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.

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.

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.

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.

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.

Estado nutricional, condições socioeconômicas, ambientais e de saúde de crianças moradoras em cortiços e favela / Nutritional status and health, environmental and socioeconomic conditions of children living in tenements and shanty towns

OBJETIVO: Comparar a freqüência da desnutrição entre crianças de 6 meses a 6 anos, moradoras em cortiços e favela, da região central de São Paulo e caracterizar as diferenças das condições socioeconômicas, ambientais e de saúde dos dois grupos. MÉTODOS: Realizou-se estudo transversal com 86 crianças moradoras em cortiços e 84 crianças residentes na favela e respectivas famílias. Classificou-se a desnutrição segundo os índices estatura/idade, peso/idade e peso/estatura, ponto de corte <-1 e <-2 escore-Z, comparados ao padrão National Center for Health Statistics. Os dados socioeconômicos, ambientais e de saúde foram coletados com a aplicação de um questionário durante as visitas domiciliares. Para analisar os dados utilizaram-se o teste do qui-quadrado e o teste t de Student ou o teste Mann-Whitney com nível de significância 5 por cento. RESULTADOS: A proporção da desnutrição leve foi duas vezes maior nas crianças moradoras em favela em relação às residentes nos cortiços e quatro vezes maior para desnutrição moderada. Com relação às variáveis pesquisadas, as famílias moradoras em favela apresentaram piores condições quanto a: renda, despesas com alimentação, trabalho, condições de moradia e saneamento (p<0,001). Quanto às condições de saúde observou-se maior ocorrência de diarréia (p=0,003) e menor cobertura vacinal (p<0,001) entre as crianças moradoras em favela. CONCLUSÃO: A freqüência da desnutrição nas crianças da favela estudada foi maior do que a encontrada nos cortiços e as famílias moradoras na favela foram consideradas extremamente pobres, com condições socioeconômicas e ambientais piores do que nos cortiços, evidenciando aspectos da pobreza urbana ligados à desnutrição infantil.

OBJECTIVE: The objective was to compare malnutrition rates among children aged from 6 months to 6 years living in tenements and shanty towns in downtown São Paulo city and characterize the differences in the socioeconomic, environmental and health conditions of the two groups. METHODS: A cross-sectional study was done with 86 children living in tenements and 84 children living in shanty towns and their respective families. Malnutrition was classified according to their height-for-age, weight-for-age and weight-for-height indices when compared with those of the National Center for Health Statistics. Z-scores < -1 and < -2 were used as the cut-off points of malnutrition. Socioeconomic, environmental and health data were collected by administering a questionnaire during home visits. Data were analyzed by applying the chi-square, Student's t or Mann-Whitney tests. The significance level was set at 5 percent. RESULTS: Mild malnutrition rate was two times higher in children living in shanty towns than in those living in tenements and moderate malnutrition rate was four times higher. Regarding the analyzed variables, dwellers of shanty towns had lower incomes, spent less on food and had worse jobs and living and sanitary conditions (p<0.001). Diarrhea was more frequent (p=0.003) and vaccination rates were lower (p<0.001) among children living in shanty towns. CONCLUSION: The rate of malnutrition found for children living in the studied shanty town was higher than that found for children living in tenements. Families living in shanty towns were considered extremely poor, with worse socioeconomic and environmental conditions than those living in tenements, evidencing aspects of urban poverty associated with childhood malnutrition.

Sistema de classificação de pacientes na especialidade enfermagem psiquiátrica / Patient system classification in psychiatric nursing

OBJETIVO: Estudar um Instrumento para Classificação do Nível de Dependência de Pacientes Psiquiátricos aos Cuidados de Enfermagem, foi objetivo deste estudo. MÉTODOS: Os indicadores críticos do cuidado (aparência e higiene, expressão do pensamento, humor e afeto, interação social, atividades, alimentação e hidratação, sono, medicação, eliminações, sinais vitais e outros controles, problemas e queixas somáticas). RESULTADOS: Com gradação de 1 a 3 pontos permitiram identificar os níveis de dependência. Foi aplicada a técnica Delphi e, os avaliadores concordaram pela manutenção dos 11 indicadores críticos. CONCLUSÃO: Os resultados deste estudo mostram que o instrumento é valido e pode contribuir para o avanço tecnológico e científico da Especialidade no Brasil.