A longitudinal analysis of the fluctuation of food stores in Belo Horizonte, Minas Gerais, Brazil.

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

Evolution of fruit and vegetable intake among health promotion service participants in a Brazilian metropolis: 48-month follow-up of a randomized controlled community trial.

OBJECTIVE: To assess longitudinal effects of a nutrition intervention on fruit and vegetable (F&V) intake among Primary Health Care (PHC) service participants in Belo Horizonte, Brazil. METHODS: Demographics and health data on 3414 PHC service participants were collected at baseline in 2013-2014. F&V intake was assessed at baseline, 12, 36, and 48 months until 2017-2018. Services were randomized to control (CG, usual care) or intervention (IG, usual care and a Transtheoretical Model-based intervention to increase F&V intake). We performed difference-in-differences (DiD) analysis to identify intervention effects on F&V intake, and sensitivity analyses of participants observed at all timepoints. RESULTS: Participants were mostly middle-aged, low-income women. Mean baseline intakes were 168.7 g of fruit, 202.0 g of vegetables, and 370.7 g of F&V, with lower fruit in the IG (164.1 g) than the CG (172.3 g). At 12 months, the intervention increased fruit intake in the IG and fruit and F&V intake among individuals with low baseline F&V intake. Fruit intake remained higher at 36 months in the IG. No effect on vegetable intake was identified. According to sensitivity analyses, effects on fruit intake among the complete sample did not remain significant at 36 months, and an effect on fruit intake at 36 months was identified among those with adequate baseline F&V intake. Reductions in F&V intake did not remain significant. CONCLUSIONS: At 12 months, a TTM-based intervention increased fruit intake in the overall sample, and fruit and F&V intake among individuals with low baseline intakes. Repeated interventions may be needed over time. TRIAL REGISTRATION NUMBER: RBR-9h7ckx.

Evaluating the Adequate and Healthy Food Promotion Program in Primary Care: a mixed methods research. / Avaliação do Programa de Promoção da Alimentação Adequada e Saudável na Atenção Primária: pesquisa de métodos mistos.

This article aims to analyze the implementation of an Adequate and Healthy Food Promotion Program in Primary Health Care in the municipalities of Minas Gerais. Mixed Methods Research with Data Concomitant Embedded Strategy. Evaluative research from the perspective of the implementation analysis was employed in the quantitative approach. An exploratory-descriptive study was conducted using content analysis in the qualitative approach. Qualitative and quantitative data were incorporated for analysis from their imbrication. The Program Implementation Level (IL) was 92.5%, representing an adequate implementation. The methodology of the actions proposed in the program and the implementation of Continuing Education were convergent strengths that emerged from data imbrication. The need for more human resources for planning and implementing the program and the lack of a kitchen for cooking workshops were identified as challenges. The Program's implementation was adequate and can be extended to other Brazilian municipalities to help professionals structure interventions to promote adequate and healthy food in the Primary Care work routine.

O objetivo deste artigo é analisar a implantação do Programa de Promoção da Alimentação Adequada e Saudável na Atenção Primária à Saúde em municípios de Minas Gerais. Pesquisa de Métodos Mistos com Estratégia Incorporada Concomitante de dados. Na abordagem quantitativa utilizou-se pesquisa avaliativa na perspectiva da análise de implantação. Na abordagem qualitativa realizou-se estudo exploratório-descritivo utilizando a análise de conteúdo. Os dados qualitativos e quantitativos foram incorporados para análise a partir de sua imbricação. O Grau de Implantação do programa foi 92,5% representando uma implantação adequada. Na imbricação dos dados, a metodologia das ações propostas no programa e a realização da atividade de Educação Permanente foram pontos fortes convergentes que emergiram. Recursos Humanos insuficientes para planejamento e execução do programa e falta de cozinha para oficina culinária foram apontados como desafios. A implantação do programa foi adequada e poderá ser estendida para outros municípios brasileiros, de forma a apoiar os profissionais a estruturar intervenções de promoção da alimentação adequada e saudável na rotina de trabalho na Atenção Primária.

Evaluation of Nutrient Consumption for the Prevention of Chronic Diseases in Health Promotion Services: A Controlled and Randomized Community Trial to Promote Fruits and Vegetables.

To evaluate the effectiveness of a collective intervention to encourage the consumption of fruits and vegetables on the nutrients intake for the prevention of chronic non-communicable diseases (NCDs), a randomized controlled community trial was conducted with a representative sample from the Health Academy Program. While the individuals in the control group (CG) participated in regular physical exercise, those in the intervention group (IG) also participated in a collective intervention. After 12 months, IG and CG showed a reduction in energy, omega 3 and sodium intake and an increase in the consumption of carbohydrates, fiber, vitamins, and minerals. Individuals from the CG showed an increase in phosphorus consumption and, in the IG, a reduction in the consumption of total, saturated, and polyunsaturated fats as well as an increase in the consumption of monounsaturated fats was seen. In both groups, there was an increase in the prevalence of adequate nutrients. Participation in the nutritional intervention was associated with lower consumption of energy and protein in the diet. The results pointed to the importance of individuals' participation in the program, which, associated with nutritional intervention, promoted an improvement in the nutrient profile of the diet and the prevention and control of NCDs.

Medida do equilíbrio de decisões para redução do peso corporal entre pessoas com sobrepeso ou obesidade: uma revisão sistemática / Measuring the balance of decisions to reduce body weight among overweight or obesity people: a systematic review

Introdução: Abordagens comportamentais têm contribuído para a efetividade do tratamento da obesidade. A avaliação do equilíbrio de decisões (ED) para redução de peso, isto é, o equilíbrio entre prós e contras da mudança de comportamento, é estratégica no tratamento, contribuindo para a pactuação de estratégias para o enfrentamento dos desafios. É necessário, porém, utilizar instrumentos válidos para mensurar o ED. Objetivo: Avaliar a qualidade de instrumentos de avaliação do ED para redução do peso corporal visando qualificar o cuidado da pessoa com obesidade no Sistema Único de Saúde (SUS). Métodos: Realizou-se revisão sistemática da literatura sobre o desenvolvimento e a validação de instrumentos em sete bases de dados seguindo a metodologia Cosmin. Variações dos termos psicometria, obesidade e ED foram combinadas com operadores booleanos. Em duplicada e independentemente, duas pesquisadoras realizaram: extração de dados, avaliação da qualidade e síntese de evidências, sendo as divergências solucionadas por consenso. Esta revisão foi registrada na base internacional Prospero (CRD42020197797). Resultados: Identificaram-se cinco estudos, sendo que três realizaram a tradução e adaptação transcultural do mesmo instrumento. Todos os estudos apresentaram ED em duas dimensões (prós e contras), mas usaram métodos duvidosos ou inadequados, e a maioria apresentou evidências científicas de muito baixa qualidade. Conclusões: Os resultados não sustentaram o uso dos instrumentos existentes nem sua tradução e adaptação transcultural, sendo necessário o desenvolvimento de um novo instrumento. Este estudo, ao disponibilizar um instrumento válido para uso no SUS, poderá contribuir para qualificar o cuidado da pessoa com obesidade e deter o crescimento da obesidade no país.

Introduction: Behavioral strategies have been adding to the effectiveness of obesity treatment. And the assessment of the decisional balance (DB) for weight reduction, that is, the balance between expected losses and gains around the behavioral changes, is strategic for managing obesity. The DB assessment may contribute to the agreement on strategies to face the challenges of the treatment. But, there is a need to use a valid instrument to assess the DB. Objective: evaluate the quality of instruments assessing DB for weight reduction to qualify obesity management in the Sistema Único de Saúde ­ SUS (Unified Health System). Methods: A systematic review of studies about instrument development and/or validation was carried out on seven databases using the Cosmin methodology. Terms related to psychometrics, obesity, and DB were combined with Boolean operators to guide the search. Two researchers performed independently and in duplicate: data extraction, quality assessment, and evidence synthesis, and divergences were resolved by consensus. This review was registered in the international database Prospero (CRD42020197797). Results: Five studies were identified. Three of them reported translations and cross-cultural validity of the same instrument. All analyses presented DB in two dimensions (pros and cons, but used doubtful or inadequate methods. Most of the evidence was very low rate. Conclusions:The results did not support the instrument's use, translations, or cross-cultural adaptation. It is necessary to develop a new tool. By providing a valid instrument for use in SUS, this study could contribute to qualifying the care of people with obesity and stopping the growth of obesity in the country.

Medida do equilíbrio de decisões para redução do peso corporal entre pessoas com sobrepeso ou obesidade: uma revisão sistemática / Measuring the balance of decisions to reduce body weight among overweight or obesity people: a systematic review

Abordagens comportamentais têm contribuído para a efetividade do tratamento da obesidade. A avaliação do equilíbrio de decisões (ED) para redução de peso, isto é, o equilíbrio entre prós e contras da mudança de comportamento, é estratégica no tratamento, contribuindo para a pactuação de estratégias para o enfrentamento dos desafios. É necessário, porém, utilizar instrumentos válidos para mensurar o ED. Objetivo: Avaliar a qualidade de instrumentos de avaliação do ED para redução do peso corporal visando qualificar o cuidado da pessoa com obesidade no Sistema Único de Saúde (SUS). Métodos: Realizou-se revisão sistemática da literatura sobre o desenvolvimento e a validação de instrumentos em sete bases de dados seguindo a metodologia Cosmin. Variações dos termos psicometria, obesidade e ED foram combinadas com operadores booleanos. Em duplicada e independentemente, duas pesquisadoras realizaram: extração de dados, avaliação da qualidade e síntese de evidências, sendo as divergências solucionadas por consenso. Esta revisão foi registrada na base internacional Prospero (CRD42020197797). Resultados: Identificaram-se cinco estudos, sendo que três realizaram a tradução e adaptação transcultural do mesmo instrumento. Todos os estudos apresentaram ED em duas dimensões (prós e contras), mas usaram métodos duvidosos ou inadequados, e a maioria apresentou evidências científicas de muito baixa qualidade. Conclusões: Os resultados não sustentaram o uso dos instrumentos existentes nem sua tradução e adaptação transcultural, sendo necessário o desenvolvimento de um novo instrumento. Este estudo, ao disponibilizar um instrumento válido para uso no SUS, poderá contribuir para qualificar o cuidado da pessoa com obesidade e deter o crescimento da obesidade no país.

Introduction: Behavioral strategies have been adding to the effectiveness of obesity treatment. And the assessment of the decisional balance (DB) for weight reduction, that is, the balance between expected losses and gains around the behavioral changes, is strategic for managing obesity. The DB assessment may contribute to the agreement on strategies to face the challenges of the treatment. But, there is a need to use a valid instrument to assess the DB. Objective: evaluate the quality of instruments assessing DB for weight reduction to qualify obesity management in the Sistema Único de Saúde ­ SUS (Unified Health System). Methods: A systematic review of studies about instrument development and/or validation was carried out on seven databases using the Cosmin methodology. Terms related to psychometrics, obesity, and DB were combined with Boolean operators to guide the search. Two researchers performed independently and in duplicate: data extraction, quality assessment, and evidence synthesis, and divergences were resolved by consensus. This review was registered in the international database Prospero (CRD42020197797). Results: Five studies were identified. Three of them reported translations and cross-cultural validity of the same instrument. All analyses presented DB in two dimensions (pros and cons, but used doubtful or inadequate methods. Most of the evidence was very low rate. Conclusions: The results did not support the instrument's use, translations, or cross-cultural adaptation. It is necessary to develop a new tool. By providing a valid instrument for use in SUS, this study could contribute to qualifying the care of people with obesity and stopping the growth of obesity in the country.

Avaliação do Programa de Promoção da Alimentação Adequada e Saudável na Atenção Primária: pesquisa de métodos mistos / Evaluating the Adequate and Healthy Food Promotion Program in Primary Care: a mixed methods research

Resumo O objetivo deste artigo é analisar a implantação do Programa de Promoção da Alimentação Adequada e Saudável na Atenção Primária à Saúde em municípios de Minas Gerais. Pesquisa de Métodos Mistos com Estratégia Incorporada Concomitante de dados. Na abordagem quantitativa utilizou-se pesquisa avaliativa na perspectiva da análise de implantação. Na abordagem qualitativa realizou-se estudo exploratório-descritivo utilizando a análise de conteúdo. Os dados qualitativos e quantitativos foram incorporados para análise a partir de sua imbricação. O Grau de Implantação do programa foi 92,5% representando uma implantação adequada. Na imbricação dos dados, a metodologia das ações propostas no programa e a realização da atividade de Educação Permanente foram pontos fortes convergentes que emergiram. Recursos Humanos insuficientes para planejamento e execução do programa e falta de cozinha para oficina culinária foram apontados como desafios. A implantação do programa foi adequada e poderá ser estendida para outros municípios brasileiros, de forma a apoiar os profissionais a estruturar intervenções de promoção da alimentação adequada e saudável na rotina de trabalho na Atenção Primária.

Abstract This article aims to analyze the implementation of an Adequate and Healthy Food Promotion Program in Primary Health Care in the municipalities of Minas Gerais. Mixed Methods Research with Data Concomitant Embedded Strategy. Evaluative research from the perspective of the implementation analysis was employed in the quantitative approach. An exploratory-descriptive study was conducted using content analysis in the qualitative approach. Qualitative and quantitative data were incorporated for analysis from their imbrication. The Program Implementation Level (IL) was 92.5%, representing an adequate implementation. The methodology of the actions proposed in the program and the implementation of Continuing Education were convergent strengths that emerged from data imbrication. The need for more human resources for planning and implementing the program and the lack of a kitchen for cooking workshops were identified as challenges. The Program's implementation was adequate and can be extended to other Brazilian municipalities to help professionals structure interventions to promote adequate and healthy food in the Primary Care work routine.

Brumadinho Health Project: food and nutrition insecurity versus socioeconomic statuses and dimensions of the food system after the dam rupture.

OBJECTIVE: To describe the situation of food insecurity of families according to the socioeconomic characteristics and dimensions of the food system in Brumadinho, state of Minas Gerais, Brazil, after the dam rupture in Córrego do Feijão mine. METHODS: This is a descriptive study focused on households carried out from the baseline of the Brumadinho Health Project. Food insecurity, the main outcome, was assessed by the short version of the Brazilian Food Insecurity Scale. Other investigated variables were: socioeconomic data; geographic stratum of the households; family's assets; income; expenses; cultivation of food and animal husbandry for consumption. Descriptive analyses were performed comparing the food insecurity of the household according to the other variables by the χ2 test to compare the proportions. RESULTS: Of the investigated households (n=1,441), 35.1% were facing food insecurity. facing food insecurity had: lower prevalence of masonry households with coating (91.4%; 95%CI 87.7%-94.1% vs. 96.7%; 95%CI 94.9%-97.8%); highest proportion of rudimentary cesspit (16.9%; 95%CI 13.3%-21.2% vs. 9.4%; 95%CI 7.4-11.9); lower prevalence of own and paid-off homes (63.9%; 95%CI 56.8-70.5 vs. 77.3%; 95%CI 72.3-81.7); and income reduction after the dam rupture (33.0%; 95%CI 27.1-39.6 vs. 14.1%; 95%CI 11.2-17.6), when compared with those in a food security situation. CONCLUSION: The prevalence of food insecurity was high, with report of a reduction in household income after the dam rupture. Moreover, most of the households had worse structural quality and sewage outfall. These results evidence the vulnerability of families and possible violation of the human right to adequate food, denoting the urgency of continuous reparative actions.

Food consumption of Brumadinho Health Project participants.

OBJECTIVE: To analyze the food consumption patterns of residents of Brumadinho, Minas Gerais, Brazil, according to sociodemographic characteristics, neighborhood and area of residence. METHODS: Cross-sectional study with baseline data from the Brumadinho Health Project, conducted with 2,805 adult individuals. The healthy food consumption markers analyzed were: fruits and vegetables (FV), beans and fish; the unhealthy markers were: sweets and soda/artificial juices, whole-fat milk and red meat with visible fat or chicken with skin. Prevalence values and 95% confidence intervals were calculated for the total sample and according to sociodemographic characteristics, presence of commercial establishments with varieties of FV in the neighborhood and area of residence affected by the dam failure. RESULTS: Among the healthy food consumption markers, the most common was beans (81.6%), and among the unhealthy ones, whole-fat milk (68.8%) and red meat with visible fat/chicken with skin (61.1%). Women were more prone to higher consumption of FV, while men, of beans and fish; the prevalence of these markers was higher among individuals with higher education degrees and higher incomes. Unhealthy eating markers were more prevalent among men, younger people, individuals with lower educational level and lower incomes, and residents in an area directly affected by the dam failure or in a mining region. CONCLUSION: Less than half of the participants were considered to follow regular or recommended consumption of healthy eating markers, except for beans. Individual characteristics and area of residence were associated with individuals' food consumption patterns and should be taken into account in actions to promote adequate and healthy eating.

Comércio de alimentos para consumo imediato no entorno do Programa Academia da Saúde: uma análise segundo desigualdades / Sources of food ready to consume around the Health Academy Program units: an analysis according to inequality

Resumo Objetivou-se analisar espacialmente a distribuição de estabelecimentos de aquisição de alimentos para consumo imediato no entorno do Programa Academia da Saúde (PAS) de Belo Horizonte, Minas Gerais, Brasil, segundo Índice de Desenvolvimento Humano Municipal (IDHM). Estudo ecológico tendo o PAS como unidade de análise. Foram avaliados estabelecimentos de aquisição de alimentos para consumo imediato contidos em buffer circular com raio de 900 metros a partir das 77 unidades do PAS em funcionamento. Endereços e tipos de estabelecimento foram obtidos em lista pública e verificados em auditoria virtual. Mapas de Kernel temático foram elaborados. Identificou-se 3.050 estabelecimentos no entorno das unidades do PAS. Maiores densidades foram observadas na região Centro-sul da cidade e em áreas com IDHM alto e muito alto. Foi elevada a densidade de estabelecimentos comerciais de venda de alimentos para consumo imediato no entorno das unidades do PAS, sobretudo em áreas mais ricas. Os resultados podem subsidiar ações que visem fortalecer o PAS como promotor de ambientes alimentares saudáveis. Ademais, reforça a necessidade de políticas públicas equânimes de abastecimento e regulação visando promover o acesso à alimentação adequada e saudável para todos.

Abstract The aim of this study was to spatially examine the distribution of establishments for the acquisition of food that is ready to consume around the Health Academy Program (PAS) in Belo Horizonte, Minas Gerais, Brazil, according to the Municipal Human Development Index (IDH-M).This is an ecological study with the PAS as the unit of analysis. The establishments contained in a circular buffer with a radius of 900 meters from the 77 units of the PAS in operation were evaluated. Address and type of establishment data were obtained from a public list and verified in a virtual audit. Thematic kernel maps were used. A total of 3,050 establishments were identified around the PAS units. Higher densities were observed around units located in the city's south-central region and in areas with high and very high IDH-M. There was a high density of establishments selling ready-to-consume foods around the PAS units, especially in the wealthier parts of the city. These results are useful in supporting the planning of actions aimed at strengthening the PAS as a promoter of healthy eating environments. Further, it reinforces the need for equitable public policies for supply and regulation, aiming to promote access to adequate and healthy food for all.

Sources of food ready to consume around the Health Academy Program units: an analysis according to inequality. / Comércio de alimentos para consumo imediato no entorno do Programa Academia da Saúde: uma análise segundo desigualdades.

The aim of this study was to spatially examine the distribution of establishments for the acquisition of food that is ready to consume around the Health Academy Program (PAS) in Belo Horizonte, Minas Gerais, Brazil, according to the Municipal Human Development Index (IDH-M).This is an ecological study with the PAS as the unit of analysis. The establishments contained in a circular buffer with a radius of 900 meters from the 77 units of the PAS in operation were evaluated. Address and type of establishment data were obtained from a public list and verified in a virtual audit. Thematic kernel maps were used. A total of 3,050 establishments were identified around the PAS units. Higher densities were observed around units located in the city's south-central region and in areas with high and very high IDH-M. There was a high density of establishments selling ready-to-consume foods around the PAS units, especially in the wealthier parts of the city. These results are useful in supporting the planning of actions aimed at strengthening the PAS as a promoter of healthy eating environments. Further, it reinforces the need for equitable public policies for supply and regulation, aiming to promote access to adequate and healthy food for all.

Objetivou-se analisar espacialmente a distribuição de estabelecimentos de aquisição de alimentos para consumo imediato no entorno do Programa Academia da Saúde (PAS) de Belo Horizonte, Minas Gerais, Brasil, segundo Índice de Desenvolvimento Humano Municipal (IDHM). Estudo ecológico tendo o PAS como unidade de análise. Foram avaliados estabelecimentos de aquisição de alimentos para consumo imediato contidos em buffer circular com raio de 900 metros a partir das 77 unidades do PAS em funcionamento. Endereços e tipos de estabelecimento foram obtidos em lista pública e verificados em auditoria virtual. Mapas de Kernel temático foram elaborados. Identificou-se 3.050 estabelecimentos no entorno das unidades do PAS. Maiores densidades foram observadas na região Centro-sul da cidade e em áreas com IDHM alto e muito alto. Foi elevada a densidade de estabelecimentos comerciais de venda de alimentos para consumo imediato no entorno das unidades do PAS, sobretudo em áreas mais ricas. Os resultados podem subsidiar ações que visem fortalecer o PAS como promotor de ambientes alimentares saudáveis. Ademais, reforça a necessidade de políticas públicas equânimes de abastecimento e regulação visando promover o acesso à alimentação adequada e saudável para todos.

The COVID-19 pandemic in a Brazilian metropolis: repercussion on food prices.

We analyzed the impact of the efforts to combat the COVID-19 pandemic on the prices of food sold by a food supply center located in the sixth largest city in Brazil. We examined the percentage change in the prices of 20 types of foods, adjusted by market conditions, using municipal contingency plan stages to compare opening and closing of non-essential services, including bars and restaurants (stage 1: first phase of essential services-only; stage 2: flexibilization; and stage 3: second phase of essential services-only with a "pre-pandemic" period [stage 0]). Log-prices were lower in all contingency stages for leafy greens (variation: 42% to 56%) and vegetables (variation: 28% to 40%). Log-prices of eggs and fruit were 20% and 16% lower during stages 1 and 3, respectively. Strategies to combat the COVID-19 pandemic lowered the prices of eggs, fruit, leafy greens, and vegetables regardless of the market conditions. Accordingly, the supply and demand for fresh and minimally processed foods were affected by the economic crisis and difficulties to access and/or buy perishable foods more often. The impacts of efforts to defeat the pandemic must ensure the human right to adequate food, considering that low prices do not necessarily indicate food security.

Intervention for promoting intake of fruits and vegetables in Brazilians: a randomised controlled trial.

OBJECTIVE: To evaluate the effectiveness of a nutritional intervention to promote fruit and vegetable (FV) intake. DESIGN: A randomised controlled community trial was conducted to evaluate the effectiveness of a 7-month nutritional intervention and to promote FV intake, separately and together. All participants attended physical exercise sessions. The intervention was based on the transtheoretical model and Paulo Freire's pedagogy. The interventions included group educational sessions, motivational cards and informational materials. The primary outcome was a change in FV intake (g/d), and secondary outcomes included stages of change, self-efficacy, decisional balance and knowledge on FV. All data were collected face-to-face; and FV intake was assessed using a validated brief questionnaire. SETTING: Health promotion services of Brazilian Primary Health Care. PARTICIPANTS: 3414 users of Brazilian Primary Health Care (1931 in the control group and 1483 in the intervention group (IG)). RESULTS: At baseline, the average daily FV intake was 370·4 g/d (95 % CI 364·2, 376·6). The increase in FV intake (23·4 g/d; 95 % CI 6·7, 40·0) and fruit intake (+17·3 g/d; 95 % CI 5·1, 29·4; P = 0·01) was greater in the IG among participants in the lowest baseline intake. Participants in the IG also showed progression in the stages of change (P < 0·001), increased self-efficacy (P < 0·001) and improved knowledge of FV crops (P < 0·001). CONCLUSIONS: The nutritional intervention was effective in increasing FV intake and fruits intake among individuals with a lower intake at baseline and in maintaining FV intake among those who reported consuming FV as recommended (400 g/d).

Longitudinal effect of nutritional intervention on body weight: A randomized controlled trial.

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

Ruminant and industrial trans-fatty acids consumption and cardiometabolic risk markers: A systematic review.

The development of cardiometabolic diseases is related to conditions such as obesity, abdominal fat, insulin resistance, diabetes mellitus, elevated blood pressure and changes in lipid profile. The whole of Trans Fatty Acid (TFA) intake is associated with the increase of cardiometabolic risk factors. There are two main sources of TFA, the ruminant TFA (rTFA) which are produced by biohydrogenation in animal's rumen, and the industrial TFA (iTFA), produced by hydrogenation of vegetable oils, the individual effect of each group is still controversial. The aim of this study was to analyze the effect of industrially and ruminants TFA intake on cardiometabolic risk in adults. It was carried out a systematic search of the literature in October 2019 and two independent authors selected and extracted data from articles. After the selection process, nine clinical trials were included, and summary tables were constructed to present data for all outcomes. The results showed that both sources of TFA can increase cardiometabolic risk parameters, especially lipid profile. At levels up to 1.5%-7% of energy, the effect of rTFA seems to be greater than iTFA and it seems to be greater in women. However, rTFA seems to be less harmful than iTFA for High Density Lipoprotein cholesterol, although for total cholesterol and Low density Lipoprotein cholesterol it may be worse. In summary, both sources of TFA can increase cardiometabolic risk parameters, especially lipid profile. However, the dose of TFA and the whole composition of the food must be considered.

Fruit and vegetable consumption across generations of Brazilian primary care users.

OBJECTIVES: Despite the importance of generational approach to understand dietary patterns, studies on the topic are scarce, especially in primary health care. Thus, we aimed to analyze the association between generational status and fruit and vegetable (F + V) consumption across users of the Brazilian Primary Care Program, adjusted by health aspects, socioeconomic factors, and body mass index. METHODS: A cross-sectional study was performed from the baseline, randomized, controlled, community trial. Generational status was defined according to the year of birth as traditionalists (1934-1945), baby boomer (BB; 1946-1964), generation X (GX; 1965-1980), and generation Y (GY; 1981-1993). The consumption of F + V was classified as regular (≥5 times/wk) and adequate (3 servings of fruit/d and 3 of vegetables/d), analyzed together (F + V) and separately (fruit or vegetable) by food group. RESULTS: Of the 3356 participants, 18.1% were traditionalist, 59.0% BB, 19.7% GX, and 3.2% GY. The prevalence of regular and adequate F + V consumption was 61.7% and 37.2%, respectively. There were fewer chances of regular consumption of fruit and F + V for all generations in comparison with traditionalists. With regard to adequate consumption, there was less chance of consuming F + V only for individuals from GY and of F + V for GX and GY. CONCLUSIONS: This is one of the first studies to investigate differences in F + V consumption according to the generational status in a health service. The findings are likely to support the design of strategies to promote F + V consumption, focusing on the younger population to promote health in the present and the future.

The COVID-19 pandemic in a Brazilian metropolis: repercussion on food prices / A pandemia de COVID-19 em uma metrópole brasileira: repercussão sobre o preço dos alimentos / La pandemia de COVID-19 en una metrópolis brasileña: repercusión en los precios de las comidas

We analyzed the impact of the efforts to combat the COVID-19 pandemic on the prices of food sold by a food supply center located in the sixth largest city in Brazil. We examined the percentage change in the prices of 20 types of foods, adjusted by market conditions, using municipal contingency plan stages to compare opening and closing of non-essential services, including bars and restaurants (stage 1: first phase of essential services-only; stage 2: flexibilization; and stage 3: second phase of essential services-only with a "pre-pandemic" period [stage 0]). Log-prices were lower in all contingency stages for leafy greens (variation: 42% to 56%) and vegetables (variation: 28% to 40%). Log-prices of eggs and fruit were 20% and 16% lower during stages 1 and 3, respectively. Strategies to combat the COVID-19 pandemic lowered the prices of eggs, fruit, leafy greens, and vegetables regardless of the market conditions. Accordingly, the supply and demand for fresh and minimally processed foods were affected by the economic crisis and difficulties to access and/or buy perishable foods more often. The impacts of efforts to defeat the pandemic must ensure the human right to adequate food, considering that low prices do not necessarily indicate food security.

Foi analisado o impacto dos esforços para combater a pandemia da COVID-19 sobre o preço dos alimentos comercializados por uma central de abastecimento na sexta maior cidade brasileira. Examinou-se as variações percentuais dos preços de vinte tipos de alimentos, ajustados pelas condições de mercado e pelas fases dos planos de contingência municipais com a abertura e fechamento de serviços não essenciais como bares e restaurantes (fase 1: primeira fase, apenas de serviços essenciais; fase 2: flexibilização; e fase 3: segunda fase apenas de serviços essenciais em comparação com o período "pré-pandêmico" [fase 0]). Os preços logarítmicos eram mais baixos em todas as fases de contingência para vegetais folhosos (variação: 42% e 56%) e hortaliças (variação: 28% a 40%). Os preços logarítmicos de ovos e frutas eram 20% e 16% mais baixos durante as fases 1 e 3, respectivamente. As estratégias para mitigar a pandemia da COVID-19 resultaram em preços mais baixos para ovos, frutas, vegetais folhosos e hortaliças, independentemente das condições de mercado. Isso revela a repercussão das estratégias de combate sobre a procura e oferta de alimentos in natura e minimamente processados, o que pode ser modulado pela crise econômica e pelas dificuldades em acessar e/ou comprar alimentos perecíveis regularmente. Os esforços para eliminar os impactos da pandemia devem assegurar o direito humano à alimentação adequada, uma vez que os preços baixos podem não ser sinônimos de segurança alimentar.

Analizamos el impacto de los esfuerzos para luchar contra la pandemia de COVID-19 en los precios de las comidas vendidas por un centro de suministro alimentario, localizado en la sexta ciudad más grande de Brasil. Examinamos el porcentaje de cambios en los precios de veinte tipos de comidas, ajustados por las condiciones de mercado, por las etapas del plan de contingencia municipal, con la apertura y cierre de los servicios no esenciales como bares y restaurantes (etapa 1: 1ª fase de solo servicios esenciales; etapa 2: flexibilización; y etapa 3: 2ª fase de solo servicios esenciales, en comparación con un periodo "pre-pandemia" [etapa 0]). El registro de precios era más bajo en todas las etapas de contingencia para todas las verduras de hoja verde (variación: 42% a 56%) y hortalizas (variación: 28% a 40%). El registro de precios de huevos y frutas fueron un 20% y un 16% más bajo durante las etapas 1 y 3, respectivamente. Las estrategias para mitigar la pandemia de COVID-19 resultaron en precios más bajos para los huevos, frutas, verduras de hojas verdes y hortalizas, independientemente de sus condiciones de mercado. Además, revela su repercusión en el suministro y demanda de comidas naturales y mínimamente procesadas, lo que quizás se vio modulado por la crisis económica y las dificultades para acceder y/o comprar alimentos perecederos más frecuentemente. Los esfuerzos para eliminar los impactos de la pandemia deben garantizar el derecho humano a alimentos adecuados, puesto que un bajo precio no es indicativo de seguridad alimentaria.

Brumadinho Health Project: food and nutrition insecurity versus socioeconomic statuses and dimensions of the food system after the dam rupture / Projeto Saúde Brumadinho: insegurança alimentar e nutricional versus condições socioeconômicas e dimensões do sistema alimentar após desastre

ABSTRACT Objective: To describe the situation of food insecurity of families according to the socioeconomic characteristics and dimensions of the food system in Brumadinho, state of Minas Gerais, Brazil, after the dam rupture in Córrego do Feijão mine. Methods: This is a descriptive study focused on households carried out from the baseline of the Brumadinho Health Project. Food insecurity, the main outcome, was assessed by the short version of the Brazilian Food Insecurity Scale. Other investigated variables were: socioeconomic data; geographic stratum of the households; family's assets; income; expenses; cultivation of food and animal husbandry for consumption. Descriptive analyses were performed comparing the food insecurity of the household according to the other variables by the χ2 test to compare the proportions. Results: Of the investigated households (n=1,441), 35.1% were facing food insecurity. facing food insecurity had: lower prevalence of masonry households with coating (91.4%; 95%CI 87.7%−94.1% vs. 96.7%; 95%CI 94.9%−97.8%); highest proportion of rudimentary cesspit (16.9%; 95%CI 13.3%−21.2% vs. 9.4%; 95%CI 7.4−11.9); lower prevalence of own and paid-off homes (63.9%; 95%CI 56.8−70.5 vs. 77.3%; 95%CI 72.3−81.7); and income reduction after the dam rupture (33.0%; 95%CI 27.1−39.6 vs. 14.1%; 95%CI 11.2−17.6), when compared with those in a food security situation. Conclusion: The prevalence of food insecurity was high, with report of a reduction in household income after the dam rupture. Moreover, most of the households had worse structural quality and sewage outfall. These results evidence the vulnerability of families and possible violation of the human right to adequate food, denoting the urgency of continuous reparative actions.

RESUMO Objetivo: Descrever a situação de insegurança alimentar das famílias segundo as características socioeconômicas e dimensões do sistema alimentar em Brumadinho, Minas Gerais, Brasil, após desastre. Métodos: Estudo descritivo com foco no domicílio realizado pela linha de base do Projeto Saúde Brumadinho. A insegurança alimentar, desfecho principal, foi avaliada pela Escala Brasileira de Insegurança Alimentar curta. Outras variáveis investigadas foram: socioeconômicas; estrato geográfico do domicílio; ativos (bens); renda; despesas familiares; cultivo de alimentos e criação de animais para consumo. Foram realizadas análises descritivas comparando a insegurança alimentar do domicílio segundo as demais variáveis pelo teste χ2 para comparação das proporções. Resultados: Dos domicílios investigados (n=1.441), 35,1% estavam em situação de insegurança alimentar. As famílias em insegurança alimentar apresentavam: menores prevalências de domicílios de alvenaria com revestimento (91,4%; IC95% 87,7%−94,1% vs. 96,7%; IC95% 94,9%−97,8%); maior proporção de fossa rudimentar (16,9%; IC95% 13,3%−21,2% vs. 9,4%; IC95% 7,4−11,9); menor prevalência de domicílios próprios e quitados (63,9%; IC95% 56,8−70,5 vs. 77,3%; IC95% 72,3−81,7); e redução da renda após o rompimento da barragem (33,0%; IC95% 27,1−39,6 vs. 14,1%; IC95% 11,2−17,6), quando comparadas àquelas em segurança alimentar. Conclusão: A prevalência de insegurança alimentar foi elevada, com relato de redução da renda das famílias após o rompimento da barragem. Ademais, boa parte dos domicílios apresentava pior qualidade estrutural e escoamento de esgoto. Esses resultados evidenciam a vulnerabilidade das famílias e possível violação do direito humano à alimentação adequada, denotando a urgência de ações reparadoras contínuas.

Food consumption of Brumadinho Health Project participants / Consumo alimentar em participantes do Projeto Saúde Brumadinho

ABSTRACT: Objective: To analyze the food consumption patterns of residents of Brumadinho, Minas Gerais, Brazil, according to sociodemographic characteristics, neighborhood and area of residence. Methods: Cross-sectional study with baseline data from the Brumadinho Health Project, conducted with 2,805 adult individuals. The healthy food consumption markers analyzed were: fruits and vegetables (FV), beans and fish; the unhealthy markers were: sweets and soda/artificial juices, whole-fat milk and red meat with visible fat or chicken with skin. Prevalence values and 95% confidence intervals were calculated for the total sample and according to sociodemographic characteristics, presence of commercial establishments with varieties of FV in the neighborhood and area of residence affected by the dam failure. Results: Among the healthy food consumption markers, the most common was beans (81.6%), and among the unhealthy ones, whole-fat milk (68.8%) and red meat with visible fat/chicken with skin (61.1%). Women were more prone to higher consumption of FV, while men, of beans and fish; the prevalence of these markers was higher among individuals with higher education degrees and higher incomes. Unhealthy eating markers were more prevalent among men, younger people, individuals with lower educational level and lower incomes, and residents in an area directly affected by the dam failure or in a mining region. Conclusion: Less than half of the participants were considered to follow regular or recommended consumption of healthy eating markers, except for beans. Individual characteristics and area of residence were associated with individuals' food consumption patterns and should be taken into account in actions to promote adequate and healthy eating.

RESUMO: Objetivo: Analisar o consumo alimentar de residentes de Brumadinho, Minas Gerais, Brasil, segundo as características sociodemográficas da vizinhança e a área de residência. Métodos: Estudo transversal com dados da linha de base do Projeto Saúde Brumadinho, conduzido com 2.805 indivíduos adultos. Os marcadores de alimentação saudável analisados foram frutas e hortaliças (FH), feijão e peixe; os não saudáveis foram doces e refrigerante/suco artificial, leite com teor integral de gordura e carne vermelha com gordura visível/frango com pele. Prevalências e intervalos de confiança de 95% foram calculados para a amostra total, segundo características sociodemográficas; presença de estabelecimentos comerciais de FH na vizinhança e área de residência, segundo rompimento da barragem. Resultados: Entre os marcadores de alimentação saudável, o mais prevalente foi o feijão (81,6%) e, entre os não saudáveis, leite com teor integral de gordura (68,8%) e carne vermelha com gordura visível/frango com pele (61,1%). Mulheres apresentaram maior consumo de FH, e homens, de feijão e peixe, sendo maiores as prevalências desses marcadores entre os indivíduos com maior escolaridade e renda. Os marcadores de alimentação não saudável foram mais prevalentes entre os homens, os mais jovens, indivíduos com menor escolaridade e renda e residentes em área diretamente atingida pelo rompimento da barragem ou região de mineração. Conclusão: Menos da metade dos participantes apresentou consumo regular ou recomendado de marcadores de alimentação saudável, exceto o feijão. Características individuais e área de residência foram associadas ao consumo alimentar dos indivíduos, devendo ser consideradas nas ações de promoção da alimentação adequada e saudável.

Is the management of obesity in primary health care appropriate in Brazil?

This study aims to describe the adequacy of basic health units (UBS) in Brazil regarding structure and work process for obesity management and to evaluate user satisfaction with primary health care services. This cross-sectional study was conducted with data from the 2013-2014 National Program for Improving Primary Care Access and Quality (PMAQ) - an initiative to assess primary health care teams' performance. Data were collected between 2013 and 2014 through interviews with primary health care teams and users. All indicators of adequate care for obesity were defined within the article scope, based on data from the PMAQ. Of the 24,055 UBS analyzed, located in 4,845 different cities, only 7.6% had adequate structure for obesity management. Likewise, only 26.6% of the 114,615 users interviewed reported adequate access, and 27.8% of the UBS showed adequate service organization. Healthcare was considered as "good" or "very good" by 82.4% of users. These indicators varied according to geographic region, showing better results for the South and Southeast. Our results suggest that the country may still be at the initial stage of systematizing care with obesity, presenting significant disparities among regions.