Do Brazilian regulatory measures promote sustainable and healthy eating in the school food environment?

BACKGROUND: Regulatory measures regarding food in the school environment aim to promote a healthier food environment in public and private schools. In Brazil, implementing regulations in the school food environment does not occur the same way across states and cities, and no national regulation covers public and private schools. The present study aims to analyze regulatory measures for school food environments in Brazilian states and cities and develop a score to evaluate them. METHODS: A systematic search of the regulatory measures in force and implemented until 2021 was conducted. The score was developed based on the Model Law Project prepared by the Brazilian Institute for Consumer Protection. It considered food and nutrition education actions, restrictions on the sale and distribution of food, a ban or restriction on food advertising and marketing, and points of excellence. These points included regulations that addressed the importance of supervision and social control, laws regulated by decree, the mention of a ban on ultra-processed foods, and whether the regulatory measures covered public and private schools. RESULTS: Sixty-five cities and states regulatory measures in force were found to be evaluated jointly by a federal entity (n = 43). Among the federal entities evaluated, only 13.95% fulfilled the function of promoting sustainable and healthy eating (8-12 points). CONCLUSIONS: Brazilian children and adolescents are exposed to a school food environment with regulations that partially fulfill the function of promoting an adequate, healthy, and sustainable diet. In this sense, it is necessary to improve regulatory measures or to encourage states and cities to develop effective legal provisions that are in line with the food guide for the Brazilian population and with the perspective of a healthy school food environment for the effective promotion of adequate, healthy and sustainable and healthy food in schools.

Private school canteens: an analysis of the economic and financial aspects of the traditional and the healthy models.

BACKGROUND: One of the reasons for the more prominent resistance of canteen managers to implementing healthy canteens is based on the belief in the economic infeasibility of these models. The research aimed to verify the economic and financial viability of traditional and healthy models of school canteens in a Brazilian metropolis. METHODS: The case study was carried out with 36 companies in the school canteen sector in a Brazilian metropolis. The classification of items sold in canteens considered the extent and purpose of food processing according to the NOVA Classification. The characterization and definition of traditional canteens and healthy canteens were proposed considering the amount of in natura or minimally processed foods and culinary preparations without the presence of ultra-processed foods; the percentage of ultra-processed foods or processed foods or culinary preparations with the presence of ultra-processed foods; and the existence of prohibited foods. The economic and financial analysis was carried out mainly through the evaluation of profitability. Data were collected through an electronic self-administered questionnaire sent to canteen managers. The Mann-Whitney test was used to compare medians and the Chi-Square/Fisher's Exact Test to compare proportions. RESULTS: The study included six companies, responsible for 36 canteen units in private schools, 30 classified in the traditional model (83.3%), and six in the healthy model (16.7%). The median percentage of natural, minimally processed foods and commercialized culinary preparations was higher among the healthy model canteens (87.9% vs. 60.0%, p < 0.001). While the median percentage of ultra-processed, processed, or preparations with the presence of ultra-processed (40.0% vs. 12.1%, p < 0.001) and prohibited foods (10.0% vs. 0%, p < 0.001) sold was higher in the traditional model canteens. The results indicated that the profitability in the healthy canteens was higher (p < 0.001) than in the traditional ones. CONCLUSIONS: Healthy school canteens showed better financial and economic results compared to traditional canteens with emphasis on greater profitability and a shorter recovery time of the initial investment.

Food environments and the COVID-19 pandemic in Brazil: analysis of changes observed in 2020.

Evidence of changes caused by the COVID-19 pandemic in food security and nutrition conditions, as well as in different food environments, has called researchers' attention to substantial changes taking place in individuals' dietary habits. The aim of this study is to present and address changes that have already happened in food environments, during the first COVID-19 pandemic year, in a middle-income country. Multiple changes were observed and had direct impact on the population, among them, worsened health and nutrition indicators and advanced dietary inequalities, as well as on its food profile in different life cycles, if one takes into consideration aspects such as food availability, financial access and dietary quality.

[Perception of the food environment by Brazilian slum residents: a qualitative study]. / Percepção dos residentes de favelas brasileiras sobre o ambiente alimentar: um estudo qualitativo.

Food availability in the territory can influence food consumption by the population. However, it is important to understand how people perceive their food environment to see how food availability affects consumption in different contexts. This study aimed to assess the perception of the food environment by Brazilian slum residents in their neighborhoods. This is a qualitative study, with online focus groups guided by a script in order to gather collective discourses about access to food in Brazilian slums. The invitation to participate in this study was made through social media, and community leaders and nongovernmental organizations with actions in slums were contacted using the snowball sampling technique. Grounded theory analysis was applied with the technique of thematic networks. Access to food for slum residents involves lack of resources and essential elements for an adequate and healthy diet, such as lack of information about food, low income, and low availability of stores that sell healthy food at affordable prices. Public programs and policies are required to encourage the expansion of food and nutritional security resources, such as vegetable gardens and markets, to increase the supply and sell healthy food at affordable prices in slums. Actions are also required to address the complexity of obstacles faced by slum residents in the access to healthy foods.

A disponibilidade de venda de alimentos no território pode influenciar no consumo alimentar da população. Entretanto, é importante compreender como as pessoas percebem o seu ambiente alimentar para se entender como essa disponibilidade afeta seu consumo em contextos distintos. O objetivo foi avaliar a percepção dos moradores de favelas brasileiras sobre o ambiente alimentar em suas vizinhanças. Estudo qualitativo, em que foram realizados grupos focais online guiados por um roteiro para reunir discursos coletivos sobre o acesso aos alimentos em favelas brasileiras. O convite ocorreu por meio das redes sociais e do contato com líderes comunitários e organizações não governamentais que atuam em favelas, por meio da técnica de amostragem "bola de neve". Para a análise, foi utilizada a abordagem grounded theory (teoria fundamentada) e, como técnica, foi empregada a análise de redes temáticas. O acesso aos alimentos por moradores de favelas é permeado pela falta de recursos e elementos fundamentais para uma alimentação adequada e saudável, como: a falta de informação sobre alimentação; a renda insuficiente; e a baixa disponibilidade de estabelecimentos que comercializam alimentos saudáveis a preços acessíveis. São necessários programas e políticas públicas que incentivem a ampliação de equipamentos de segurança alimentar e nutricional, como hortas e feiras, e que aumentem a oferta de alimentos saudáveis com valores baixos nas favelas. Também são necessárias ações que abordem a complexidade das barreiras enfrentadas por moradores de favelas para ter acesso aos alimentos saudáveis.

La disponibilidad de venta de alimentos en el territorio puede influir en el consumo alimentario de la población. Sin embargo, es importante comprender la manera en que las personas perciben su entorno alimentario para comprender cómo esta disponibilidad afecta su consumo en diferentes contextos. El objetivo fue evaluar la percepción de los residentes de favelas brasileñas sobre el entorno alimentario en sus vecindarios. Estudio cualitativo, en el que se formaron grupos focales en línea orientados por un guion con el objetivo de reunir discursos colectivos sobre el acceso a los alimentos en favelas brasileñas. La invitación se dio por medio de las redes sociales y mediante el contacto con líderes comunitarios y organizaciones no gubernamentales que trabajan en favelas, utilizando la técnica de muestreo "bola de nieve". Para el análisis, se utilizó el enfoque de la grounded theory (teoría fundamentada) y, como técnica, se empleó el análisis de redes temáticas. El acceso a los alimentos de los habitantes de las favelas está permeado por la falta de recursos y elementos fundamentales para una alimentación adecuada y sana, tales como: la falta de información sobre la alimentación, los bajos ingresos y la poca disponibilidad de establecimientos que vendan alimentos sanos a precios asequibles. Se necesitan programas y políticas públicas para fomentar la ampliación de equipos de seguridad alimentaria y nutricional, como huertas y mercadillos, que aumenten la oferta y vendan alimentos sanos a precios asequibles en las favelas. También se necesitan acciones para abordar la complejidad de las barreras que enfrentan los residentes de las favelas para acceder a alimentos sanos.

Common mental disorders in Brazilian adolescents: association with school characteristics, consumption of ultra-processed foods and waist-to-height ratio.

Half of all mental health problems diagnosed in adulthood have their onset before or during adolescence, especially common mental disorders (CMD). Thus, it is relevant to study the factors associated with these disorders. This study aimed to investigate the association of school characteristics, consumption of ultra-processed foods, and waist-to-height ratio with the presence of CMD in Brazilian adolescents. This is a school-based, cross-sectional study that analyzed data from 71,553 Brazilian adolescents aged 12-17 years. The prevalence of CMD in these adolescents was 17.1% (cut-off point 5 for the General Health Questionnaire-12). Associations were estimated using multilevel logistic models, with the presence of CMD as the dependent variable. The final model, adjusted for non-modifiable individual variables, modifiable individual variables and family characteristics, identified a positive association between private-funded schools (OR = 1.10; 95%CI: 1.07-1.14), advertisements for ultra-processed foods (OR = 1.13; 95%CI: 1.09-1.17), the second to fourth quartiles of ultra-processed food intake and waist-to-height ratio (OR = 2.26; 95%CI: 2.03-2.52). This study demonstrated that the private-funded schools , the presence of ultra-processed food advertisements, the consumption of ultra-processed food, and an increased waist-to-height ratio are risk factors for CMD in Brazilian adolescents.

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.

Obesity among government-backed economy restaurant workers in Belo Horizonte, Brazil.

Introduction: This food service sector produces nutritionally balanced meals and its workers eat their meals in this environment. Since they work with nutritionally adequate meals, would these workers have a lower prevalence of obesity? Objectives: The present study aimed to describe the prevalence of obesity among government-backed economy restaurant workers in a Brazilian state capital with analysis of sociodemographic and occupational factors and associated health factors. Methods: Two hundred and fifteen (215) workers from four government-backed economy restaurants operating in the city of Belo Horizonte were evaluated. Only workers who were active during the study period were eligible for the analysis. Anthropometric data were collected for investigation in relation to sociodemographic variables and work and health conditions. Results: The sample of government-backed economy restaurant workers was 37.2% female and had a mean age of 41.9 ± 10.9 years. Based on body mass index, we found that one third of the workers were obese. Obesity was more prevalent among women, workers who were dissatisfied with their bodies, workers who mainly perform tasks in a sitting position, and workers who perform strenuous tasks. Obese people have difficulties performing physical movements, classify their tasks as arduous, and opt for more sedentary tasks. Conclusions: Three out of 10 workers in the government-backed economy restaurants were obese. Programs and actions aimed at prevention and control of obesity are needed in this sector in order to improve the physical and mental capacities of its workers, avoiding attrition of the workforce and major health problems.

Ultra-processed foods increase noncommunicable chronic disease risk.

Several studies have associated the food processing classification - NOVA - and health, but this is not true for all noncommunicable chronic diseases (NCDs). This study aimed to systematically review the association between the intake of NOVA food groups and NCDs. We hypothesized that ultra-processed foods and drinks (UPFD) and processed foods (PF) could increase the risk of NCDs, and that unprocessed (UPF) and minimally processed foods (MPF) may provide protection. We carried out a systematic review of observational studies in January 2021. Searches were performed in SCOPUS, MEDLINE (via PubMed), EMBASE, WEB OF SCIENCE, SCIELO, related articles, hand-searching of reference lists, and direct author contact. In all, 2217 citations were identified and 38 articles met the eligibility criteria for inclusion in this systematic review. Among the analyzed food groups, higher UPFD consumption was positively associated with obesity and associated with the development of all NCDs, mainly hypertension, diabetes and dyslipidemia. However, only a few studies have demonstrated the protective effect of natural foods and MPF consumption on the occurrence of NCDs. In conclusion, UPF may increase the risk of NCDs, and natural foods and MPF may reduce it. Our results reinforce the need for the implementation of policies to mitigate the intake of UPF by the population, as it would improve the quality of the dietary patterns, and directly impact on the incidence of NCDs.

Common mental disorders in Brazilian adolescents: association with school characteristics, consumption of ultra-processed foods and waist-to-height ratio / Transtornos mentais comuns em adolescentes brasileiros: associação com características escolares, consumo de alimentos ultraprocessados e razão cintura/estatura / Trastornos mentales comunes en adolescentes brasileños: asociación con características escolares, consumo de alimentos ultraprocesados y relación cintura/estatura

Abstract: Half of all mental health problems diagnosed in adulthood have their onset before or during adolescence, especially common mental disorders (CMD). Thus, it is relevant to study the factors associated with these disorders. This study aimed to investigate the association of school characteristics, consumption of ultra-processed foods, and waist-to-height ratio with the presence of CMD in Brazilian adolescents. This is a school-based, cross-sectional study that analyzed data from 71,553 Brazilian adolescents aged 12-17 years. The prevalence of CMD in these adolescents was 17.1% (cut-off point 5 for the General Health Questionnaire-12). Associations were estimated using multilevel logistic models, with the presence of CMD as the dependent variable. The final model, adjusted for non-modifiable individual variables, modifiable individual variables and family characteristics, identified a positive association between private-funded schools (OR = 1.10; 95%CI: 1.07-1.14), advertisements for ultra-processed foods (OR = 1.13; 95%CI: 1.09-1.17), the second to fourth quartiles of ultra-processed food intake and waist-to-height ratio (OR = 2.26; 95%CI: 2.03-2.52). This study demonstrated that the private-funded schools , the presence of ultra-processed food advertisements, the consumption of ultra-processed food, and an increased waist-to-height ratio are risk factors for CMD in Brazilian adolescents.

Resumo: Metade de todos os problemas de saúde mental diagnosticados na idade adulta têm seu início antes ou durante a adolescência, especialmente os transtornos mentais comuns (TMC). Desta maneira, é importante estudar os fatores associados a estes transtornos. Este estudo objetiva investigar a associação entre características escolares, consumo de alimentos ultraprocessados e razão cintura/estatura com a presença de TMC em adolescentes brasileiros. Trata-se de um estudo transversal de base escolar que analisou dados de 71.553 adolescentes brasileiros de 12-17 anos. A prevalência de TMC nesses adolescentes foi de 17,1% (ponto de corte 5 para o Questionário de Saúde Geral - GHQ-12). As associações foram estimadas por meio de modelos logísticos multiníveis, tendo como variável dependente a presença de TMC. O modelo final, ajustado para variáveis individuais não modificáveis, variáveis individuais modificáveis e características familiares, identificou uma associação positiva entre dependência administrativa privada (OR = 1,1; IC95%: 1,07-1,14), presença de propaganda de alimentos ultraprocessados (OR = 1,13; IC95%: 1,09-1,17), segundo a quarto quartis de consumo de alimentos ultraprocessados e razão cintura/estatura (OR = 2,26; IC95%: 2,03-2,52). Este estudo demonstrou que a dependência administrativa privada da escola, a presença de propagandas de alimentos ultraprocessados, o consumo de alimentos ultraprocessados e o aumento da razão cintura/estatura são fatores de risco para TMC em adolescentes brasileiros.

Resumen: La mitad de todos los problemas de salud mental diagnosticados en la edad adulta empiezan antes o durante la adolescencia, sobre todo los trastornos mentales comunes (TMC). Así, es importante estudiar los factores asociados a estos trastornos. El objetivo de este estudio es investigar la asociación entre las características escolares, el consumo de alimentos ultraprocesados y la proporción cintura/estatura y la presencia de TMC en adolescentes brasileños. Se trata de un estudio transversal de base escolar que analizó datos de 71.553 adolescentes brasileños de 12 a 17 años. La prevalencia de TMC en estos adolescentes fue del 17,1% (punto de corte 5 para el Cuestionario General de Salud - GHQ-12). Se estimaron las asociaciones a través de modelos logísticos multinivel, con la presencia de TMC como variable dependiente. El modelo final, ajustado para variables individuales no modificables, variables individuales modificables y características familiares, identificó una asociación positiva entre la dependencia administrativa privada (OR = 1,10; IC95%: 1,07-1,14), la presencia de publicidad de alimentos ultraprocesados (OR = 1,13; IC95%: 1,09-1,17), segundo al cuarto cuartil de consumo de alimentos ultraprocesados y la proporción cintura/estatura (OR = 2,26; IC95%: 2,03-2,52). Este estudio demostró que la dependencia administrativa privada de la escuela, la presencia de publicidades de alimentos ultraprocesados, el consumo de alimentos ultraprocesados y el aumento de la proporción cintura/estatura son factores de riesgo para trastornos mentales comunes en adolescentes brasileños.

Acesso físico às feiras de orgânicos municipais em favelas de Belo Horizonte, Minas Gerais / Physical access to municipal organic food fairs in favelas in Belo Horizonte, Minas Gerais

Introdução: Favelas são regiões que não foram priorizadas pelas políticas públicas, e isso se reflete no ambiente alimentar e, consequentemente, na dificuldade de acesso aos alimentos, sobretudo aqueles produzidos de forma sustentável. Objetivo: Caracterizar o acesso físico às feiras de orgânicos municipais em favelas de Belo Horizonte, Minas Gerais, identificando desertos e pântanos alimentares e realizando uma comparação com a disponibilidade, distância e tempo de deslocamento de estabelecimentos que ofertam alimentos convencionais nessas áreas. Métodos: Foi analisada a distribuição das feiras de orgânicos municipais, dos equipamentos públicos de segurança alimentar e nutricional e dos estabelecimentos que ofertam alimentos cadastrados na Secretaria da Fazenda do Estado de Minas Gerais para o ano de 2019, nos 192 setores censitários localizados em favelas de Belo Horizonte. Para as análises closestfacility e distância de deslocamento, foi utilizado o buffer network de 500 metros. Também foi realizada a análise do tempo de deslocamento utilizando transporte público. Resultados: As feiras de orgânicos municipais estão em menor número e mais distantes dos centroides das favelas. E, além da maior distância para acessar as feiras caminhando, acessá-las por meio de transporte público leva, em geral, um tempo maior de deslocamento. Conclusões: São necessários programas e políticas públicas que incentivem a abertura de feiras de orgânicos e outros tipos de estabelecimentos que ofertam alimentos in natura e minimamente processados que adotem modelos de produção sustentáveis em áreas de favelas, a fim de reduzir as iniquidades de acesso aos alimentos saudáveis e sustentáveis nesse território.Introdução: Favelas são regiões que não foram priorizadas pelas políticas públicas, e isso se reflete no ambiente alimentar e, consequentemente, na dificuldade de acesso aos alimentos, sobretudo aqueles produzidos de forma sustentável. Objetivo: Caracterizar o acesso físico às feiras de orgânicos municipais em favelas de Belo Horizonte, Minas Gerais, identificando desertos e pântanos alimentares e realizando uma comparação com a disponibilidade, distância e tempo de deslocamento de estabelecimentos que ofertam alimentos convencionais nessas áreas. Métodos: Foi analisada a distribuição das feiras de orgânicos municipais, dos equipamentos públicos de segurança alimentar e nutricional e dos estabelecimentos que ofertam alimentos cadastrados na Secretaria da Fazenda do Estado de Minas Gerais para o ano de 2019, nos 192 setores censitários localizados em favelas de Belo Horizonte. Para as análises closestfacility e distância de deslocamento, foi utilizado o buffer network de 500 metros. Também foi realizada a análise do tempo de deslocamento utilizando transporte público. Resultados: As feiras de orgânicos municipais estão em menor número e mais distantes dos centroides das favelas. E, além da maior distância para acessar as feiras caminhando, acessá-las por meio de transporte público leva, em geral, um tempo maior de deslocamento. Conclusões: São necessários programas e políticas públicas que incentivem a abertura de feiras de orgânicos e outros tipos de estabelecimentos que ofertam alimentos in natura e minimamente processados que adotem modelos de produção sustentáveis em áreas de favelas, a fim de reduzir as iniquidades de acesso aos alimentos saudáveis e sustentáveis nesse território.

Introduction: Favelas are usually in regions forgotten by public policies, and it reflects on their residents' food environment, as well as on their tough time accessing food, mainly produced through sustainable ways. Objective: Featuring the physical access to municipal organic-food fairs in Belo Horizonte City, Minas Gerais State, based on identifying food deserts and swamps and comparing food availability to distance and displacement time from shops that sell conventional food in these places. Methods: The distribution of organic food municipal fairs, as well as of both food security and nutrition public equipment, and shops selling food that was registered at Minas Gerais State Treasure Secretariat in 2019, located in the 192 census sectors set in Belo Horizonte favelas. The closest facility and displacement distance analyses were based on the 500m buffer network. Displacement time linked to public transportation usage was also analyzed. Results: The number of organic food municipal fairs in favelas is smaller, and favelas are located farther from fairs' centroids. The distance to be crossed to get to fairs on foot in favelas is also longer, and getting to them by public transportation often demands longer displacements. Conclusions: Public programs and policies are needed to encourage new organic fairs and other establishment types capable of providing fresh and minimally processed food in favela areas based on sustainable production models. It must be done to reduce inequities in access to healthy and sustainable food in these territories.

Percepção dos residentes de favelas brasileiras sobre o ambiente alimentar: um estudo qualitativo / Perception of the food environment by Brazilian slum residents: a qualitative study / Percepción de los residentes de favelas brasileñas sobre el entorno alimentario: un estudio cualitativo

Resumo A disponibilidade de venda de alimentos no território pode influenciar no consumo alimentar da população. Entretanto, é importante compreender como as pessoas percebem o seu ambiente alimentar para se entender como essa disponibilidade afeta seu consumo em contextos distintos. O objetivo foi avaliar a percepção dos moradores de favelas brasileiras sobre o ambiente alimentar em suas vizinhanças. Estudo qualitativo, em que foram realizados grupos focais online guiados por um roteiro para reunir discursos coletivos sobre o acesso aos alimentos em favelas brasileiras. O convite ocorreu por meio das redes sociais e do contato com líderes comunitários e organizações não governamentais que atuam em favelas, por meio da técnica de amostragem "bola de neve". Para a análise, foi utilizada a abordagem grounded theory (teoria fundamentada) e, como técnica, foi empregada a análise de redes temáticas. O acesso aos alimentos por moradores de favelas é permeado pela falta de recursos e elementos fundamentais para uma alimentação adequada e saudável, como: a falta de informação sobre alimentação; a renda insuficiente; e a baixa disponibilidade de estabelecimentos que comercializam alimentos saudáveis a preços acessíveis. São necessários programas e políticas públicas que incentivem a ampliação de equipamentos de segurança alimentar e nutricional, como hortas e feiras, e que aumentem a oferta de alimentos saudáveis com valores baixos nas favelas. Também são necessárias ações que abordem a complexidade das barreiras enfrentadas por moradores de favelas para ter acesso aos alimentos saudáveis.

Abstract Food availability in the territory can influence food consumption by the population. However, it is important to understand how people perceive their food environment to see how food availability affects consumption in different contexts. This study aimed to assess the perception of the food environment by Brazilian slum residents in their neighborhoods. This is a qualitative study, with online focus groups guided by a script in order to gather collective discourses about access to food in Brazilian slums. The invitation to participate in this study was made through social media, and community leaders and nongovernmental organizations with actions in slums were contacted using the snowball sampling technique. Grounded theory analysis was applied with the technique of thematic networks. Access to food for slum residents involves lack of resources and essential elements for an adequate and healthy diet, such as lack of information about food, low income, and low availability of stores that sell healthy food at affordable prices. Public programs and policies are required to encourage the expansion of food and nutritional security resources, such as vegetable gardens and markets, to increase the supply and sell healthy food at affordable prices in slums. Actions are also required to address the complexity of obstacles faced by slum residents in the access to healthy foods.

Resumen La disponibilidad de venta de alimentos en el territorio puede influir en el consumo alimentario de la población. Sin embargo, es importante comprender la manera en que las personas perciben su entorno alimentario para comprender cómo esta disponibilidad afecta su consumo en diferentes contextos. El objetivo fue evaluar la percepción de los residentes de favelas brasileñas sobre el entorno alimentario en sus vecindarios. Estudio cualitativo, en el que se formaron grupos focales en línea orientados por un guion con el objetivo de reunir discursos colectivos sobre el acceso a los alimentos en favelas brasileñas. La invitación se dio por medio de las redes sociales y mediante el contacto con líderes comunitarios y organizaciones no gubernamentales que trabajan en favelas, utilizando la técnica de muestreo "bola de nieve". Para el análisis, se utilizó el enfoque de la grounded theory (teoría fundamentada) y, como técnica, se empleó el análisis de redes temáticas. El acceso a los alimentos de los habitantes de las favelas está permeado por la falta de recursos y elementos fundamentales para una alimentación adecuada y sana, tales como: la falta de información sobre la alimentación, los bajos ingresos y la poca disponibilidad de establecimientos que vendan alimentos sanos a precios asequibles. Se necesitan programas y políticas públicas para fomentar la ampliación de equipos de seguridad alimentaria y nutricional, como huertas y mercadillos, que aumenten la oferta y vendan alimentos sanos a precios asequibles en las favelas. También se necesitan acciones para abordar la complejidad de las barreras que enfrentan los residentes de las favelas para acceder a alimentos sanos.

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.

Ambiente alimentar no entorno dos equipamentos públicos de segurança alimentar e nutricional de Belo Horizonte, Minas Gerais / Food environment around public food and nutrition security facilities in Belo Horizonte, Minas Gerais

A Segurança Alimentar e Nutricional (SAN) é conceituada como um direito ao acesso regular e permanente aos alimentos. Com este objetivo, políticas e programas intersetoriais foram articulados e promoveram a implantação de Equipamentos Públicos de Segurança Alimentar e Nutricional (EPSAN), para proporcionar a disponibilidade e o acesso a alimentos saudáveis e economicamente acessíveis. A acessibilidade, na avaliação do ambiente alimentar, pode ser caracterizada pela variedade, proximidade e densidade dos estabelecimentos comerciais. OBJETIVO: Avaliar o ambiente alimentar comunitário no entorno dos Equipamentos Públicos de Segurança Alimentar e Nutricional. MÉTODOS: Trata-se de um estudo observacional analítico, do tipo transversal, realizado na cidade de Belo Horizonte, Minas Gerais. A unidade de análise foi o buffer no entorno dos EPSAN e no entorno dos setores censitários sem EPSAN. Os critérios de inclusão dos EPSAN foram: possuir atividade de comercialização de alimentos para consumo no domicílio e implantação até maio de 2019. Os EPSAN foram selecionados com base em uma amostragem aleatória simples, estratificada pelas regionais administrativas e pelo Índice de Vulnerabilidade da Saúde (IVS). Os critérios para inclusão para definição de áreas sem EPSAN foram: não conter nenhum EPSAN, estar na mesma regional administrativa da área com EPSAN correspondente; estar 1000m distante do EPSAN; possuir a mesma classificação de IVS do setor censitário com EPSAN correspondente. Os critérios de inclusão dos estabelecimentos comerciais foram: comercializar alimentos para consumo no domicílio; localizar-se dentro do buffer com raio de 500m ao redor do EPSAN; e dentro do buffer com raio de 500m ao redor do centroide da área sem EPSAN. Foi realizada análise descritiva, estimador de Kernel e Método do Vizinho Mais Próximo. RESULTADOS: Os EPSAN participantes foram Direto da Roça (n=2), Feira-Livre (n=3), Feira-Orgânica (n=1), Mercado Municipal (n=3) e Sacolão ABasteCer (n=1). Dos estabelecimentos avaliados, 39,6% (n=113) estavam nas áreas com EPSAN e 60,5% (n=172) nas áreas sem EPSAN, sendo diferente significativamente. A maioria era Lojas de Conveniência e Padaria (24,2%), Casa de Carnes (21,0%), Sacolões e Feiras-Livres (19,0%), com padrão de distribuição de aleatoriedade (45,0%). A análise de Kernel mostrou que 7 EPSAN encontravam-se próximo aos estabelecimentos comerciais. CONCLUSÃO: Observou-se menor número de estabelecimentos comerciais no entorno dos EPSAN, com predominância do tipo lojas de conveniência e padaria, casa de carnes e sacolões e feiras-livres, e padrão de aleatoriedade. Ressalta-se a importância do fortalecimento de políticas e programas de incentivo à implantação de um maior número de estabelecimentos saudáveis como EPSAN, mercados de agricultores e estandes de frutas e hortaliças.

Food and Nutritional Security (FNS) is conceptualized as a right to regular and permanent access to food. To this end, intersectoral policies and programs were articulated and promoted the implementation of Food and Nutrition Security Public Venues (FNSPV), to provide the availability and access to healthy and economically accessible food. Accessibility, in the assessment of the food environment, can be characterized by the variety, proximity and density of commercial establishments. OBJECTIVE: To assess the community food environment around FNSPV. METHODS: It is an analytical observational study, of the transversal type, carried out in the city of Belo Horizonte, Minas Gerais. The unit of analysis was the buffer around the FNSPV and around the census sectors without FNSPV. The inclusion criteria for the FNSPV were: having activity to sell food for consumption at home and implantation until May 2019. The FNSPV were selected based on a simple random sampling, stratified by the administrative regions and the Health Vulnerability Index (HVI). The criteria for inclusion of the census sectors without FNSPV were: not to contain any FNSPV, to be in the same administrative region of the case; be 1000m away from PFSV, have the same HVI classification as the census sector in the case. The inclusion criteria for commercial establishments were: selling food for consumption at home; locate inside the buffer with a 500m radius around the FNSPV; and inside the buffer with a 500m radius around the census sectors without FNSPV. Descriptive analysis, Kernel estimator and Nearest Neighbor Method were performed. RESULTS: The census sectors without PFSV were Farmers' markets (n = 2), Food Markets (n = 3), Organic Farmers' market (n = 1), Open-air food markets (n = 3) and Public greengrocer (n = 1). Of the establishments evaluated, 39.6% (n = 113) were in areas with FNSPV and 60.5% (n = 172) in areas without FNSPV, being significantly different. The majority were Convenience Stores and Bakery (24.2%), Meat Shop (21.0%), Public greengrocers and Open-air food markets (19.0%), with a random distribution pattern (45.0%). Kernel analysis showed that 7 FNSPV were close to commercial establishments. CONCLUSION: There was a smaller number of commercial establishments in the vicinity of the FNSPV, with a predominance of convenience stores and bakeries, meat shop and Public greengrocers and Open-air food markets, and a random pattern. The importance of strengthening policies and programs to encourage the implantation of a larger number of healthy establishments like an important strategy to change food environments.