Relationship between polyvictimization and overweight among adolescents from São Paulo city, Brazil.

This study is to identify victimization patterns and analyze the association between the experience of polyvictimization and overweight or obesity among adolescent girls and boys. The sample consisted of 2680 Brazilian ninth-graders enrolled in public and private schools, taken from the São Paulo Project for the social development of children and adolescents (SP-PROSO). Victimization was explored in two ways: (i) as per Finkelhor and (ii) by latent class analysis (LCA). The interest outcomes were overweight and obesity. Multinomial logistic regression models were used to study the relationship between victimization and overweight or obesity, controlling for confounders. LCA grouped boys and girls adolescents into three classes. These classes received the same labels, but the patterns differed between sexes. Class 1 was characterized by fewer types of victimization suffered and lower endorsement values in the analyzed items and was named bullying and indirect victimization (♀: 42.7%, n = 546; ♂: 21.6%, n = 293). Class 2 included more victimization types than Class 1 and less than Class 3. This class was labeled family violence and peer victimization (♀: 29.1%, n = 356; ♂: 47.9%, n = 652). Class 3 was named high polyvictimization (♀: 28.2%, n = 345; ♂: 30.5%, n = 418). According to Finkelhor, polyvictimization was not associated with overweight or obesity in both sexes. Only the class of high polyvictimization was associated with being overweight (ORadj: 1.60, 95%CI: 1.01-2.54) in girls. In this study, polyvictimization was associated with being overweight only among adolescent girls. Longitudinal studies in different contexts and populations are needed to understand this relationship.

Nova diet quality scores and risk of weight gain in the NutriNet-Brasil cohort study.

OBJECTIVE: To assess the prospective association of two diet quality scores based on the Nova food classification with BMI gain. DESIGN: The NutriNet-Brasil cohort is an ongoing web-based prospective study with continuous recruitment of participants aged ≥ 18 years since January 2020. A short 24-h dietary recall screener including 'yes/no' questions about the consumption of whole plant foods (WPF) and ultra-processed foods (UPF) was completed by participants at baseline. The Nova-WPF and the Nova-UPF scores were computed by adding up positive responses regarding the consumption of thirty-three varieties of WPF and twenty-three varieties of UPF, respectively. Participants reported their height at baseline and their weight at both baseline and after approximately 15 months of follow-up. A 15-month BMI (kg/m2) increase of ≥5 % was coded as BMI gain. SETTING: Brazil. PARTICIPANTS: 9551 participants from the NutriNet-Brasil cohort. RESULTS: Increasing quintiles of the Nova-UPF score were linearly associated with higher risk of BMI gain (relative risk Q5/Q1 = 1·34; 95 % CI 1·15, 1·56), whereas increasing quintiles of the Nova-WPF score were linearly associated with lower risk (relative risk Q5/Q1 = 0·80; 95 % CI 0·69, 0·94). We identified a moderate inverse correlation between the two scores (-0·33) and a partial mediating effect of the alternative score: 15 % for the total effect of the Nova-UPF score and 25 % for the total effect of the Nova-WPF score. CONCLUSIONS: The Nova-UPF and Nova-WPF scores are independently associated with mid-term BMI gain further justifying their use in diet quality monitoring systems.

The relationship between ultra-processed food consumption and internalising symptoms among adolescents from São Paulo city, Southeast Brazil.

OBJECTIVE: To investigate the association between ultra-processed food (UPF) consumption and internalising symptoms (IS) among adolescents. DESIGN: It is a cross-sectional study. Paper-pencil survey was completed in classroom with information on UPF consumption, IS and selected covariates. IS were assessed with the Internalizing Symptoms sub-scale from the Social Behaviour Questionnaire (IS-SBQ). UPF was evaluated with a FFQ extracted from the Brazilian National School Health Survey. Crude and adjusted association between UPF and IS was investigated with structural equation models. SETTING: São Paulo, SP, Brazil. PARTICIPANTS: A total of 2680 students, Mage = 14·85; (95 % CI 14·81, 14·88). RESULTS: UPF consumption was associated with higher scores in IS in the crude (ß = 0·14; P < 0·001) and adjusted (ß = 0·12; P < 0·001) models. The higher the consumption of UPF, the higher is the IS score. The following variables were associated with a lower risk of UPF consumption: male sex, public school and having more meals with parents. The change in the magnitude of the standardised score was almost negligible, but the model was significantly improved with the inclusion of covariates. CONCLUSIONS: Our results provide evidence about the positive association between UPF consumption and IS among adolescents. The association, despite its low magnitude, remained significant after adjusting for potential confounders. These results are relevant considering the increase in UPF consumption worldwide and in low- and middle-income countries. Also, our study emphasises the importance of a healthy diet with a reduction in UPF consumption among adolescents.

Association between self-control and health risk behaviors: a cross-sectional study with 9th grade adolescents in São Paulo.

BACKGROUND: Self-control (SC) has been consistently found associated with diverse health risk behaviors (HRBs), but little research refers to low- and middle-income countries. Furthermore, there is evidence that some HRBs tend to aggregate, however studies with the specific purpose of addressing the relation between SC and multiple health risk behaviors (MHRBs) are rare. The objective of this study is to analyze these associations and provide evidence to help filling these gaps. METHODS: A sample of 2106 9th grade students from the city of São Paulo responded a self-administered questionnaire in 2017. We tested the association of SC measured as an ordinal variable with four levels (higher, high, medium and low) with six HRBs (binge drinking, marijuana use, smoking, high consumption of ultra-processed food, sedentary behavior and bullying perpetration), in both separated and aggregated forms (MHRBs), controlling for potential confounders. Binary logistic regression was used to test the association between exposure (SC) and single outcomes. In order to analyze the association of SC with MHRBs, multinomial logistic regression was employed. RESULTS: SC was associated with five of six HRBs investigated and with MHRBs. The effect size of the association of SC and MHRBs increased in a steep pattern with accumulation of more HRBs. CONCLUSION: Low self-control is associated with most HRBs investigated and the magnitude of the association increases when more than two or three HRBs are accumulated. There seems to be a group of adolescents in a position of pronounced vulnerability for MHRBs. This should be considered when designing public policy and prevention programs. In contexts of limited or scarce resources and public funds, interventions focusing the most vulnerable groups, instead of universal interventions, should be considered.

Food environment, social deprivation and obesity among students from Brazilian public schools.

OBJECTIVE: To investigate the relationship between social deprivation and the food environment. Furthermore, to evaluate if the food environment is associated with the prevalence of obesity among students in Brazilian public schools. DESIGN: Cross-sectional. For the classification of obesity, weight and height were measured, and the cut-off point of BMI-for-age Z-score >+2 was adopted. Social deprivation level was determined from the Health Vulnerability Index (HVI). To assess the food environment, the density of food establishments in urban residential areas was calculated. Associations between the food environment and the presence of obesity were estimated by binary logistic regression through a generalized estimating equations model. SETTING: Juiz de Fora, Minas Gerais, Brazil. SUBJECTS: Children and adolescents (n 661) aged 7-14 years. RESULTS: The lowest social deprivation level showed a higher density of all types of establishments that sold predominantly unhealthy foods. An inverse association was found between the density of supermarkets and hypermarkets and the presence of obesity (OR=0·58; 95 % CI 0·36, 0·93). For the other categories of food retailers, no significant differences were found. CONCLUSIONS: The findings reinforce the need for public policies that promote equality in the food environments of the city. Also, further investigations into the influence of the presence of supermarkets on the nutritional status of children and adolescents are required.

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.

How and why ultra-processed foods harm human health.

The analysis of food using a perspective centred on nutrients seems inadequate for understanding the dietary transition and its impact on the growth of obesity and chronic diseases. Industrial food processing is now proposed as the key to explain the relationship between food and health. The NOVA food classification considers the degree and the purpose of food processing, which includes physical, biological and chemical processes used after foods are separated from nature, and before being consumed or prepared as dishes and meals. NOVA has four food groups: (1) unprocessed and minimally processed foods; (2) processed culinary ingredients; (3) processed foods and (4) ultra-processed foods, which are formulations made mostly or entirely from substances derived from group 1 foods and additives, with little if any intact group 1 food. Many investigations linking high ultra-processed food consumption with deterioration of diets and adverse health outcomes are reinforced by prospective studies, systematic reviews and meta-analyses. There are various plausible explanations of why diets high in ultra-processed foods are harmful. Their production and consumption continue to rise worldwide. Efficient and effective public policies and actions that reduce production and consumption of ultra-processed products are needed, to protect human health now and in future.

Food environment near schools in the largest Brazilian metropolis: analyses and contributions based on census data.

We aimed to investigate and compare the distribution of establishments that sell food near municipal, state, and private schools in the municipality of São Paulo, Brazil. This cross-sectional, exploratory, and census study was conducted in 3,121 schools. Circular buffers were traced around schools and concentrations or dispersions of food stores (in absolute numbers and densities) were analyzed. A p-trend was calculated to analyze how food stores density behaved as the buffer radius distance increased. Stratified regression models were built to analyze the characteristics of the food environment. Snack bars and street vendors are the most common types of establishments surrounding schools. Some categories of food stores are concentrated (such as candy stores around municipal and private schools, mini markets around municipal schools, and snack bars around private schools), whereas others (such as super and hypermarkets and fruit and vegetable stores) are dispersed around public schools. The food environment around schools shows differences regarding the instance that administers them and private schools have more food stores around them. Poor-quality food environment around schools exposes students to risk factors regarding excessive unhealthy food consumption.

Changes in dietary markers during the covid-19 pandemic in Brazil.

OBJECTIVE: Evaluate changes in the Brazilian population's diet and its determinants during the covid-19 pandemic. METHODS: We used diet data collected by the Datafolha Institute in 2019 (n = 1,384), 2020 (n =1,214), and 2021 (n = 1,459) from independent and representative samples of the adult population (aged 18 to 55 years) from all socioeconomic classes and geographic regions of Brazil. Food consumption was measured by checking the consumption of 22 sets of food on the day before the survey. The third cycle also included questions about changes in eating habits during the pandemic. We estimated the prevalence of consumption of the food sets in each cycle of the survey and used statistical tests for comparisons of proportions between the three cycles. RESULTS: Between 2019 and 2020, we observed a significant increase in the consumption of cereals, milk, packaged snacks or salty cookies, and industrialized sauces, as opposed to a decrease in the consumption of eggs. Between 2019 and 2021 and between 2020 and 2021, on the other hand, there was a significant decrease in the consumption of cereals, vegetables, fruits, and industrialized fruit juices and an increase in the consumption of soda, sweets, cookies, sausages, industrialized sauces, and ready meals. When asked about the main changes in the purchase and preparation of meals, 46.3% of the respondents reported consuming more food prepared at home during the pandemic. Regarding changes in eating habits, 48.6% of the respondents reported a change in their eating habits during the pandemic. The main reasons for such changes were greater concern with health (39.1%) and self-reported decreased family income (30.2%). CONCLUSIONS: The covid-19 pandemic had a negative impact on the diet of the population, and increased consumption of ultra-processed foods was reported for that period.

Malnutrition in mother-child dyads in the Brazilian National Survey on Child Nutrition (ENANI-2019).

Malnutrition affects billions of individuals worldwide and represents a global health challenge. This study aimed to determine the prevalence of malnutrition (undernutrition or overweight) among mother-child dyads in children under 5 years old in Brazil in 2019 and to estimate changes in this prevalence from 2006 to 2019. Individual-level data from the Brazilian National Survey on Child Nutrition (ENANI-2019) and the Brazilian National Survey of Demography and Health of Women and Children carried out in 2006 (PNDS 2006) were analyzed. Malnutrition outcomes in mother-child dyads included overweight mother and child, undernourished mother and child, and the double burden of malnutrition, i.e., overweight mother and child having any form of undernourishment (stunting, wasting, or underweight). Prevalence and 95% confidence intervals (95%CI) were estimated. Most women (58.2%) and 9.7% of the children were overweight, 6.9% were stunted, and 3.1% of mothers and 2.9% of the children were underweight. The prevalence of overweight in the mother-child dyad was 7.8% and was statistically higher in Southern Brazil (9.7%; 95%CI: 7.5; 11.9) than in the Central-West (5.4%; 95%CI: 4.3; 6.6). The prevalence of overweight mother and stunted child was 3.5%, with statistically significant difference between the extremes of the mother's education [0-7 vs. ≥ 12 years, 4.8% (95%CI: 3.2; 6.5) and 2.1%, (95%CI: 1.2; 3.0), respectively]. Overweight in the dyad increased from 5.2% to 7.8%, and the double burden of malnutrition increased from 2.7% to 5.2% since 2006. Malnutrition in Brazilian mother-child dyads seems to be a growing problem, and dyads with lower formal education, higher maternal age, and from the South Region of Brazil were more vulnerable.

Availability and consumption of ultra-processed foods in schools in the municipality of São Paulo, Brazil: results of the SP-Proso. / Disponibilidade e consumo de ultraprocessados em escolas do Município de São Paulo, Brasil: resultados do SP-Proso.

Ultra-processed foods are markers of unhealthy eating patterns, and their consumption is high among adolescents. Characteristics of the school eating environment associate with student eating practices. This study aims to investigate the association between the presence of school canteens and the availability of ultra-processed foods in school canteens with the consumption of these foods, inside the school, among adolescents of the 9th grade (14 years) of the public and private schools of the city of São Paulo, Brazil. We conducted a cross-sectional study with SP-Proso data, in a sample of 2,680 adolescents. We elaborated multilevel linear regression models to evaluate associations between the exposures: presence of school canteens and availability of ultra-processed foods with outcomes of consumption frequency of ultra-processed foods in the school. We found an association between the presence of school canteens and the higher frequency of consumption of sausages (0.46; 95%CI: 0.24; 0.68), package snacks (0.50; 95%CI: 0.19; 0.80), goodies (0.82; 95%CI: 0.55; 1.09), and sugary drinks (0.34; 95%CI: 0.06; 0.62), as well as a score of consumption frequency of ultra-processed foods (2.37; 95%CI: 1.25; 3.48). The availability of package snacks, goodies, and sugary drinks in school canteens increased the frequency of consumption of these foods. We observed a dose-response effect between the diversity of ultra-processed foods in canteens and the frequency of consumption of these foods. A school food environment with greater availability of ultra-processed products is associated with their higher consumption in school, indicating the need to regulate the sale of food within these institutions.

Alimentos ultraprocessados são marcadores de padrões alimentares não saudáveis e seu consumo é elevado entre os adolescentes. Características do ambiente alimentar escolar se associam a práticas alimentares de estudantes. O objetivo do estudo foi investigar a associação entre a presença de cantinas e a disponibilidade de alimentos ultraprocessados nas cantinas com o consumo destes alimentos, dentro da escola, entre adolescentes do 9º ano do Ensino Fundamental das redes pública e particular do Município de São Paulo, Brasil. Foi realizado um estudo transversal com dados do SP-Proso, em amostra de 2.680 adolescentes. Foram feitos modelos de regressão linear multinível para avaliar as associações entre as exposições presença de cantinas nas escolas e disponibilidade de alimentos ultraprocessados com desfechos de frequência de consumo de ultraprocessados na escola. A presença de cantinas esteve associada à maior frequência de consumo de embutidos (0,46; IC95%: 0,24; 0,68), salgadinhos de pacote (0,50; IC95%: 0,19; 0,80), guloseimas (0,82; IC95%: 0,55; 1,09) e bebidas açucaradas (0,34; IC95%: 0,06; 0,62), bem como um escore de frequência de consumo de ultraprocessados (2,37; IC95%: 1,25; 3,48). A disponibilidade de salgadinhos de pacote, guloseimas e bebidas açucaradas nas cantinas aumentou a frequência de consumo desses alimentos. Foi observado um efeito dose/resposta entre a diversidade de ultraprocessados nas cantinas e a frequência de consumo destes alimentos. Um ambiente alimentar escolar com maior disponibilidade de ultraprocessados está associado ao maior consumo dos mesmos na escola, o que aponta para a necessidade de regulamentar o comércio de alimentos dentro destas instituições.

Los alimentos ultraprocesados son marcadores de patrones alimentarios no saludables y su consumo es elevado entre los adolescentes. Características del entorno alimentario escolar se asocian a prácticas alimentarias de estudiantes. El objetivo del estudio fue investigar la asociación entre la presencia de cantinas, y la disponibilidad de alimentos ultraprocesados en las mismas, con el consumo de estos alimentos dentro de la escuela, entre adolescentes del 9º año de la enseñanza fundamental de las redes pública y privada del Municipio de São Paulo, Brasil. Se realizó un estudio transversal con datos del SP-Proso, en una muestra de 2.680 adolescentes. Se realizaron modelos de regresión lineal multinivel para evaluar las asociaciones entre las exposiciones presencia de cantinas en las escuelas y disponibilidad de alimentos ultraprocesados con resultados de frecuencia de consumo de ultraprocesados en la escuela. La presencia de cantinas estuvo asociada a una mayor frecuencia de consumo de embutidos (0,46; IC95%: 0,24; 0,68), aperitivos de bolsa (0,50; IC95%: 0,19; 0,80), golosinas (0,82; IC95%: 0,55; 1,09) y bebidas azucaradas (0,34; IC95%: 0,06; 0,62), así como un marcador de frecuencia de consumo de ultraprocesados (2,37; IC95%: 1,25; 3,48). La disponibilidad de aperitivos de bolsa, golosinas y bebidas azucaradas en las cantinas aumentó la frecuencia de consumo de esos alimentos. Se observó un efecto dosis/respuesta entre la diversidad de ultraprocesados en las cantinas y la frecuencia de consumo de estos alimentos. Un ambiente alimentario escolar con mayor disponibilidad de ultraprocesados está asociado a un mayor consumo de los mismos en la escuela, lo que apunta a la necesidad de regular el comercio de alimentos dentro de estas instituciones.

Body weight changes in the NutriNet Brasil cohort during the covid-19 pandemic.

This study describes body weight changes among participants of the NutriNet Brasil cohort (n = 14,259) during the covid-19 pandemic. We analyzed data reported before the pandemic onset (01/26/2020 to 03/18/2020) and about six months after (09/14/2020 to 10/19/2020). Our results show that 19.7% of the participants gained ≥ 2 kg. Weight gain was directly associated with male gender, lower education, and previous presence of overweight, and inversely associated with age. In turn, 15.2% lost ≥ 2kg, being directly associated with male gender and previous presence of overweight and inversely associated with age.

Are laws restricting soft drinks sales in Brazilian schools able to lower their availability?

OBJECTIVE: To describe students protected by laws and exposed to soft drinks sales and assess whether forbidding laws are associated with lower availability of these beverages. METHODS: We identified laws forbidding non-government administered cafeterias or sales of soft drinks in schools in the 27 Brazilian state capitals. Data on soft drinks sales were obtained from Pesquisa Nacional de Saúde do Escolar 2015 (PeNSE - National Survey of School Health 2015), for a representative sample of 9th graders from public and private schools. Students were attributed with the status of their school regarding the law and sale of soft drinks. Co-variables were school status (public or private), school size, geographic regions, mother's educational level, score of goods and services. We performed multivariate analyses using Poisson regression. RESULTS: The total of 23 laws forbidding sales of soft drinks covered 63.0% of capitals, comprising 56.9% of students. Law coverage was higher among students from more developed regions (67.6%) and in public schools (60.6%), compared with those from less developed regions (38.0%) and private schools (45.8%). Soft drinks were available for 33.9% of students. Students attending public schools in less developed regions had the lowest availability of soft drinks, regardless of law coverage (14.8%; 12.0%); while students attending private schools in these regions had a high availability, regardless of law coverage (82.1%; 73.4%). Restrictive laws were associated with lower sales of soft drinks in more developed regions, and restrictions had a greater association with the availability of soft drinks in public schools (PR = 0.25; 95%CI = 0.15-0.41), compared with private schools (PR = 0.48; 95%CI = 0.35-0.66). CONCLUSION: Laws restricting soft drinks in schools were associated with fewer sales in more developed regions. Private schools were less compliant with the law than public schools. A broadly enforced national law could reduce the availability of soft drinks in schools.

Victims, bullies and bully-victims: prevalence and association with negative health outcomes from a cross-sectional study in São Paulo, Brazil.

OBJECTIVES: To estimate the prevalence of self-reported bullying as victims, bullies or bully-victims among 9th grade adolescents in the city of São Paulo, Brazil; to investigate association between bullying with negative health outcomes. METHODS: Cross-sectional data were obtained in 2017 from a sample of Brazilian adolescents (n = 2680) using a structured, self-administered questionnaire. Bivariate and multivariate Poisson regression were employed to assess in which extent the experience of bullying in position of victim, bully or bully-victim affects adolescents' health. RESULTS: Prevalence of bullying victimization was 18.3%, while victimization/perpetration and perpetration corresponded to 10.42% and 4.9%, respectively. Adolescents who experienced bullying victimization were more likely to present high levels of internalizing symptoms, to report self-harm, to present negative self-rated health and to use tobacco, when compared with those not involved. Bullies were more likely to use alcohol and to binge drinking. bully-victims presented a higher prevalence of all health outcomes, except for tobacco use. CONCLUSIONS: Our findings highlight the effect of bullying in adolescents' health, regardless of the position. Planned intersectoral efforts between parents, health and education systems to prevent bullying could therefore reduce negative health outcomes during adolescence.

Dietary changes in the NutriNet Brasil cohort during the covid-19 pandemic.

OBJECTIVE: To describe the dietary characteristics of participants in the NutriNet Brasil cohort immediately before and during the covid-19 pandemic. METHODS: Our data stem from an adult cohort created to prospectively investigate the relationship between diet and morbidity and mortality from chronic non-communicable diseases in Brazil. For this study, we selected the first participants (n = 10,116) who answered twice to a simplified questionnaire on their diet the day before, the first time when entering the study, between January 26 and February 15, 2020, and the second between May 10 and 19, 2020. The questionnaire inquiries about the consumption of healthy (vegetables, fruits and legumes) and unhealthy (ultra-processed foods) eating markers. Comparisons of indicators based on the consumption of these markers before and during the pandemic are presented for the study population and according to gender, age group, macro-region of residence and schooling. Chi-square tests and t-tests were used to compare proportions and means, respectively, adopting p < 0.05 to identify significant differences. RESULTS: For all participants, we found a modest but statistically significant increase in the consumption of healthy eating markers and stability in the consumption of unhealthy food markers. This favorable pattern of dietary changes during the pandemic occurred in most sociodemographic strata. We observed a less favorable changing pattern, with a tendency to increasing consumption of healthy and unhealthy food markers, in the Northeast and North macro-regions and among people with less schooling, suggesting social inequalities in the response to the pandemic. CONCLUSIONS: If confirmed, the trend of increased consumption of ultra-processed foods in underdeveloped regions and by people with less schooling is concerning, as eating these foods increases the risk of obesity, hypertension and diabetes, whose presence increases the severity and lethality of covid-19.

Food environment near schools in the largest Brazilian metropolis: analyses and contributions based on census data / Ambiente alimentar próximo às escolas na maior metrópole brasileira: análises e contribuições com base em dados censitários / Entorno alimentario cerca de las escuelas en la mayor metrópoli brasileña: análisis y contribuciones a partir de datos censales

Abstract: We aimed to investigate and compare the distribution of establishments that sell food near municipal, state, and private schools in the municipality of São Paulo, Brazil. This cross-sectional, exploratory, and census study was conducted in 3,121 schools. Circular buffers were traced around schools and concentrations or dispersions of food stores (in absolute numbers and densities) were analyzed. A p-trend was calculated to analyze how food stores density behaved as the buffer radius distance increased. Stratified regression models were built to analyze the characteristics of the food environment. Snack bars and street vendors are the most common types of establishments surrounding schools. Some categories of food stores are concentrated (such as candy stores around municipal and private schools, mini markets around municipal schools, and snack bars around private schools), whereas others (such as super and hypermarkets and fruit and vegetable stores) are dispersed around public schools. The food environment around schools shows differences regarding the instance that administers them and private schools have more food stores around them. Poor-quality food environment around schools exposes students to risk factors regarding excessive unhealthy food consumption.

Resumo: Este estudo transversal, exploratório e censitário realizado em 3.121 escolas buscou investigar e comparar a distribuição de estabelecimentos de venda de alimentos no entorno de escolas municipais, estaduais e particulares da cidade de São Paulo, Brasil. Foram traçados buffers circulares ao redor das escolas e analisadas as concentrações ou dispersões de estoques de alimentos (em números absolutos e densidades). Foi calculado o valor de p de tendencia para analisar o comportamento das densidades dos estabelecimentos com o aumento da distância do raio do buffer. As características do ambiente alimentar foram analisadas por modelos de regressão estratificada. Lanchonetes e vendedores ambulantes são os tipos de estabelecimentos mais presentes nos entornos das escolas. Algumas categorias de lojas de alimentos estão concentradas (como lojas de doces em torno de escolas municipais e particulares, minimercados em torno de escolas municipais e lanchonetes em torno de escolas particulares), e outras (como super e hipermercados e hortifrútis) estão dispersas em torno de escolas públicas. O ambiente alimentar ao redor das escolas difere de acordo com a instância que as administra, e as particulares têm mais lojas de alimentos nos arredores. O ambiente alimentar de baixa qualidade ao redor das escolas expõe os alunos a fatores de risco para o consumo excessivo de alimentos não saudáveis.

Resumen: Este estudio transversal, exploratorio y censal realizado en 3.121 escuelas, buscó investigar y comparar la distribución de los establecimientos de venta de alimentos en el entorno de escuelas municipales, estatales y privadas de la ciudad de São Paulo, Brasil. Se trazaron buffers circulares alrededor de las escuelas y se analizaron las concentraciones o dispersiones de las existencias de alimentos (en números absolutos y densidades). Se calculó el valor de p de la tendencia para analizar el comportamiento de las densidades de los establecimientos al aumentar la distancia al radio del buffer. Las características del entorno alimentario se analizaron por medio de modelos de regresión estratificada. Las cafeterías y los vendedores ambulantes son los tipos de establecimientos más presentes en el entorno de las escuelas. Algunas categorías de tiendas de alimentos están concentradas (como tiendas de dulces alrededor de las escuelas municipales y privadas, minimercados alrededor de escuelas municipales y cafeterías alrededor de escuelas privadas), y otras (como super e hipermercados y tiendas de frutas y hortalizas) están dispersas alrededor de las escuelas públicas. El entorno alimentario alrededor de las escuelas difiere según la instancia que las administra, y hay más tiendas de alimentos en las inmediaciones de las escuelas privadas. El entorno alimentario de baja calidad alrededor de las escuelas expone a los estudiantes a factores de riesgo para el consumo excesivo de alimentos poco saludables.

OVERWEIGHT, PERCEIVED ENVIRONMENT, AND SOCIAL DEPRIVATION: A STUDY ON THE PERCEPTION OF PARENTS OR GUARDIANS. / EXCESSO DE PESO, AMBIENTE PERCEBIDO E PRIVAÇÃO SOCIAL: UM ESTUDO DA PERCEPÇÃO DE PAIS OU RESPONSÁVEIS.

OBJECTIVE: To investigate parents' or guardians' perception of their residential proximity to food retailers, leisure areas, and spaces for physical activity according to neighborhood social deprivation, and test associations between the perceived environment and their children's overweight. METHODS: Cross-sectional study conducted with 408 children and adolescents (6- to 15-year-olds) attending public schools in a medium-sized Brazilian city. Data were collected from 2011 to 2014. A telephone interview using a structured research tool determined the presence of overweight and the walking time between the participants' home and the places evaluated. The indicator of social deprivation adopted was the Health Vulnerability Index. Logistic regression models were constructed to predict the perception of proximity (social deprivation as an explanatory variable) and evaluate perceived environmental factors (explanatory variables) associated with overweight (outcome). RESULTS: Residents of areas with higher social vulnerability showed a probability of perceived proximity 50 to 71% lower to supermarkets, street/produce markets, parks, recreation areas/community centers, and gyms compared to residents of less vulnerable areas. The perceived proximity to parks reduced the chance of overweight in children and adolescents in 73%, with an odds ratio (OR) of 0.27 (95%CI 0.07-0.95; p<0.05). CONCLUSIONS: The perceived environment of the residential area infrastructure might be related to neighborhood social deprivation and the presence of overweight in children and adolescents.

OBJETIVO: Investigar a percepção de pais ou responsáveis sobre a proximidade residencial a locais de venda de alimentos, de lazer e de atividade física segundo a privação social da vizinhança e testar associações do ambiente percebido com o excesso de peso de seus filhos. MÉTODOS: Estudo transversal conduzido com 408 crianças e adolescentes (6 a 15 anos de idade) de escolas públicas de um município de médio porte brasileiro. A coleta de dados ocorreu de 2011 a 2014. Foram determinados a presença de excesso de peso e o tempo de deslocamento da residência dos participantes aos locais avaliados, questionados durante entrevista telefônica com instrumento de pesquisa estruturado. O indicador de privação social adotado foi o Índice de Vulnerabilidade da Saúde. Modelos de regressão logística foram construídos para predizer a proximidade percebida (privação social como variável explicativa) e para avaliar os fatores do ambiente percebido (variáveis explicativas) associados ao excesso de peso (desfecho). RESULTADOS: Moradores de áreas com maior vulnerabilidade social apresentaram chances de percepção de proximidade 50 a 71% menores para supermercados, feiras/sacolões, parques, áreas de lazer/centros comunitários e academias de ginástica, quando comparados a residentes de áreas com menor vulnerabilidade. A percepção de proximidade a parques reduziu em 73% a chance de excesso de peso em crianças e adolescentes, com Odds Ratio (OR) de 0,27 (IC95% 0,07-0,95; p<0,05). CONCLUSÕES: A percepção ambiental sobre a infraestrutura da área residencial pode estar relacionada com a privação social da vizinhança e a presença de excesso de peso em crianças e adolescentes.

Changes in dietary markers during the covid-19 pandemic in Brazil / Mudanças nos marcadores da alimentação durante a pandemia de covid-19 no Brasil

ABSTRACT OBJECTIVE Evaluate changes in the Brazilian population's diet and its determinants during the covid-19 pandemic. METHODS We used diet data collected by the Datafolha Institute in 2019 (n = 1,384), 2020 (n =1,214), and 2021 (n = 1,459) from independent and representative samples of the adult population (aged 18 to 55 years) from all socioeconomic classes and geographic regions of Brazil. Food consumption was measured by checking the consumption of 22 sets of food on the day before the survey. The third cycle also included questions about changes in eating habits during the pandemic. We estimated the prevalence of consumption of the food sets in each cycle of the survey and used statistical tests for comparisons of proportions between the three cycles. RESULTS Between 2019 and 2020, we observed a significant increase in the consumption of cereals, milk, packaged snacks or salty cookies, and industrialized sauces, as opposed to a decrease in the consumption of eggs. Between 2019 and 2021 and between 2020 and 2021, on the other hand, there was a significant decrease in the consumption of cereals, vegetables, fruits, and industrialized fruit juices and an increase in the consumption of soda, sweets, cookies, sausages, industrialized sauces, and ready meals. When asked about the main changes in the purchase and preparation of meals, 46.3% of the respondents reported consuming more food prepared at home during the pandemic. Regarding changes in eating habits, 48.6% of the respondents reported a change in their eating habits during the pandemic. The main reasons for such changes were greater concern with health (39.1%) and self-reported decreased family income (30.2%). CONCLUSIONS The covid-19 pandemic had a negative impact on the diet of the population, and increased consumption of ultra-processed foods was reported for that period.

RESUMO OBJETIVO Analisar mudanças na alimentação da população brasileira e seus determinantes durante a pandemia de covid-19. MÉTODOS Foram utilizados dados de alimentação coletados pelo instituto Datafolha, em 2019 (n = 1.384), 2020 (n = 1.214) e 2021 (n = 1.459), de amostras independentes e representativas da população adulta (entre 18 e 55 anos) de todas as classes socioeconômicas e regiões geográficas do Brasil. O consumo alimentar foi aferido por meio da verificação do consumo de 22 conjuntos de alimentos no dia anterior à pesquisa. No terceiro ciclo, também foram incluídas questões sobre mudanças nos hábitos alimentares durante a pandemia. Estimou-se a prevalência de consumo dos conjuntos de alimentos em cada ciclo da pesquisa e foram utilizados testes estatísticos para comparações de proporções entre os três ciclos. RESULTADOS Observou-se, entre 2019 e 2020, aumento significativo no consumo de cereais, leite, salgadinhos de pacote ou biscoitos salgados e molhos industrializados, em contraponto à diminuição do consumo de ovos. Entre 2019 e 2021 e entre 2020 e 2021, por outro lado, houve diminuição significativa no consumo de cereais, hortaliças, frutas e sucos de fruta industrializados e aumento no consumo de refrigerante, biscoito doce, recheado ou bolinho de pacote, embutidos, molhos industrializados e refeições prontas. Quando questionados sobre as principais mudanças na compra e preparo das refeições, 46,3% dos entrevistados relataram consumir mais alimentos preparados em casa durante a pandemia. Em relação a mudanças nos hábitos alimentares, 48,6% dos entrevistados relataram alteração na alimentação durante a pandemia. Os principais motivos para tais mudanças foram maior preocupação com a saúde (39,1%) e autorrelato de diminuição da renda familiar (30,2%). CONCLUSÕES A pandemia de covid-19 teve impacto negativo na alimentação da população, e foi reportado aumento no consumo de alimentos ultraprocessados durante esse período.

Malnutrition in mother-child dyads in the Brazilian National Survey on Child Nutrition (ENANI-2019) / Má nutrição em díades mãe-filho no Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019) / Malnutrición en díadas madre-hijo en el Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019)

Abstract: Malnutrition affects billions of individuals worldwide and represents a global health challenge. This study aimed to determine the prevalence of malnutrition (undernutrition or overweight) among mother-child dyads in children under 5 years old in Brazil in 2019 and to estimate changes in this prevalence from 2006 to 2019. Individual-level data from the Brazilian National Survey on Child Nutrition (ENANI-2019) and the Brazilian National Survey of Demography and Health of Women and Children carried out in 2006 (PNDS 2006) were analyzed. Malnutrition outcomes in mother-child dyads included overweight mother and child, undernourished mother and child, and the double burden of malnutrition, i.e., overweight mother and child having any form of undernourishment (stunting, wasting, or underweight). Prevalence and 95% confidence intervals (95%CI) were estimated. Most women (58.2%) and 9.7% of the children were overweight, 6.9% were stunted, and 3.1% of mothers and 2.9% of the children were underweight. The prevalence of overweight in the mother-child dyad was 7.8% and was statistically higher in Southern Brazil (9.7%; 95%CI: 7.5; 11.9) than in the Central-West (5.4%; 95%CI: 4.3; 6.6). The prevalence of overweight mother and stunted child was 3.5%, with statistically significant difference between the extremes of the mother's education [0-7 vs. ≥ 12 years, 4.8% (95%CI: 3.2; 6.5) and 2.1%, (95%CI: 1.2; 3.0), respectively]. Overweight in the dyad increased from 5.2% to 7.8%, and the double burden of malnutrition increased from 2.7% to 5.2% since 2006. Malnutrition in Brazilian mother-child dyads seems to be a growing problem, and dyads with lower formal education, higher maternal age, and from the South Region of Brazil were more vulnerable.

Resumo: A má nutrição afeta bilhões de indivíduos em todo o mundo e representa um desafio de saúde global. Este estudo teve como objetivo determinar a prevalência de má nutrição (desnutrição ou excesso de peso) entre díades mãe-filho em crianças menores de cinco anos no Brasil em 2019 e estimar as mudanças nessa prevalência de 2006 a 2019. Foram analisados dados individuais do Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019) e da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher realizada em 2006 (PNDS 2006). Os desfechos de má nutrição incluíram mãe e filho com excesso de peso, mãe e filho desnutridos e a dupla carga de má nutrição, ou seja, mãe com excesso de peso e filho com qualquer forma de desnutrição (défict de crescimento, magreza ou baixo peso). Foram estimadas a prevalência e os intervalos de 95% de confiança (IC95%). A maioria das mulheres (58,2%) e 9,7% das crianças estavam acima do peso, 6,9% apresentaram déficit de crescimento e 3,1% das mães e 2,9% das crianças estavam abaixo do peso. A prevalência de excesso de peso na díade mãe-filho foi de 7,8% e foi estatisticamente maior no Sul do Brasil (9,7%; IC95%: 7,5; 11,9) do que no Centro-oeste (5,4%; IC95%: 4,3; 6,6). A prevalência de mãe com sobrepeso e filho com déficit de crescimento foi de 3,5%, com uma diferença estatisticamente significante entre os extremos de escolaridade materna [(0-7 vs. ≥ 12 anos de estudo), 4,8% (IC95%: 3,2; 6,5) and 2,1% (IC95%: 1,2; 3,0), respectivamente]. O excesso de peso na díade aumentou de 5,2% para 7,8% e a dupla carga de má nutrição aumentou de 2,7% para 5,2% desde 2006. A má nutrição nas díades mãe-filho brasileiras parece ser um problema crescente, sendo as mais vulneráveis aquelas com menor escolaridade e maior idade materna e residentes na Região Sul do Brasil.

Resumen: La malnutrición afecta a muchas personas en todo el mundo y representa un desafío para la salud mundial. Este estudio tuvo como objetivo determinar la prevalencia de malnutrición (desnutrición o sobrepeso) entre díadas madre-hijo en niños menores de cinco años en Brasil en 2019 y estimar cambios en esta prevalencia de 2006 a 2019. Se analizaron datos individuales del Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019) y de la Encuesta Nacional de Demografía y Salud del Niño y de la Mujer de 2006 (PNDS 2006). Los resultados de la malnutrición incluyeron a madre e hijo con sobrepeso, madre e hijo desnutridos y la doble carga de mala nutrición, es decir, madre con sobrepeso e hijo con cualquier forma de desnutrición (retardo en el crecimiento, emaciación o bajo peso). Se calcularon prevalencias y los intervalos de 95% de confianza (IC95%). La mayoría de las mujeres (58,2%) y el 9,7% de los niños tenían sobrepeso, el 6,9% de los niños presentaban retraso en el crecimiento, y el 3,1% de las madres y el 2,9% de los niños, bajo peso. La prevalencia de sobrepeso en la díada madre-hijo fue del 7,8%, estadísticamente mayor en el Sur de Brasil (9,7%; IC95%: 7,5; 11,9) que en el Centro-Oeste (5,4%; IC95%: 4,3; 6,6). La prevalencia de madres con sobrepeso y de niños con retraso del crecimiento fue del 3,5%, con una diferencia estadísticamente significativa entre los extremos de nivel educativo de la madre [(0-7 vs. ≥ 12 años de nivel educativo), 4,8% (IC95%: 3,2; 6,5) y 2,1% (IC95%: 1,2; 3,0), respectivamente]. El sobrepeso en la díada tuvo un aumento del 5,2% al 7,8%, y la doble carga de mala nutrición aumentó del 2,7% al 5,2% desde 2006. La malnutrición en la díada madre-hijo brasileña resulta ser un problema creciente, siendo las más vulnerables aquellas con menor escolaridad y mayor edad materna y residentes en la Región Sur de Brasil.