 0·003) and 12·5 % (P < 0·001), respectively. Corn snacks showed an increase in availability (13·5 %; P = 0·002). The increase in advertising was observed for fruits and vegetables (34·6 %; P < 0·001) and ultra-processed foods (47·6 %; P < 0·001). Supermarkets showed an increase in the Healthy Food Store Index (three points; P < 0·001), while fruits and vegetables stores showed a decrease of one point in the index (P < 0·001). CONCLUSIONS: The unequal changes in the consumers' food environment according to the food stores types demonstrate the importance of food supply policies that promote a healthy environment and favour the maintenance of traditional healthy food retailers.


Asunto(s)
Dieta Saludable , Abastecimiento de Alimentos , Frutas , Verduras , Humanos , Brasil , Estudios Longitudinales , Abastecimiento de Alimentos/estadística & datos numéricos , Dieta Saludable/estadística & datos numéricos , Supermercados , Comportamiento del Consumidor/estadística & datos numéricos , Promoción de la Salud/métodos , Atención Primaria de Salud/estadística & datos numéricos , Bocadillos , Publicidad/estadística & datos numéricos , Conducta Alimentaria , Comida Rápida/estadística & datos numéricos
2.
BMC Health Serv Res ; 24(1): 1197, 2024 Oct 08.
Artículo en Inglés | MEDLINE | ID: mdl-39379993

RESUMEN

BACKGROUND: Obesity is a chronic disease characterized by excess body fat and is a risk factor for other chronic non-communicable diseases. Its multifactorial and complex nature makes its management a challenge for health services. This manuscript presents an investigation protocol that aims to analyze the effectiveness of collective nutritional interventions for obesity management applicable to primary health care. METHODS: Randomized Controlled Community Trial (RCCT) in a representative sample of users of the Programa Academia de Saúde (PAS), in Belo Horizonte, Minas Gerais, Brazil, with obesity. The research consists of four phases: (1) Screening to identify the participants eligible for the nutritional interventions (individuals with obesity, readiness for change to lose body weight, and willingness and interest to participate in a group activity for six months or more); (2) Baseline to characterize the participants; (3) Implementation of collective nutritional interventions; (4) Reassessment of the participants. Participants in the control group (CG) will receive the usual health service care, and participants in the intervention group (IG) will participate in collective nutritional interventions based on Therapeutic Group 1 (TG1) or Therapeutic Group 2 (TG2) of the "Instructive of Collective Approach for the obesity management in SUS". DISCUSSION: The strengths of the study include its robust RCCT design, which allows for longitudinal analyses and is suitable for investigating causal hypotheses and applying strategies to improve adherence to interventions. Furthermore, the study included a representative sample of a public health service and aims to evaluate therapeutic proposals from the Brazilian Ministry of Health, which can contribute to implementation and extension in the national territory. TRIAL REGISTRATION: RBR-3vzsyqq and RBR-6pg682m.


Asunto(s)
Atención Primaria de Salud , Humanos , Brasil , Masculino , Femenino , Adulto , Manejo de la Obesidad/métodos , Obesidad/terapia , Persona de Mediana Edad
3.
BMC Public Health ; 23(1): 2454, 2023 12 07.
Artículo en Inglés | MEDLINE | ID: mdl-38062435

RESUMEN

BACKGROUND: Changes in food environments have the potential to affect consumption, nutritional status, and health, and understanding these changes is of utmost importance. This study, therefore, aimed to examine the fluctuation of food stores that sell fruits and vegetables over five years in the health promotion service area of Primary Health Care (PHC) in Belo Horizonte, Minas Gerais, Brazil. METHODS: This was an ecological study that used data from a food environment audit conducted in the realm of Brazilian PHC. Buffers of 1 mile (equivalent to 1600 m) were created around health promotion services to define food environments. All food stores and open-air food markets that sold fruits and vegetables (FV) within this buffer area were considered eligible. The data collection was performed during two periods: the baseline, in 2013, and after five years, in 2018. This study compares the fluctuation by the type of stores and according to the health vulnerability index (HVI). RESULTS: After 5 years, 35.2% of the stores were stable; 154 stores were closed, and 155 were opened. The stability was greater in low-vulnerability areas, and the fluctuation differed by type of store only for areas with high vulnerability. The number of supermarket decreased in high HVI territories; and local stores, showed greater stability when compared to specialized FV markets. CONCLUSIONS: The differences in store fluctuations according to the vulnerability of areas demonstrate the importance of food supply policies considering the local characteristics to reduce inequities of access to healthy foods.


Asunto(s)
Comercio , Características de la Residencia , Humanos , Brasil , Frutas , Verduras , Abastecimiento de Alimentos
4.
BMC Public Health ; 20(1): 652, 2020 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-32393214

RESUMEN

BACKGROUND: Given the current worldwide epidemic of obesity, there is a demand for interventions with higher impact, such as those carried out in the primary health care (PHC) setting. Here we evaluate the effect of intervention performed according to the stages of change of the transtheoretical model (TTM) for weight management. METHODS: This randomized controlled trial in Brazilian PHC offered free physical exercise and nutrition education. The participants were women, aged 20 years or older who were obese or overweight, users in PHC service. The intervention group (IG, n = 51) received the same orientation as the comparison group (CG, n = 35) plus individual health counseling based on the TTM aimed at weight loss, which lasted 6 months. The outcome measures were anthropometric, food, and nutrient profiles. Inflammatory parameters were evaluated in a random subsample. The inter-group and intra-group differences were evaluated using interntion-to-treat analysis, and analysis of covariance (ANCOVA) used to assess intervention effectiveness. RESULTS: There was a difference between groups of - 1.4 kg (CI95%: - 2.5; - 0.3) in body weight after the intervention. About 97% of women in the IG reported benefits of the intervention and presented positive changes in diet, biochemical markers, and anthropometry. The IG showed better body mass index, resistine, and blood glucose results compared to the CG during follow-up. CONCLUSION: The individualized TTM-based intervention, combined with usual care, was an effective strategy in PHC. These results should encourage the use of interdisciplinary practices; nevertheless, research to identify additional strategies is needed to address barriers to weight maintenance among obese low-income women. TRIAL REGISTRATION: The trial is registered with Brazilian clinical trials under the code: RBR-8t7ssv, Registration date: 12/12/2017 (retrospectively registered).


Asunto(s)
Ciencias Bioconductuales/métodos , Obesidad/terapia , Sobrepeso/terapia , Programas de Reducción de Peso/métodos , Adulto , Anciano , Índice de Masa Corporal , Brasil , Dieta , Ejercicio Físico , Terapia por Ejercicio/métodos , Femenino , Humanos , Persona de Mediana Edad , Obesidad/psicología , Sobrepeso/psicología , Educación del Paciente como Asunto/métodos , Pobreza , Atención Primaria de Salud , Resultado del Tratamiento , Pérdida de Peso , Adulto Joven
5.
Nutrition ; 93: 111436, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34479045

RESUMEN

OBJECTIVES: This study evaluates, in the medium and long term (12, 36, and 48 mo), the effect of an intervention to promote consumption of fruit and vegetables on the body weight of Brazilian primary health care users. METHODS: A follow-up with participants (n = 3414) in a controlled randomized trial was performed in a primary health care service. Those in the control group performed the service's usual intervention (guided physical exercise 3 times/wk), and those in the intervention group additionally participated for 7 mo in collective activities to promote consumption of fruit and vegetables. Sociodemographic, health, and body weight data were collected by face-to-face interview at baseline and after 12 mo. At 36 and 48 mo, weight was obtained by telephone interview and was validated. Adherence to the intervention was assessed by the presence of the actions. Weight change (Δ) was measured by subtracting the weight at each follow-up time from the baseline measurement. RESULTS: Participants in both groups had a minor weight loss of about 0.1 kg over 12, 36, and 48 mo. The addition of an intervention for consumption of fruit and vegetables did not enhance this effect. Higher weight loss was observed in individuals with obesity classes II and III with low adherence in the intervention and after 36 mo (Δ = -27.1 kg; P = 0.024). CONCLUSIONS: Participating in the primary health care service contributed to a small reduction in weight, and the intervention for consumption of fruit and vegetables did not enhance this effect. However, greater weight loss was observed in participants with obesity and those who adhered to the intervention.


Asunto(s)
Frutas , Verduras , Brasil , Humanos , Obesidad/terapia , Pérdida de Peso
6.
Nutrition ; 66: 108-114, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31254949

RESUMEN

OBJECTIVES: The aim of this study was to investigate the association between aspects of the consumer food environment in food stores selling fruit and vegetables (FVs) and the incidence of overweight among users of a Brazilian primary health care service. METHODS: This cross-sectional study assessed individual-level and food environment variables, within the context of a representative sample of a primary health care service in a Brazilian city (the Health Academy Program [HAP]) in 2013. Users of HAP units and multiple aspects of the consumer food environment (availability, diversity, variety, quality, advertising, and price) related to FVs and ultraprocessed foods (UPFs) were examined. Multilevel logistic models were used to examine the relationships among overweight and consumer environment characteristics. We analyzed 2810 participants and audited 336 food stores. RESULTS: More than 70% of stores had adequate diversity and variety of FVs; Regarding quality, only 24.5% of stores presented inadequate quality of fruits and 39.6% inadequate quality of vegetables. UPFs were present in 60.6% of FV stores. The results indicated a high prevalence of overweight (62.6%) in participants of the health promotion service and the multilevel models revealed an association with variety of vegetables in stores (0.99; 95% confidence interval, 0.97-0.99; P < 0.05). CONCLUSIONS: Given the importance of food environment in food choice at the time of purchase, it is important to consider consumer food environment in determining consumption. The results suggest that increased exposure to healthy foods should be included as guidelines for weight management.


Asunto(s)
Comportamiento del Consumidor/estadística & datos numéricos , Calidad de los Alimentos , Abastecimiento de Alimentos/métodos , Sobrepeso/epidemiología , Adulto , Brasil/epidemiología , Estudios Transversales , Femenino , Manipulación de Alimentos , Frutas , Promoción de la Salud , Humanos , Masculino , Persona de Mediana Edad , Verduras , Adulto Joven
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