Food price trends during the COVID-19 pandemic in Brazil.

The present study aims to analyze the trends in food price in Brazil with emphasis on the period of the Covid-19 pandemic (from March 2020 to March 2022). Data from the Brazilian Household Budget Survey and the National System of Consumer Price Indexes were used as input to create a novel data set containing monthly prices (R$/Kg) for the foods and beverages most consumed in the country between January 2018 and March 2022. All food items were divided according to the Nova food classification system. We estimated the mean price of each food group for each year of study and the entire period. The monthly price of each group was plotted to analyze changes from January 2018 to March 2022. Fractional polynomial models were used to synthesize price changes up to 2025. Results of the present study showed that in Brazil unprocessed or minimally processed foods and processed culinary ingredients were more affordable than processed and ultra-processed foods. However, trend analyses suggested the reversal of the pricing pattern. The anticipated changes in the prices of minimally processed food relative to ultra-processed food, initially forecasted for Brazil, seem to reflect the impact of the Covid-19 pandemic on the global economy. These results are concerning as the increase in the price of healthy foods aggravates food and nutrition insecurity in Brazil. Additionally, this trend encourages the replacement of traditional meals for the consumption of unhealthy foods, increasing a health risk to the population.

Food and nutrition public establishments: assessment of the food environment.

This article aims to assess the community food environment around areas with and without Food and Nutrition Public Establishments (FNPE). Cross-sectional study carried out in Belo Horizonte, Brazil. The unit of analysis was the buffer (500m) around the FNPE and the census tracts without FNPE. The investigated establishments should market food for consumption at home and be located within the buffer of the areas with and without FNPE. Data collection performed by direct observation (active search) in August to October 2019. Data collected were location and type of commercial establishments, the density of the establishments was calculated. Descriptive analysis, spatial distribution (Kernel estimator) and Nearest Neighbor analysis were performed. Of the evaluated establishments, 60.5% were in the areas without FNPE and 39.6% in the areas with FNPE, showing a random distribution pattern. Of these, 24.2% were convenience stores and bakeries, 21.0% butcher stores, and 19.0% street markets. Seven FNPE were close to commercial establishments. There were fewer establishments around the FNPE, with convenience stores and bakeries predominating.

Availability and price of fruits and vegetables in the surroundings of food and nutrition public establishments.

BACKGROUND: Inequalities of access to healthy food reinforce the need to strengthen public policies on Food and Nutritional Security. In this context, Food and Nutrition Public Establishments, which are public spaces for distribution and commercialization of healthy foods, stand out. However, in middle-income countries there is little monitoring of the impacts of public policies on food environments, which are fundamental for strengthening these actions. Thus, the purpose of the study was to evaluate the availability and price of fruits and vegetables in areas with and without Food and Nutrition Public Establishments. METHODOLOGY: A cross-sectional study carried out in Belo Horizonte, Brazil. Audits were conducted in the retail food environment of a representative sample of Food and Nutrition Public Establishments (n = 10) and corresponding census sectors, without Food and Nutrition Public Establishments (n = 10). Information was collected on the availability and price of the most consumed fruits and vegetables in Belo Horizonte. The food retailers were grouped into fresh food retailers and mixed food retailers. The Chi-Square test was used to compare the availability of fruits and vegetables between areas. The Mann Whitney test was used to compare the prices of fruit and vegetables and the price differences between fresh food retailers and mixed food retailers between areas. RESULTS: 148 food retailers were audited, including 17 Food and Nutrition Public Establishments. In fresh food retailers, the availability of vegetables was higher in areas with Food and Nutrition Public Establishments (p = 0.024). In mixed food retailers there was low availability of fruit and vegetables in both areas (34.0% vs. 26.2%; p>0.05). The price difference between fresh food retailers and mixed food retailers differed significantly between areas (p<0.001). In general, fresh food retailers had lower prices than mixed food retailers only in areas with Food and Nutrition Public Establishments. CONCLUSIONS: The presence of Food and Nutrition Public Establishments was associated with the availability of vegetables, and with lower prices in fresh food retailers compared with mixed food retailers. Monitoring and understanding the impacts of public policies on the food environment are essential to register trends and provide relevant information to civil society and government authorities.

Food and nutrition public establishments: assessment of the food environment / Equipamentos públicos de segurança alimentar e nutricional: avaliação do ambiente alimentar

Abstract This article aims to assess the community food environment around areas with and without Food and Nutrition Public Establishments (FNPE). Cross-sectional study carried out in Belo Horizonte, Brazil. The unit of analysis was the buffer (500m) around the FNPE and the census tracts without FNPE. The investigated establishments should market food for consumption at home and be located within the buffer of the areas with and without FNPE. Data collection performed by direct observation (active search) in August to October 2019. Data collected were location and type of commercial establishments, the density of the establishments was calculated. Descriptive analysis, spatial distribution (Kernel estimator) and Nearest Neighbor analysis were performed. Of the evaluated establishments, 60.5% were in the areas without FNPE and 39.6% in the areas with FNPE, showing a random distribution pattern. Of these, 24.2% were convenience stores and bakeries, 21.0% butcher stores, and 19.0% street markets. Seven FNPE were close to commercial establishments. There were fewer establishments around the FNPE, with convenience stores and bakeries predominating.

Resumo O objetivo deste artigo é avaliar o ambiente alimentar comunitário de áreas com e sem estabelecimentos públicos de segurança alimentar e nutricional (EPSAN). Estudo transversal realizado em Belo Horizonte, Brasil. Unidade de análise foi o buffer (500m) no entorno dos EPSAN e dos setores censitários sem EPSAN. Os estabelecimentos investigados deveriam comercializar alimentos para consumo no domicílio e localizar-se dentro do buffer das áreas com e sem EPSAN. Coleta de dados realizada por observação direta (busca ativa) de agosto a outubro de 2019. Os dados coletados foram localização e tipo dos estabelecimentos comerciais, e também foi calculada a densidade dos estabelecimentos. Foram feitas análise descritiva, distribuição espacial (estimador de Kernel) e análise do vizinho mais próximo. Dos estabelecimentos avaliados, 60,5% estavam nas áreas sem EPSAN, e 39,6% nas áreas com EPSAN, apresentando padrão de distribuição aleatório. Desses, 24,2% eram lojas de conveniência e padarias, 21,0% açougues e 19,0% feiras-livres. Sete EPSAN encontravam-se próximos aos estabelecimentos comerciais. Havia menor número de estabelecimentos no entorno dos EPSAN, com predominância de lojas de conveniência e padaria.

Impact of implementation of front-of-package nutrition labeling on sugary beverage consumption and consequently on the prevalence of excess body weight and obesity and related direct costs in Brazil: An estimate through a modeling study.

RATIONALE: Intake of sugary beverages has been associated with obesity and chronic non-communicable diseases, thereby increasing the direct health costs related to these diseases. Front-of-package nutrition labeling (FoPNL) aims to help consumers understand food composition, thereby improving food choices and preventing the development of such diseases. OBJECTIVE: To estimate, over five years, the impact of implementing FoPNL in Brazil on the prevalence of excess body weight and obesity in adults who consume sugary beverages and the direct costs related to such problems. METHODS: A simulation study to performed to estimate the effect of FoPNL implementation on the prevalence of excess body weight and obesity. The VIGITEL research database (2019), published in the 2020 report, was used in this study (the final sample consisted of 12,471 data points representing 14,380,032 Brazilians). The scenarios were considered: base (trend in sugary beverage intake); 1 (base scenario associated with the changes in energy content of the purchased beverages observed after the first phase of the Chilean labeling law (-9.9%); and 2 (scenario 1 associated with reformulation of beverages, total energy reduction of -1.6%). Changes in body weight were estimated using the simulation model of Hall et al. (2011) over five years. A linear trend in the prevalence of obesity and excess body weight in the Brazilian population was considered. The impact of the prevalence of obesity and excess body weight on body mass index was estimated. In addition, the direct health costs related to obesity were estimated. RESULTS: Energy consumption from sugary beverages after FoPNL implementation is expected to be reduced by approximately 28 kcal/day (95% CI, -30 to -27) considering scenario 1. In scenarios 1 and 2, without FoPNL, the prevalence of obesity and excess body weight over five years was estimated to be 25.3% and 25.2%, and 64.4% and 64.2%, respectively. By extrapolating the results to the entire Brazilian population, it was observed that the implementation of FoPNL may reduce the prevalence of obesity by -0.32 percentage points and -0.35 percentage points (scenario 1 and 2, respectively) and excess body weight by -0.42 percentage points and -0.48 percentage points (scenarios 1 and 2, respectively) in five years. It is estimated that after five years of implementation, it will be possible to save approximately US$ 5,5 millions (95% CI 4,7 to 8,8) in scenario 1, reaching approximately US$ 6,1 millions (95% CI 5,3 to 9,8) in scenario 2. CONCLUSION: The results of this modeling study indicate that FoPNL may reduce prevalence of excess body weight and obesity, representing strategic public policies for obesity prevention.

Educational inequality in consumption of in natura or minimally processed foods and ultra-processed foods: The intersection between sex and race/skin color in Brazil.

Background: It remains uncertain how the intersection between educational, gender, and race/skin color inequalities influences food consumption in Brazil. In this study, we examined the educational inequality in the consumption of in natura/minimally processed and ultra-processed foods by Brazilians with an intersectional perspective between sex and race/color. Methods: We used cross-sectional data from the Telephone Surveillance System (VIGITEL 2019), comprising 52,443 participants ≥ 18 years. Daily food consumption was considered high when consumption of ≥5 foods for each food group was reported the day before the survey. Educational inequality in food consumption was assessed by the slope index of inequality (SII) and the relative index of inequality (RII) according to sex and race/color (White; Black/Brown). Positive SII and RII values > 1.0 indicate higher food consumption among more educated participants. Results: The consumptions of in natura/minimally processed and ultra-processed foods were more prevalent in those with the highest level of education (≥12 years) and intermediate education (9-11 years), respectively. However, highly educated White women had higher consumption of in natura/minimally processed foods than Black women with the same education level, and White men in low and intermediate school levels had higher consumption of these foods than Black men with the same education levels. We found higher absolute educational inequality for in natura/minimally processed foods among White women (SII 21.8, 95% CI 15.3, 28.4) and Black/Brown men (SII 19.3, 95% CI 12.5, 26.1). Black/Brown men (SII 7.3, 95% CI 0.5, 14.0) and Black/Brown women (SII 5.6, 95% CI 1.0, 10.2) had higher absolute educational inequality than White men (SII -3.3, 95% CI -10.9, 4.3; P = 0.04) in the consumption of ultra-processed foods. Conclusion: Educational inequalities influenced the consumption of in natura/minimally processed more than ultra-processed foods, and, for the latter, inequalities were greater among Black/Brown men and women than among White men.

Replacing ultra-processed foods with fresh foods to meet the dietary recomendations: a matter of cost?

The study aimed to analyze the economic impact of the adoption of optimized and nutritionally balanced diets to Brazilian families, considering the Brazilian dietary guidelines and the economic disparities of the population. Data from the Brazilian Household Budget Survey from 2008-2009 (550 strata; 55,970 households) were used. About 1,700 foods and beverages purchased by the Brazilians were classified into 4 groups according to NOVA system. Linear programming models estimated isoenergetic diets preserving the current diet as baseline and optimizing healthier diets gradually based on the "golden rule" of the Brazilian dietary guidelines, respecting nutritional restrictions for macronutrients and micronutrients (based on international recommendations) and food acceptance limits (10th and 90th percentiles of the per capita calorie distribution from the population). The diet cost was defined based on the sum of the average cost of each food group, both in the current and optimized diets (BRL per 2,000Kcal/person/day). The economic impact of the Brazilian dietary guidelines to Brazilian household budget was analyzed by comparison the cost of the optimized diets to the cost of the current diet, calculated for the total population and by income level. Three healthier diets were optimized. Current diet cost was BRL 3.37, differed among low- and high-income strata (BRL 2.62 and BRL 4.17, respectively). Regardless of income, diet cost decreased when approaching the guidelines. However, low-income strata compromised their household budget more than two times the high-income strata (20.2% and 7.96%, respectively). Thus, the adoption of healthier eating practices can be performed with the same or lower budget.

Three decades of household food availability according to NOVA - Brazil, 1987-2018 / Três décadas da disponibilidade domiciliar de alimentos segundo a NOVA - Brasil, 1987-2018

ABSTRACT OBJECTIVE To evaluate the trend of household food acquisition according to the NOVA classification in Brazil between 1987-1988 and 2017-2018. METHODS We used household food acquisition data from five editions of the Pesquisas de Orçamentos Familiares (Household Budget Surveys), conducted by the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics), in the years 1987-1988, 1995-1996, 2002-2003, 2008-2009, and 2017-2018. All reported foods were categorized according to the NOVA classification. The household availability of food groups and subgroups was expressed through their share (%) in total calories, for all Brazilian families, by household situation (urban or rural), for each of the five geographic regions of the country, by fifths of the household income per capita distribution (2002-2003, 2008-2009 and 2017-2018 surveys), and for the 11 main urban regions of the country (1987-1988, 1995-1996, 2002-2003, 2008-2009 and 2017-2018 surveys). Linear regression models were used to assess the trend of increasing or decreasing food purchases. RESULTS The diet of the Brazilian population is still composed predominantly of foods in natura or minimally processed and processed culinary ingredients. However, our findings point to trends of increasing share of ultra-processed foods in the diet. This increase of 0.4 percentage points per year between 2002 and 2009 slowed down to 0.2 percentage points between 2008 and 2018. The consumption of ultra-processed food was higher among households with higher income, in the South and Southeast regions, in urban areas, and in metropolitan regions. CONCLUSION Our results indicate an increase in the share of ultra-processed foods in the diet of Brazilians. This is a worrisome scenario, since the consumption of such foods is associated with the development of diseases and the loss of nutritional quality of the diet.

RESUMO OBJETIVO Avaliar a tendência da aquisição domiciliar de alimentos de acordo com a classificação NOVA no Brasil entre 1987-1988 e 2017-2018. MÉTODOS Foram utilizados dados de aquisição domiciliar de alimentos provenientes de cinco edições da Pesquisas de Orçamentos Familiares, realizada pelo Instituto Brasileiro de Geografia e Estatística, nos anos 1987-1988, 1995-1996, 2002-2003, 2008-2009 e 2017-2018. Todos os alimentos reportados foram categorizados segundo a classificação NOVA. A disponibilidade domiciliar dos grupos e subgrupos de alimentos foi expressa por meio de sua participação (%) nas calorias totais, para o conjunto das famílias brasileiras, por situação do domicílio (urbana ou rural), para cada uma das cinco regiões geográficas do país, por quintos da distribuição de renda domiciliar per capita (inquéritos de 2002-2003, 2008-2009 e 2017-2018); e para as 11 principais regiões urbanas do país (inquéritos de 1987-1988, 1995-1996, 2002-2003, 2008-2009 e 2017-2018). Modelos de regressão linear foram utilizados para avaliar a tendência de aumento ou diminuição na aquisição dos alimentos. RESULTADOS A dieta da população brasileira ainda é composta predominantemente por alimentos in natura e minimamente processados e ingredientes culinários processados. No entanto, nossos achados apontam tendências de aumento da participação de alimentos ultraprocessados na dieta. Esse aumento que foi de 0,4 pontos percentuais ao ano na primeira porção do período estudado, entre 2002 e 2009, e desacelerou para 0,2 pontos percentuais entre 2008 e 2018. O consumo de alimentos ultraprocessados foi maior entres os domicílios de maior renda, nas regiões Sul e Sudeste, na área urbana, e nas regiões metropolitanas. CONCLUSÃO Os resultados do presente estudo apontam um aumento na participação de alimentos ultraprocessados na dieta dos brasileiros. Cenário preocupante, uma vez que o consumo de tais alimentos está associado ao desenvolvimento de doenças e à perda da qualidade nutricional da dieta.

Replacing ultra-processed foods with fresh foods to meet the dietary recomendations: a matter of cost? / ¿Reemplazar comidas ultraprocesadas por comida fresca para cumplir con las recomendaciones dietéticas: una cuestión de coste? / Substituir alimentos ultraprocessados por alimentos frescos para atender as recomendações alimentares: uma questão de custo?

The study aimed to analyze the economic impact of the adoption of optimized and nutritionally balanced diets to Brazilian families, considering the Brazilian dietary guidelines and the economic disparities of the population. Data from the Brazilian Household Budget Survey from 2008-2009 (550 strata; 55,970 households) were used. About 1,700 foods and beverages purchased by the Brazilians were classified into 4 groups according to NOVA system. Linear programming models estimated isoenergetic diets preserving the current diet as baseline and optimizing healthier diets gradually based on the "golden rule" of the Brazilian dietary guidelines, respecting nutritional restrictions for macronutrients and micronutrients (based on international recommendations) and food acceptance limits (10th and 90th percentiles of the per capita calorie distribution from the population). The diet cost was defined based on the sum of the average cost of each food group, both in the current and optimized diets (BRL per 2,000Kcal/person/day). The economic impact of the Brazilian dietary guidelines to Brazilian household budget was analyzed by comparison the cost of the optimized diets to the cost of the current diet, calculated for the total population and by income level. Three healthier diets were optimized. Current diet cost was BRL 3.37, differed among low- and high-income strata (BRL 2.62 and BRL 4.17, respectively). Regardless of income, diet cost decreased when approaching the guidelines. However, low-income strata compromised their household budget more than two times the high-income strata (20.2% and 7.96%, respectively). Thus, the adoption of healthier eating practices can be performed with the same or lower budget.

El objetivo del estudio fue analizar el impacto económico de la adopción de dietas optimizadas y nutricionalmente equilibradas en familias brasileñas, considerando las guías alimentarias y las disparidades económicas de la población. Los datos se recopilaron de la Encuesta de Presupuestos por Hogares desde 2008-2009 (550 estratos; 55 970 hogares). Se clasificaron alrededor de 1.700 comidas y bebidas, adquiridas por brasileños en 4 grupos, según el sistema NOVA. Los modelos de programación lineal estimaron dietas isoenergéticas, preservando la dieta actual como base de referencia, y optimizando las dietas más sanas gradualmente, basadas en la "regla de oro" de las guías alimentarias, respecto a restricciones nutricionales en macronutrientes y micronutrientes (basadas en recomendaciones internacionales), y los límites de aceptación alimentarios (10o y 90o percentiles de la distribución calórica per cápita de la población). El coste de la dieta se definió basado en el total del coste medio de cada grupo de comida, ambos en las dietas actual y optimizada (BRL por 2.000Kcal/persona/día). El impacto económico de las guías alimentarias para el presupuesto por hogar se analizó mediante comparación del coste de dietas optimizadas con el coste de la dieta actual, calculado para el total de población y por nivel de ingresos. Se optimizaron las tres dietas más saludables. El coste de la dieta actual fue BRL 3,37, diferenciando los estratos entre bajo- y altos-ingresos (BRL 2,62 y BRL 4,17, respectivamente). A pesar del ingreso, el coste de la dieta decreció cuando se aproximaba a las recomendaciones de las guías. No obstante, los estratos de bajos ingresos comprometieron su presupuesto doméstico más de dos veces, respecto a los estratos de ingresos más altos (20,2% y 7,96%, respectivamente). Por ello, la adopción de prácticas alimentarias más sanas se puede conseguir con el mismo presupuesto o incluso más bajo.

O objetivo desse estudo foi analisar o impacto econômico da adoção de dietas otimizadas e nutricionalmente balanceadas para famílias brasileiras, considerando as diretrizes alimentares para a população brasileira e as disparidades econômicas da população. Foram usados dados da Pesquisa Nacional de Orçamentos Familiares de 2008-2009 (550 estratos; 55.970 domicílios). Cerca de 1,7 mil alimentos e bebidas adquiridos pelos brasileiros foram classificados em quatro grupos de acordo com o sistema NOVA. Modelos de programação linear estimaram dietas isoenergéticas preservando a dieta atual como linha de base e otimizando dietas mais saudáveis gradativamente com base na "regra de ouro" das diretrizes alimentares, respeitando restrições nutricionais para macronutrientes e micronutrientes (com base em recomendações internacionais) e limites de aceitação alimentar (10º e 90º percentis da distribuição de calorias per capita da população). O custo da dieta foi definido a partir da soma do custo médio de cada grupo de alimentos, tanto na dieta atual quanto na otimizada (R$ por 2.000Kcal/pessoa/dia). O impacto econômico das diretrizes alimentares para o orçamento familiar brasileiro foi analisado comparando-se o custo das dietas otimizadas com o custo da dieta atual, calculado para a população total e por nível de renda. Três dietas mais saudáveis foram otimizadas. O custo da dieta atual era de R$ 3,37, diferindo entre os estratos de baixa e alta renda (R$ 2,62 vs. R$ 4,17). Independentemente da renda, o custo da dieta diminuiu com a abordagem das diretrizes. No entanto, os estratos de baixa renda comprometeram seu orçamento familiar mais de duas vezes que os estratos de alta renda (20,20% vs. 7,96%). Assim, a adoção de práticas alimentares mais saudáveis pode ser realizada com orçamento igual ou inferior.

Association between the price of ultra-processed foods and obesity in Brazil.

BACKGROUND AND AIMS: To estimate the relationship between the price of ultra-processed foods and prevalence of obesity in Brazil and examine whether the relationship differed according to socioeconomic status. METHODS AND RESULTS: Data from the national Household Budget Survey from 2008/09 (n = 55 570 households, divided in 550 strata) were used. Weight and height of all individuals were used. Weight was measured by using portable electronic scales (maximum capacity of 150 kg). Height (or length) was measured using portable stadiometers (maximum capacity: 200 cm long) or infant anthropometers (maximum capacity: 105 cm long). Multivariate regression models (log-log) were used to estimate price elasticity. An inverse association was found between the price of ultra-processed foods (per kg) and the prevalence of overweight (Body mass index (BMI) ≥25 kg/m2) and obesity (BMI ≥30 kg/m2) in Brazil. The price elasticity for ultra-processed foods was -0.33 (95% CI: -0.46; -0.20) for overweight and -0.59 (95% CI: -0.83; -0.36) for obesity. This indicated that a 1.00% increase in the price of ultra-processed foods would lead to a decrease in the prevalence of overweight and obesity of 0.33% and 0.59%, respectively. For the lower income group, the price elasticity for price of ultra-processed foods was -0.34 (95% CI: -0.50; -0.18) for overweight and -0.63 (95% CI: -0.91; -0.36) for obesity. CONCLUSION: The price of ultra-processed foods was inversely associated with the prevalence of overweight and obesity in Brazil, mainly in the lowest socioeconomic status population. Therefore, the taxation of ultra-processed foods emerges as a prominent tool in the control of obesity.

What to expect from the price of healthy and unhealthy foods over time? The case from Brazil.

OBJECTIVE: To measure change in price of food groups over time (1995-2030) in Brazil, considering the Brazilian Dietary Guidelines' recommendations. DESIGN: Data from the Household Budget Survey (2008-2009 HBS) and the National System of Consumer Price Indexes (NSCPI) were used to create a data set containing monthly prices for the foods and beverages most consumed in the country (n 102), from January 1995 to December 2017. Data on price of foods and beverages from 2008-2009 HBS (referring to January 2009) were used to calculate real price over time using the monthly variation in prices from NSCPI. All prices were deflated to December 2017. Foods and beverages were classified following the Brazilian Dietary Guidelines' recommendations. The monthly price for each food group and subgroup was used to analyse changes in prices from 1995 to 2017 and to forecast prices up to 2030 using fractional polynomial models. SETTING: Brazil. PARTICIPANTS: National estimates of foods and beverages purchased for Brazil. RESULTS: In 1995, ultra-processed foods were the most expensive group (R$ 6·51/kg), followed by processed foods (R$ 6·44/kg), then unprocessed or minimally processed foods and culinary ingredients (R$ 3·45/kg). Since the early 2000s, the price of ultra-processed foods underwent successive reductions, becoming cheaper than processed foods and reducing the distance between it and the price of the other group. Forecasts indicate that unhealthy foods will become cheaper than healthy foods in 2026. CONCLUSIONS: Food prices in Brazil have changed unfavourably considering the Brazilian Dietary Guidelines' recommendations. This may imply a decrease in the quality of the population's diet.

Malnutrition in all its forms and social inequalities in Brazil.

OBJECTIVE: To describe malnutrition (undernutrition and excess weight) by income, education and race/ethnicity in the Brazilian population. DESIGN: Cross-sectional study. SETTING: Brazil. PARTICIPANTS: Children aged <5 years (n 14 580), adolescents aged 11-19 years (n 31 892) and adults aged 20-49 years (n 84 660). RESULTS: Among children, prevalence of excess weight, wasting and stunting was 16·9, 2·8 and 6·0 %, respectively. Differences related to income, education and race/ethnicity were verified, except for prevalence of wasting by education level. Girls and boys presented 18·4 and 20·5 % of excess weight, 2·8 and 3·7 % of underweight and 5·5 and 7·3 % of stunting, respectively. Prevalence of excess weight was lower among poorer, lower-educated (only for boys) and white adolescents, while stunting was lower among higher-income, higher-educated and white adolescents. Over three-quarters of women and almost half of men presented excess weight. Among adults, 3·9 % of women and 1·7 % of men were underweight, and 5·7 % of women and 0·2 % of men presented short stature. Prevalence of excess weight for women was higher among lower education and black, while for men it was higher among higher income and education and white. Short stature was more prevalent among black and mixed-race, low-educated and low-income women. Underweight prevalence was higher among low-educated, black and mixed-race women. CONCLUSIONS: In Brazil, the prevalence of excess weight was at least threefold higher than that of undernutrition for children and adolescents and at least sevenfold higher for adults. Social inequalities were observed in the distribution of malnutrition across the lifespan and by gender.

Is neighbourhood social deprivation in a Brazilian city associated with the availability, variety, quality and price of food in supermarkets?

OBJECTIVE: To verify differences in the availability, variety, quality and price of unprocessed and ultra-processed foods in supermarkets and similar establishments in neighbourhoods with different social deprivation levels at Juiz de Fora, Minas Gerais, Brazil. DESIGN: Cross-sectional study. SETTING: The Obesogenic Environment Study in São Paulo's Food Store Observation Tool (ESAO-S) was applied in thirty-three supermarket chains, wholesale and retail supermarkets. RESULTS: Fruits, vegetables and ultra-processed foods were available in almost all establishments, without differences according to Health Vulnerability Index (HVI; which varies from 0 to 1 point and the higher the worse; P > 0·05). Most establishments were concentrated in low vulnerability areas and offered healthy foods with greater variety and quality, despite higher prices. The Healthy Food Store Index (HFSI; which varies from 0 to 16 points and the higher the best) was calculated from the ESAO-S and the mean score was 8·91 (sd 1·51). The presence and variety of unprocessed foods count as positive points, as do the absence of ultra-processed products. When HFSI was stratified by HVI, low HVI neighbourhoods presented higher HFSI scores, compared with medium, high and very high HVI neighbourhoods (P = 0·001). CONCLUSIONS: Supermarkets and similar establishments are less dense in areas of greater social deprivation and have lower prices of healthy foods, but the variety and quality of those foods are worse, compared with areas of low vulnerability. We found worse HFSI for supermarkets located in areas with greater vulnerability. Those findings can guide specific public policies improving the urban food environment.

Determinants of teachers' work ability in basic education in Brazil: Educatel Study, 2016. / Determinantes de capacidade para o trabalho no cenário da Educação Básica do Brasil: Estudo Educatel, 2016.

The study aimed to analyze the relationship between health, work characteristics, education, and skills on the work ability of teachers in basic education in Brazil. This was a cross-sectional, population-based study using data from the Brazilian National Survey on Health, Work Conditions, and Absences in Schoolteachers in Basic Education (Educatel Study). A probabilistic sample of 6,510 teachers answered a telephone interview in 2015 with questions on sociodemographic data, health status, education and skills, work characteristics, and absenteeism. Structural equation modeling (SEM) was used in multivariate analysis and standardized coefficients (SC) were calculated to analyze direct and indirect effects between the outcomes. Health status showed a direct effect on work ability (SC = -0.83, p < 0.01). Work characteristics directly affected health status (SC = 0.60, p < 0.01) and work ability (SC = -0.25, p < 0.05), especially noise at work and students' unruliness. Total effect (sum of direct and indirect effects) of work characteristics on work ability was -0.75 (p < 0.01). The study concluded that the relations between health status and work characteristics of Brazilian teachers in basic education are complex and negatively affect work ability. Potential actions to promote and maintain work ability should take into account the psychosocial demands of teaching and measures to maintain order and discipline in the classroom.

O objetivo desse estudo foi analisar a relação entre saúde, características do trabalho, educação e competências sobre a capacidade para o trabalho de professores da Educação Básica no Brasil. Trata-se de um estudo transversal, de base populacional, segundo dados da Pesquisa Nacional sobre Saúde, Condições de Trabalho e Faltas dos Professores nas Escolas da Educação Básica (Estudo Educatel). Uma amostra probabilística composta por 6.510 professores respondeu a um questionário telefônico (2015) contendo informações sociodemográficas, estado de saúde, educação e competências, características do trabalho e absenteísmo. A modelagem de equações estruturais (MEE) foi usada como técnica multivariada e os coeficientes padronizados (CP) foram calculados para analisar os efeitos diretos e indiretos entre os desfechos. O estado de saúde apresentou um efeito direto sobre a capacidade para o trabalho (CP = -0,83, p < 0,01). As características do trabalho interferiram diretamente no estado de saúde (CP = 0,60, p < 0,01) e capacidade para o trabalho (CP = -0,25, p < 0,05), com destaque para ruído no trabalho e indisciplina dos alunos; o efeito total (soma dos efeitos direto e indireto) das características do trabalho sobre a capacidade para o trabalho foi igual a -0,75 (p < 0,01). Este estudo concluiu que as relações entre estado de saúde e características do trabalho dos professores da Educação Básica são complexas e afetam negativamente a capacidade para o trabalho. Potenciais ações de promoção e manutenção da capacidade para o trabalho devem considerar as exigências psicossociais da atividade docente e medidas para controlar a ordem e a disciplina na sala de aula.

El objetivo fue analizar la relación entre salud, características del trabajo, educación y competencias sobre la capacidad para el trabajo de profesores de educación básica en Brasil. Es un estudio transversal, de base poblacional, según datos de la Encuesta Nacional sobre Salud, Condiciones de Trabajo y Ausencias de los Profesores en las Escuelas de Educación Básica (Estudio Educatel). Una muestra probabilística, compuesta por 6.510 profesores, respondió a un cuestionario telefónico (2015), que contenía información sociodemográfica, estado de salud, educación y competencias, características del trabajo y absentismo. Se utilizó modelos de ecuaciones estructurales (MEE) como técnica de análiseis multivariantes y se calcularon los coeficientes estandarizados (CP por sus siglas en portugués) para analizar los efectos directos e indirectos entre las variables. El estado de salud presentó un efecto directo sobre la capacidad para el trabajo (CP = -0,83, p < 0,01). Las características del trabajo interfirieron directamente en el estado de salud (CP = 0,60, p < 0,01) y capacidad para el trabajo (CP = -0,25, p < 0,05), destacando el ruido en el trabajo e indisciplina de los alumnos; el efecto total (suma de los efectos directo e indirecto) de las características de trabajo sobre la capacidad para el trabajo fue igual a -0,75 (p < 0,01). Este estudio concluyó que las relaciones entre estado de salud y características del trabajo de los profesores de educación básica son complejas y afectan negativamente la capacidad para el trabajo. Potenciales acciones de promoción y manutención de la capacidad para el trabajo deben considerar las exigencias psicosociales de la actividad docente y medidas para controlar el orden y la disciplina en la clase.

Hypotheses, design, and instruments in the Educatel Study, Brazil, 2015/2016. / Hipóteses, delineamento e instrumentos do Estudo Educatel, Brasil, 2015/2016.

The Educatel Study 2015/2016 was designed to evaluate health and work conditions in a representative sample of the 2,220,000 schoolteachers working in Basic Education in Brazil. The article aimed to describe the telephone survey's basis and design, using a questionnaire consisting of 54 short, simple questions, most of which with multiple-choice answers (closed questions) addressing diseases, accidents, absenteeism, frequency of healthy behaviors, physical and psychosocial environment, and employment characteristics. In the pilot stage, the multi-theme questionnaire was assessed in order to verify the effects of the terminology, the format of the questions and the multiple-choice answers, the questionnaire's internal organization, production of the answers, and duration of the interview. The interviewers' training and follow-up and listening of the calls in real time aimed to identify communications problems. The teachers were interviewed at school after prior contact with the school assistant to set appointments. The advantages and risks of biases related to the telephone interview modality should be considered to interpret the results. The results on the teachers' profile, illnesses, and school environment will provide inputs for elaborating inter-sector measures to improve the target group's health, which is related to Brazil's school system indicators based on the concepts presented here.

O Estudo Educatel 2015/2016 foi delineado para avaliar a saúde e as condições do trabalho realizado nas escolas, de uma amostra representativa dos 2.220.000 professores que atuavam na Educação Básica no Brasil. O objetivo do artigo foi descrever as bases e o delineamento da pesquisa telefônica, que utilizou questionário composto por 54 perguntas curtas e simples, a maioria composta de respostas preestabelecidas (questões fechadas), versando sobre morbidades, acidentes, absenteísmo, frequência dos comportamentos saudáveis, ambiente físico e psicossocial, e características do emprego. Na etapa piloto, o questionário multitemático foi avaliado a fim de verificar os efeitos da terminologia usada, o formato das questões e das alternativas de resposta, a organização interna das perguntas, a produção das respostas e a duração da entrevista. O treinamento dos entrevistadores, o acompanhamento e a escuta das chamadas em tempo real buscaram identificar problemas de comunicação. Os professores foram entrevistados na escola, após contato prévio com o assistente escolar para agendamento. Para interpretar os resultados, alerta-se sobre as vantagens e riscos de vieses relacionados à modalidade de entrevista por telefone. Os resultados sobre o perfil dos professores, adoecimento e ambiente escolar fornecerão insumos para a elaboração de ações intersetoriais para melhorar a saúde do grupo alvo que, de acordo com as concepções que foram aqui apresentadas, estaria relacionada aos indicadores educacionais brasileiros.

El Estudio Educatel 2015/2016 fue diseñado para evaluar la salud y las condiciones del trabajo realizado en las escuelas, de una muestra representativa de los 2.220.000 profesores que actuaban en la Educación Básica en Brasil. El objetivo del artículo fue describir las bases y el lineamiento de la encuesta telefónica, que utilizó un cuestionario compuesto por 54 preguntas cortas y simples, la mayoría compuesta de respuestas preestablecidas (cuestiones cerradas), que versaban sobre morbilidades, accidentes, absentismo, frecuencia de comportamientos saludables, ambiente físico y psicosocial, y características del empleo. En la etapa piloto, el cuestionario multitemático se evaluó a fin de verificar los efectos de la terminología usada, el formato de las cuestiones y de las alternativas de respuesta, la organización interna de las preguntas, la producción de las respuestas y la duración de la entrevista. El entrenamiento de los entrevistadores, el seguimiento y la escucha de las llamadas en tiempo real procuraron identificar problemas de comunicación. Los profesores fueron entrevistados en la escuela, tras un contacto previo con el asistente escolar para fijar citas. Con el fin de interpretar los resultados, se alerta sobre las ventajas y riesgos de sesgos relacionados con la modalidad de entrevista por teléfono. Los resultados sobre el perfil de los profesores, enfermedad y ambiente escolar proporcionarán insumos para la elaboración de acciones intersectoriales, con el objeto de mejorar la salud del grupo objetivo que, de acuerdo con las concepciones que fueron aquí presentadas, estaría relacionada con los indicadores educacionales brasileños.

Determinantes de capacidade para o trabalho no cenário da Educação Básica do Brasil: Estudo Educatel, 2016 / Determinantes de capacidad para el trabajo en el escenario de la educación infantil de Brasil: Estudio Educatel, 2016 / Determinants of teachers' work ability in basic education in Brazil: Educatel Study, 2016

O objetivo desse estudo foi analisar a relação entre saúde, características do trabalho, educação e competências sobre a capacidade para o trabalho de professores da Educação Básica no Brasil. Trata-se de um estudo transversal, de base populacional, segundo dados da Pesquisa Nacional sobre Saúde, Condições de Trabalho e Faltas dos Professores nas Escolas da Educação Básica (Estudo Educatel). Uma amostra probabilística composta por 6.510 professores respondeu a um questionário telefônico (2015) contendo informações sociodemográficas, estado de saúde, educação e competências, características do trabalho e absenteísmo. A modelagem de equações estruturais (MEE) foi usada como técnica multivariada e os coeficientes padronizados (CP) foram calculados para analisar os efeitos diretos e indiretos entre os desfechos. O estado de saúde apresentou um efeito direto sobre a capacidade para o trabalho (CP = -0,83, p < 0,01). As características do trabalho interferiram diretamente no estado de saúde (CP = 0,60, p < 0,01) e capacidade para o trabalho (CP = -0,25, p < 0,05), com destaque para ruído no trabalho e indisciplina dos alunos; o efeito total (soma dos efeitos direto e indireto) das características do trabalho sobre a capacidade para o trabalho foi igual a -0,75 (p < 0,01). Este estudo concluiu que as relações entre estado de saúde e características do trabalho dos professores da Educação Básica são complexas e afetam negativamente a capacidade para o trabalho. Potenciais ações de promoção e manutenção da capacidade para o trabalho devem considerar as exigências psicossociais da atividade docente e medidas para controlar a ordem e a disciplina na sala de aula.

El objetivo fue analizar la relación entre salud, características del trabajo, educación y competencias sobre la capacidad para el trabajo de profesores de educación básica en Brasil. Es un estudio transversal, de base poblacional, según datos de la Encuesta Nacional sobre Salud, Condiciones de Trabajo y Ausencias de los Profesores en las Escuelas de Educación Básica (Estudio Educatel). Una muestra probabilística, compuesta por 6.510 profesores, respondió a un cuestionario telefónico (2015), que contenía información sociodemográfica, estado de salud, educación y competencias, características del trabajo y absentismo. Se utilizó modelos de ecuaciones estructurales (MEE) como técnica de análiseis multivariantes y se calcularon los coeficientes estandarizados (CP por sus siglas en portugués) para analizar los efectos directos e indirectos entre las variables. El estado de salud presentó un efecto directo sobre la capacidad para el trabajo (CP = -0,83, p < 0,01). Las características del trabajo interfirieron directamente en el estado de salud (CP = 0,60, p < 0,01) y capacidad para el trabajo (CP = -0,25, p < 0,05), destacando el ruido en el trabajo e indisciplina de los alumnos; el efecto total (suma de los efectos directo e indirecto) de las características de trabajo sobre la capacidad para el trabajo fue igual a -0,75 (p < 0,01). Este estudio concluyó que las relaciones entre estado de salud y características del trabajo de los profesores de educación básica son complejas y afectan negativamente la capacidad para el trabajo. Potenciales acciones de promoción y manutención de la capacidad para el trabajo deben considerar las exigencias psicosociales de la actividad docente y medidas para controlar el orden y la disciplina en la clase.

The study aimed to analyze the relationship between health, work characteristics, education, and skills on the work ability of teachers in basic education in Brazil. This was a cross-sectional, population-based study using data from the Brazilian National Survey on Health, Work Conditions, and Absences in Schoolteachers in Basic Education (Educatel Study). A probabilistic sample of 6,510 teachers answered a telephone interview in 2015 with questions on sociodemographic data, health status, education and skills, work characteristics, and absenteeism. Structural equation modeling (SEM) was used in multivariate analysis and standardized coefficients (SC) were calculated to analyze direct and indirect effects between the outcomes. Health status showed a direct effect on work ability (SC = -0.83, p < 0.01). Work characteristics directly affected health status (SC = 0.60, p < 0.01) and work ability (SC = -0.25, p < 0.05), especially noise at work and students' unruliness. Total effect (sum of direct and indirect effects) of work characteristics on work ability was -0.75 (p < 0.01). The study concluded that the relations between health status and work characteristics of Brazilian teachers in basic education are complex and negatively affect work ability. Potential actions to promote and maintain work ability should take into account the psychosocial demands of teaching and measures to maintain order and discipline in the classroom.

Hipóteses, delineamento e instrumentos do Estudo Educatel, Brasil, 2015/2016 / Hipótesis, lineamiento e instrumentos del Estudio Educatel, Brasil, 2015/2016 / Hypotheses, design, and instruments in the Educatel Study, Brazil, 2015/2016

O Estudo Educatel 2015/2016 foi delineado para avaliar a saúde e as condições do trabalho realizado nas escolas, de uma amostra representativa dos 2.220.000 professores que atuavam na Educação Básica no Brasil. O objetivo do artigo foi descrever as bases e o delineamento da pesquisa telefônica, que utilizou questionário composto por 54 perguntas curtas e simples, a maioria composta de respostas preestabelecidas (questões fechadas), versando sobre morbidades, acidentes, absenteísmo, frequência dos comportamentos saudáveis, ambiente físico e psicossocial, e características do emprego. Na etapa piloto, o questionário multitemático foi avaliado a fim de verificar os efeitos da terminologia usada, o formato das questões e das alternativas de resposta, a organização interna das perguntas, a produção das respostas e a duração da entrevista. O treinamento dos entrevistadores, o acompanhamento e a escuta das chamadas em tempo real buscaram identificar problemas de comunicação. Os professores foram entrevistados na escola, após contato prévio com o assistente escolar para agendamento. Para interpretar os resultados, alerta-se sobre as vantagens e riscos de vieses relacionados à modalidade de entrevista por telefone. Os resultados sobre o perfil dos professores, adoecimento e ambiente escolar fornecerão insumos para a elaboração de ações intersetoriais para melhorar a saúde do grupo alvo que, de acordo com as concepções que foram aqui apresentadas, estaria relacionada aos indicadores educacionais brasileiros.

El Estudio Educatel 2015/2016 fue diseñado para evaluar la salud y las condiciones del trabajo realizado en las escuelas, de una muestra representativa de los 2.220.000 profesores que actuaban en la Educación Básica en Brasil. El objetivo del artículo fue describir las bases y el lineamiento de la encuesta telefónica, que utilizó un cuestionario compuesto por 54 preguntas cortas y simples, la mayoría compuesta de respuestas preestablecidas (cuestiones cerradas), que versaban sobre morbilidades, accidentes, absentismo, frecuencia de comportamientos saludables, ambiente físico y psicosocial, y características del empleo. En la etapa piloto, el cuestionario multitemático se evaluó a fin de verificar los efectos de la terminología usada, el formato de las cuestiones y de las alternativas de respuesta, la organización interna de las preguntas, la producción de las respuestas y la duración de la entrevista. El entrenamiento de los entrevistadores, el seguimiento y la escucha de las llamadas en tiempo real procuraron identificar problemas de comunicación. Los profesores fueron entrevistados en la escuela, tras un contacto previo con el asistente escolar para fijar citas. Con el fin de interpretar los resultados, se alerta sobre las ventajas y riesgos de sesgos relacionados con la modalidad de entrevista por teléfono. Los resultados sobre el perfil de los profesores, enfermedad y ambiente escolar proporcionarán insumos para la elaboración de acciones intersectoriales, con el objeto de mejorar la salud del grupo objetivo que, de acuerdo con las concepciones que fueron aquí presentadas, estaría relacionada con los indicadores educacionales brasileños.

The Educatel Study 2015/2016 was designed to evaluate health and work conditions in a representative sample of the 2,220,000 schoolteachers working in Basic Education in Brazil. The article aimed to describe the telephone survey's basis and design, using a questionnaire consisting of 54 short, simple questions, most of which with multiple-choice answers (closed questions) addressing diseases, accidents, absenteeism, frequency of healthy behaviors, physical and psychosocial environment, and employment characteristics. In the pilot stage, the multi-theme questionnaire was assessed in order to verify the effects of the terminology, the format of the questions and the multiple-choice answers, the questionnaire's internal organization, production of the answers, and duration of the interview. The interviewers' training and follow-up and listening of the calls in real time aimed to identify communications problems. The teachers were interviewed at school after prior contact with the school assistant to set appointments. The advantages and risks of biases related to the telephone interview modality should be considered to interpret the results. The results on the teachers' profile, illnesses, and school environment will provide inputs for elaborating inter-sector measures to improve the target group's health, which is related to Brazil's school system indicators based on the concepts presented here.

Dietary patterns, sociodemographic and behavioral characteristics among Brazilian adolescents. / Padrões alimentares, características sociodemográficas e comportamentais entre adolescentes brasileiros.

INTRODUCTION: Inadequate dietary patterns in childhood and adolescence are a major risk factor for the early onset of obesity and other chronic diseases. OBJECTIVES: To identify and to analyze dietary patterns among Brazilian adolescents. METHODS: Data from the Brazilian National School Health Survey (PeNSE) of 2015 were used (n = 10,926 adolescents). The identification and analyses of dietary patterns were calculated using principal component analysis and linear regression, respectively. RESULTS: Two dietary patterns were identified. The first one was characterized by the presence of markers of unhealthy eating, and the second one by markers of healthy eating. The adherence to the unhealthy pattern was positively associated with female adolescents, which mothers had completed, at least, the elementary school, residents in developed regions and urban areas, as well as those students who usually chose to skip breakfast, to not have meals with their parents/guardians, and who usually had meals while watching TV/studying, and at fast food restaurants. DISCUSSION: Analyses of the consumption of isolated food groups, which do not consider the diet in all its complexity, have been insufficient in explaining the main outcomes of the public health nutrition area. CONCLUSION: Our findings contributed to the identification of the most vulnerable population groups to unhealthy dietary patterns and to the understanding of the coexistence of different food habit determinants among adolescents.

INTRODUçÃO: Padrões inadequados de alimentação na infância e na adolescência são um dos principais fatores de risco para o aparecimento precoce da obesidade e de outras doenças crônicas. OBJETIVOS: Identificar e analisar os padrões alimentares entre os adolescentes brasileiros. MÉTODOS: Foram utilizados dados da Pesquisa Nacional de Saúde do Escolar de 2015 (n = 10.926 adolescentes). A identificação e a análise dos padrões alimentares foram realizadas por meio da análise de componentes principais e pela regressão linear, respectivamente. RESULTADOS: Dois padrões foram identificados: o primeiro, caracterizado por marcadores de uma alimentação não saudável; e o segundo, por marcadores de uma alimentação saudável. A adesão ao padrão não saudável esteve positivamente associada aos adolescentes do sexo feminino, que possuem mães com, ao menos, ensino fundamental completo, que residem em regiões mais desenvolvidas e em área urbana, bem como entre aqueles que possuem o hábito de não tomar café da manhã, não realizar as refeições com os pais/responsáveis, se alimentar enquanto estuda ou assiste TV e frequentar restaurantes fast-food. DISCUSSÃO: Análises do consumo de grupos alimentares isolados, que não consideram a dieta em toda a sua complexidade, têm se mostrado insuficientes na explicação dos principais desfechos da área de nutrição em saúde pública. CONCLUSÃO: Os achados contribuíram para a identificação de grupos populacionais mais vulneráveis ao padrão alimentar não saudável e para a compreensão da coexistência de diferentes determinantes ao hábito alimentar entre os adolescentes.

Nutritional status, body image, and their association with extreme weight control behaviors among Brazilian adolescents, National Adolescent Student Health Survey 2015. / Estado nutricional, imagem corporal e associação com comportamentos extremos para controle de peso em adolescentes brasileiros, Pesquisa Nacional de Saúde do Escolar de 2015.

INTRODUCTION: This study aimed to analyze the association between nutritional status, body image perception, and extreme weight control behaviors among adolescents. METHODS: This is an analytical cross-sectional study conducted in Brazil based on the National Adolescent Student Health Survey (Pesquisa Nacional de Saúde do Escolar - PeNSE) of 2015, with adolescents aged 13 to 17 years. Nutritional status and body image perception were the independent variables. The two dependent variables were vomiting or laxative use and use of medicines and other formulas for weight control in the 30 days prior to data collection. We used Poisson regression models for association, with demographic variables for control. RESULTS: 7.4% of adolescents (95%CI 6.7 - 8.2) reported vomiting or using laxatives, with no difference between genders. The prevalence of use of medicines and formulas was higher among boys (7.8%; 95%CI 6.6 - 8.9). The association between nutritional status and extreme behaviors was not significant. However, the prevalence of vomiting or laxative use for adolescents who considered themselves very fat was 2.3 (95%CI 1.1 - 4.7) times higher for boys and 5.3 (95%CI 3.3 - 8.6) times higher for girls, while the use of medicines and formulas was 4.0 (95%CI 2.3 - 7.1) times higher for girls who considered themselves very fat. CONCLUSION: Body image perception seems to have a greater influence on extreme behaviors than nutritional status. Strategies involving health services and schools have great potential to impact the self-esteem and health of students positively.

INTRODUÇÃO: Este estudo objetivou analisar a associação entre estado nutricional, percepção da imagem corporal e comportamentos extremos para controle de peso nos adolescentes. METODOLOGIA: Estudo transversal analítico, realizado no Brasil a partir da Pesquisa Nacional de Saúde do Escolar (PeNSE) de 2015, com adolescentes de 13 a 17 anos. Estado nutricional e percepção da imagem corporal foram as variáveis independentes. As dependentes foram vômito ou uso de laxantes e uso de remédios e outras fórmulas para controle de peso nos últimos 30 dias. Modelos de regressão de Poisson foram empregados para associação, com uso de variáveis demográficas para controle. RESULTADOS: 7,4% dos adolescentes (IC95% 6,7 - 8,2) relataram vômito ou uso de laxantes, sem diferença entre os sexos. A prevalência de uso de remédio e fórmulas foi maior entre meninos (7,8%; IC95% 6,6 - 8,9). A associação entre estado nutricional e comportamentos extremos não foi significativa; entretanto, a prevalência de vômito ou uso de laxantes foi 2,3 (IC95% 1,1 - 4,7) vezes maior em meninos e 5,3 (IC95% 3,3 - 8,6) vezes maior em meninas que se sentiam muito gordos(as), ao passo que uso de remédios e fórmulas foi 4,0 vezes (IC95% 2,3 - 7,1) maior em meninas que sentiam muito gordas. CONCLUSÃO: A percepção da imagem corporal parece ter maior influência na prática dos comportamentos extremos do que o estado nutricional. Estratégias envolvendo serviços de saúde e escolas têm grande potencialidade para ações que impactem positivamente na autoestima e na saúde dos estudantes.

Trends in sweetened beverages consumption among adults in the Brazilian capitals, 2007-2016.

OBJECTIVE: To analyse trends in sweetened beverages consumption among adults in Brazil between 2007 and 2016. DESIGN: A time-series analysis, with data from the Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL). The prevalence of regular consumption (≥5 d/week), the average daily consumption (millilitres) and the prevalence of non-consumption of these beverages were analysed. The temporal variations of the indicators were calculated by linear regression. The analyses were performed for the complete set of the evaluated population and stratified by sociodemographic characteristics. SETTING: Brazilian capitals and Federal District. SUBJECTS: Brazilian adults aged ≥18 years (n 519 641). RESULTS: There was a reduction in both regular and average daily consumption of sugar- and artificially sweetened beverages (-1·28 percentage points (pp)/year, P=0·001 and -9·63 ml/year, P=0·001, respectively). The same result regarding regular consumption was found when only sugar-sweetened beverages were analysed (-1·11 pp/year, P=0·011). Similar trends were identified in the stratified analyses, with a greater magnitude of reduction among males, young adults, those with higher schooling and residents of more developed regions. Coincidentally, there was an increase in the prevalence of adults who did not consume sweetened beverages (1·54 pp/year, P=0·005). CONCLUSIONS: The consumption of sweetened beverages decreased during the period. However, a significant portion of the population still referred a daily consumption of these beverages.