Consumption of in natura and ultra-processed foods in adults: an analysis of social, metabolic, and lifestyle determinants.

OBJECTIVE: To assess the social, metabolic, and lifestyle determinants of consumption of fruits, vegetables, and greens (FVG) and ultra-processed food (ULT) in adults from Pernambuco. METHODS: Cross-sectional and analytical study, conducted in 2015/2016. In addition to sociodemographic variables, the determinants of lifestyle were level of physical activity, alcohol consumption, tobacco use, and metabolic variables were self-reported hypertension, blood glucose, and Body Mass Index (BMI). Consumption was measured by the Food Frequency Questionnaire, then created the Frequency of Consumption Index (SFI) of the mean intake of ULT and FVG foods. The indices of FVG and ULT consumption were transformed into quartiles and these variables were included in the multinomial logistic regression, considering their determinants when p<0.05. RESULTS: The sample was representative of the state, with 1,067 people being interviewed, whose intake of ULT was higher than that of FVG in the lowest and highest quartile of the consumption index. Consumption of fruit and vegetables was higher in higher consumption of alcoholic beverages (p=0.031) and BMI>25 kg/m2 (p=0.047); and lower in the lowest income (p=0.001). ULT intake was higher in young adults (p=0.005), lower income (p=0.044), and controlled blood glucose (p=0.021). Rural areas were 52% less exposed to medium-high ULT consumption (p<0.006). CONCLUSION: Higher rate of ULT consumption in relation to fresh foods, with income as a common determinant, inversely associated with ULT intake and directly related to FVG, which demands structuring policies.

Sociodemographic determinants of eating patterns in two Latin American populations.

BACKGROUND: The present study aimed to describe the dietary patterns of a population from Brazil and another from Colombia with respect to understanding their determinants, similarities and differences. METHODS: An analytical cross-sectional study was conducted based on secondary data. The dietary patterns of the adult population of Pernambuco, Brazil, as well as those of the adult population of Antioquia, Colombia, were analysed using principal component analysis method with orthogonal varimax rotation, and a Poisson regression with robust variance was used to verify the association between eating patterns and socio-economic variables. RESULTS: In each population, three eating patterns were identified. One of them related to healthy eating, named "Prudent", was identified in the two populations analysed. In Pernambuco, a food pattern consisting exclusively of foods with some degree of processing was verified, entitled "Processed". The food culture was reflected in the pattern called "Traditional-Regional" in Pernambuco and the "Traditional" and "Regional" patterns in Antioquia. CONCLUSIONS: Income, education, age, family size, food security status and area of residence were presented as determinants of dietary patterns in both populations. Elements of the food transition were found, which seems to have happened more rapidly in Pernambuco. The food groups that make up the dietary patterns of each population are similar, but the foods that constitute them present differences due to their availability depending on aspects such as climate, soil quality, access to water, local culture and food tradition.

[From production to impacts on health and the environment: an analysis of food systems in Brazil, Colombia and Panama]. / Da produção aos impactos na saúde e no ambiente: uma análise dos sistemas alimentares de Brasil, Colômbia e Panamá.

The scope of this article is to describe the main components of the food systems of Brazil, Colombia and Panama. It involved a narrative review of the literature from 2000 to 2022, based on the concept of food systems proposed by the Committee on World Food Security. A system of agro-industrial production, monoculture, use of pesticides and exploitation of natural resources predominates in all three countries, and the area occupied by family farmers is reduced. Multinational supermarket chains dominate food distribution, essentially in large urban centers, despite the increasing search for alternative models. Advances have been made in food labeling regulation (Colombia and Brazil) and in the taxation of sugar-sweetened beverages (Panama). The predominant food systems in these countries generate a significant and negative environmental impact, favor the consumption of ultra-processed foods, high prevalence of obesity and chronic non-transmissible diseases and increase in hunger, violating the human right to adequate food.

O objetivo deste artigo é descrever os principais componentes dos sistemas alimentares de Brasil, Colômbia e Panamá. Revisão narrativa de literatura dos anos 2000 a 2022, ancorada no conceito de sistemas alimentares do Comitê de Segurança Alimentar Mundial. Nos três países, predomina um sistema de produção agroindustrial, monocultura, uso de agrotóxicos e exploração dos recursos naturais. A área ocupada por produtores familiares é reduzida. As redes multinacionais de supermercados dominam a distribuição dos alimentos, essencialmente nos grandes centros urbanos, apesar da crescente busca por modelos alternativos. Nota-se avanços na regulamentação da rotulagem de alimentos (Colômbia e Brasil) e na tributação de bebidas açucaradas (Panamá). Os sistemas alimentares predominantes nesses países geram importante e negativo impacto ambiental, favorecem o consumo de alimentos ultraprocessados, a elevada prevalência de obesidade e doenças crônicas não transmissíveis e o aumento da fome, violando o direito humano à alimentação adequada.

Da produção aos impactos na saúde e no ambiente: uma análise dos sistemas alimentares de Brasil, Colômbia e Panamá / From production to impacts on health and the environment: an analysis of food systems in Brazil, Colombia and Panama

Resumo O objetivo deste artigo é descrever os principais componentes dos sistemas alimentares de Brasil, Colômbia e Panamá. Revisão narrativa de literatura dos anos 2000 a 2022, ancorada no conceito de sistemas alimentares do Comitê de Segurança Alimentar Mundial. Nos três países, predomina um sistema de produção agroindustrial, monocultura, uso de agrotóxicos e exploração dos recursos naturais. A área ocupada por produtores familiares é reduzida. As redes multinacionais de supermercados dominam a distribuição dos alimentos, essencialmente nos grandes centros urbanos, apesar da crescente busca por modelos alternativos. Nota-se avanços na regulamentação da rotulagem de alimentos (Colômbia e Brasil) e na tributação de bebidas açucaradas (Panamá). Os sistemas alimentares predominantes nesses países geram importante e negativo impacto ambiental, favorecem o consumo de alimentos ultraprocessados, a elevada prevalência de obesidade e doenças crônicas não transmissíveis e o aumento da fome, violando o direito humano à alimentação adequada.

Abstract The scope of this article is to describe the main components of the food systems of Brazil, Colombia and Panama. It involved a narrative review of the literature from 2000 to 2022, based on the concept of food systems proposed by the Committee on World Food Security. A system of agro-industrial production, monoculture, use of pesticides and exploitation of natural resources predominates in all three countries, and the area occupied by family farmers is reduced. Multinational supermarket chains dominate food distribution, essentially in large urban centers, despite the increasing search for alternative models. Advances have been made in food labeling regulation (Colombia and Brazil) and in the taxation of sugar-sweetened beverages (Panama). The predominant food systems in these countries generate a significant and negative environmental impact, favor the consumption of ultra-processed foods, high prevalence of obesity and chronic non-transmissible diseases and increase in hunger, violating the human right to adequate food.

Birth-related and current factors associated with physical inactivity in the leisure time in Brazilian adolescents.

BACKGROUND: To determine whether biological and sociodemographic factors at birth and current factors are associated with insufficient physical activity during leisure among Brazilian adolescents. METHODS: A school-based cross-sectional study with national coverage was conducted involving Brazilian adolescents 12 to 17 years of age in municipalities with more than 100 thousand residents. The sample consisted of 74,589 adolescents who participated in the Study of Cardiovascular Risk in Adolescents. Insufficient leisure-time physical activity was categorized based on total volume (<300 minutes/week = insufficiently active; >300 minutes/week = sufficiently active). Poisson regression models were used to assess associated factors. RESULTS: Most adolescents were classified as insufficiently active (54.8%; 95%CI: 53.7-55.9). The variables associated with insufficient physical activity during leisure were the female sex (70.4%; 95%CI: 68.8-71.9), age between 15 and 17 years (57.8%; 95%CI: 56.3-59.2), pertaining to the low or middle class (54.5%; 95%CI: 52.8-56.1), and not being overweight (55.9%; 95%CI: 54.6-57.1). CONCLUSION: Contrary to our hypothesis, birth related factors (e.g., low birth weight, preterm birth and exclusive breastfeeding until 6 months of age) are not associated with physical inactivity. The prevalence of insufficient physical activity during leisure was high among the adolescents evaluated and was associated with sociodemographic characteristics as well as nutritional status. It is necessary to implement strategies focused on physical activity at schools.

Temporal variation in prevalence, awareness and control of hypertension in urban and rural areas in Northeast Brazil between 2006 and 2016.

To assess the evolution in prevalence, awareness and control of hypertension for over 10 years in Pernambuco State, Northeast Brazil, two cross-sectional studies were conducted based on random samples of households in urban and rural areas, in 2006 and 2015/2016, involving adults aged 20 years or older. Hypertension was defined as systolic blood pressure of at least 140mmHg or diastolic blood pressure of at least 90mmHg as well as the reported use of antihypertensive medication. A logistic regression analysis was conducted to estimate the influence of the social, behavioral and anthropometric determinants on hypertension. Although social and behavioral factors improved in this 10-year period, overweight and abdominal obesity increased. Approximately one third of the adult population of Pernambuco had hypertension in 2006 and this prevalence was maintained in 2015/2016. In rural areas, awareness concerning hypertension rose from 44.8% in 2006 to 67.3% in 2015/2016, and control from 5.3% to 27.1%, so that awareness and control were similar in urban and rural areas in 2015/2016. After an adjustment for potential confounding factors, the likelihood of having hypertension more than doubled among men (OR = 2.03; p < 0.001), middle (OR = 4.41; p < 0.001) and old-age subjects (OR = 14.44; p < 0.001), and those who had abdominal obesity (OR = 2.04; p < 0.001) in urban areas and among middle-aged (OR = 2.56; p < 0.001), less educated individuals (OR = 2.21; p = 0.006) and those who were overweight (OR = 2.23; p < 0.001) in rural areas. Despite the favorable evolution in the management of hypertension in Pernambuco, public health measures focused in vulnerable populations are still required, mainly in rural areas, to improve primary prevention and decrease the disease rate.

Temporal variation in prevalence, awareness and control of hypertension in urban and rural areas in Northeast Brazil between 2006 and 2016 / Variação temporal na prevalência, conhecimento e controle da hipertensão arterial em áreas urbanas e rurais do Nordeste brasileiro entre 2006 e 2016 / Variación temporal de la prevalencia, concienciación y control de la hipertensión en áreas urbanas y rurales en el nordeste brasileño entre 2006 y 2016

Abstract: To assess the evolution in prevalence, awareness and control of hypertension for over 10 years in Pernambuco State, Northeast Brazil, two cross-sectional studies were conducted based on random samples of households in urban and rural areas, in 2006 and 2015/2016, involving adults aged 20 years or older. Hypertension was defined as systolic blood pressure of at least 140mmHg or diastolic blood pressure of at least 90mmHg as well as the reported use of antihypertensive medication. A logistic regression analysis was conducted to estimate the influence of the social, behavioral and anthropometric determinants on hypertension. Although social and behavioral factors improved in this 10-year period, overweight and abdominal obesity increased. Approximately one third of the adult population of Pernambuco had hypertension in 2006 and this prevalence was maintained in 2015/2016. In rural areas, awareness concerning hypertension rose from 44.8% in 2006 to 67.3% in 2015/2016, and control from 5.3% to 27.1%, so that awareness and control were similar in urban and rural areas in 2015/2016. After an adjustment for potential confounding factors, the likelihood of having hypertension more than doubled among men (OR = 2.03; p < 0.001), middle (OR = 4.41; p < 0.001) and old-age subjects (OR = 14.44; p < 0.001), and those who had abdominal obesity (OR = 2.04; p < 0.001) in urban areas and among middle-aged (OR = 2.56; p < 0.001), less educated individuals (OR = 2.21; p = 0.006) and those who were overweight (OR = 2.23; p < 0.001) in rural areas. Despite the favorable evolution in the management of hypertension in Pernambuco, public health measures focused in vulnerable populations are still required, mainly in rural areas, to improve primary prevention and decrease the disease rate.

Resumo: O estudo teve como objetivo avaliar a evolução da prevalência, conhecimento e controle da hipertensão arterial ao longo de 10 anos no Estado de Pernambuco, Nordeste do Brasil. Foram realizados dois estudos transversais em amostras aleatórias em domicílios em áreas urbanas e rurais, em 2006 e 2015/2016, incluindo adultos com 20 anos ou mais. A hipertensão arterial foi definida como pressão sistólica de pelo menos 140mmHg ou pressão diastólica de pelo menos 90mmHg ou o uso referido de medicação anti-hipertensiva. Foi realizada análise de regressão logística para estimar a influência dos determinantes sociais, comportamentais e antropométricos sobre a hipertensão. Os fatores sociais e comportamentais melhoraram ao longo da década em questão, mas as taxas de sobrepeso e de obesidade abdominal aumentaram. Aproximadamente um terço da população adulta de Pernambuco apresentava hipertensão em 2006, e essa prevalência foi mantida em 2015/2016. Nas áreas rurais, o conhecimento da hipertensão aumentou de 44,8% em 2006 para 67,3% em 2015/2016, e o controle aumentou de 5,3% para 27,1%, de maneira que o conhecimento e o controle foram muito semelhantes entre áreas urbanas e rurais em 2015/2016. Após ajustar para potenciais fatores de confusão, a probabilidade de apresentar hipertensão mais do que dobrou entre homens (OR = 2,03; p < 0,001), adultos jovens (OR = 4,41; p < 0,001) e idosos (OR = 14,44; p < 0,001), e entre aqueles com obesidade abdominal (OR = 2,04; p < 0,001) nas áreas urbanas e adultos jovens (OR = 2,56; p < 0,001), pessoas com menor escolaridade (OR = 2,21; p = 0,006) e pessoas com sobrepeso (OR = 2,23; p < 0,001) nas áreas rurais. Apesar da evolução favorável no manejo da hipertensão no Estado de Pernambuco, são necessárias medidas de saúde pública focadas nas populações mais vulneráveis, principalmente nas áreas rurais, para melhorar a prevenção primária e impedir o aumento da hipertensão.

Resumen: El objetivo de este estudio fue evaluar la evolución de la prevalencia, concienciación y control de la hipertensión durante 10 años en el Estado de Pernambuco, Nordeste brasileño. Se llevaron a cabo dos estudios transversales, basados en muestras aleatorias de hogares ubicados en áreas urbanas y rurales, en 2006 y 2015/2016, implicando a adultos con 20 años y más edad. La hipertensión fue definida como presión arterial sistólica de al menos 140mmHg, presión arterial diastólica de al menos 90mmHg, o el consumo informado de medicación antihipertensiva. Se realizó un análisis de regresión logística para estimar la influencia de los determinantes sociales, comportamentales y antropométricos en la hipertensión. Los factores sociales y comportamentales mejoraron durante este período de 10 años, a pesar de que sobrepeso y la obesidad abdominal aumentaron. Aproximadamente un tercio de la población adulta de Pernambuco sufría hipertensión en 2006 y esta prevalencia se mantuvo en 2015/2016. En las áreas rurales, la concienciación sobre la hipertensión aumentó de un 44,8% en 2006, a un 67,3% en 2015/2016, y el control de un 5,3% a un 27,1%, así pues la concienciación y control fueron similares en áreas urbanas y rurales en 2015/2016. Tras el ajuste para los factores potenciales de confusión, la probabilidad de sufrir hipertensión es más del doble entre hombres (OR = 2,03; p < 0,001) de mediana edad (OR = 4,41; p < 0,001) e individuos de edad avanzada (OR = 14,44; p < 0,001), y aquellos que sufrieron obesidad abdominal (OR = 2,04; p < 0,001) en áreas urbanas, y entre los de mediana edad (OR = 2,56; p < 0,001), individuos menos educados (OR = 2,21; p = 0,006) y quienes sufrían sobrepeso (OR = 2,23; p < 0,001) en áreas rurales. A pesar de la evolución favorable en la gestión de la hipertensión en Pernambuco, se necesitan medidas de salud pública que se centren en las poblaciones vulnerables, principalmente en las áreas rurales, para mejorar la prevención primaria y frenar el incremento de la enfermedad.

(Mal)nutrition and the new epidemiological trend in a context of development and inequalities. / A (des)nutrição e o novo padrão epidemiológico em um contexto de desenvolvimento e desigualdades.

The current context of intense social, economic and political transformations has contributed to changes in the health profile of the population and generated discussions about the impact of these changes on the reorganization of society. At the present moment, the increase in non-communicable illnesses and diseases raises major concerns about the paradox of malnutrition and obesity. Based on an in-depth reading and interpretation of texts, documents and databases, this article discusses issues related to nutrition, considering the dimensions of shortages and excesses, the evolution of nutrition over time, and the connection with the new epidemiological trend. We begin with a conceptual characterization, the historical background and the anthropological connections with the guiding theme of the article. We then describe the prevalence, distribution and secular trend of malnutrition and obesity, as well as the temporal relationship with the new epidemiological trend in Brazil within a context of development and inequalities. Finally, we reflect on the issue of (mal)nutrition in post-modernity, the new interests at stake in the health-disease process, as well as international experiences and strategies of partnerships designed to overcome these problems. We conclude by discussing some current advances and challenges in relation to the complexity and speed of contemporary changes.

A (des)nutrição e o novo padrão epidemiológico em um contexto de desenvolvimento e desigualdades / (Mal)nutrition and the new epidemiological trend in a context of development and inequalities

O atual contexto de intensas transformações sociais, econômicas e políticas tem contribuído para as mudanças no perfil de adoecimento da população e gerado discussões acerca de seus impactos na reorganização da sociedade. Atualmente, o aumento de doenças e agravos não transmissíveis impulsiona inquietudes quanto ao paradoxo da coexistência entre desnutrição e obesidade. A partir da leitura e interpretação de textos, documentos e banco de dados, este artigo discute os aspectos relacionados à nutrição, contemplando as dimensões de escassez e excessos, sua evolução ao longo do tempo, além da conexão com o novo padrão epidemiológico. Iniciamos com a caracterização conceitual, a historicidade e a interface antropológica do tema norteador. Em seguida, descrevemos a prevalência, a distribuição e a tendência secular da desnutrição e da obesidade, além das relações temporais com o novo padrão epidemiológico no Brasil em um contexto de desenvolvimento e desigualdades. Trazemos ainda uma reflexão acerca da (des)nutrição na pós-modernidade, os interesses e os interessados no processo saúde doença, assim como experiências internacionais e estratégias de cooperação solidária. Concluímos com alguns avanços e desafios atuais diante da complexidade e velocidade das mudanças contemporâneas.

Prevalência do excesso de peso e fatores associados em mulheres em idade reprodutiva no Nordeste do Brasil / Prevalence of overweight and associated factors in women in reproductive age in Northeast Brazil

RESUMO Objetivo: Determinar a prevalência do excesso de peso e fatores associados em mulheres em idade reprodutiva no município de Vitória de Santo Antão, Pernambuco. Métodos: Estudo transversal com 322 mulheres, conduzido entre os meses de janeiro e abril de 2013 através de busca ativa nos domicílios. O estado nutricional foi classificado pelo índice de massa corporal para as maiores de 18 anos e pelo índice de massa corporal/idade para as adolescentes. A variável dependente foi o excesso de peso (sobrepeso/obesidade) e os fatores associados (variáveis independentes) foram: as condições socioeconômicas e demográficas (idade, escolaridade, alfabetização, trabalho remunerado, classe econômica, condição de segurança alimentar e nutricional, número de pessoas no domicílio, condições de saneamento básico, piso, teto, número de cômodos e de dormitórios), comportamental (prática de atividade física) e história reprodutiva (menarca, número de gestações e método contraceptivo). A regressão de Poisson foi utilizada para a análise dos fatores associados ao excesso de peso. Resultados: A prevalência de excesso de peso nas mulheres foi de 60,9%. O modelo regressão mostrou que a idade (20-39 anos: razões de prevalências 1,84 intervalo de confiança 95% 1,04-3,24; ≥40 anos: razões de prevalências 2,20; intervalo de confiança 95% 1,18-4,08) e a idade da menarca (≤13anos: razões de prevalências 1,37; intervalo de confiança 95% 1,03-1,82) se associaram ao excesso de peso. Conclusão: A prevalência de excesso de peso representou quase dois terços da população estudada e esteve associada com a maior idade cronológica e a menor idade da menarca, o que corrobora outros resultados da literatura científica.

ABSTRACT Objective: To determine the prevalence of overweight and its associated factors in women of childbearing age from the city of Vitória de Santo Antao, Pernanbuco. Method: This cross-sectional study with 322 women was conducted between the months of January and April 2013, by door-to-door active case finding. The nutritional status of individuals aged more than 18 years was classified according to the body mass index, and of adolescents, according to the body mass index-for-age. The dependent variable was overweight (overweight/obesity), and the associated factors (independent variables) were: socioeconomic and demographic characteristics (age, education level, literacy status, employment status, socioeconomic class, food security, number of household dwellers, basic sanitation, floor, roof, and number of rooms and bedrooms), behavioral characteristics (physical activity), and reproductive history (age at menarche, number of pregnancies, and contraceptive method). Poisson regression analyzed the factors associated with excess weight. Results: The prevalence of overweight was 60.9%. The regression model showed that age (20-39 years: prevalence ratio 1.84; 95% confidence interval 1.04-3.24; ≥40 years: prevalence ratio 2.20; 95% confidence interval 1.18-4.08) and age at menarche (≤13 years: prevalence ratio 1.37; 95% confidence interval 1.03-1.82) were associated with excess weight. Conclusion: The prevalence of overweight accounted for nearly two-thirds of the study sample and was associated with higher age and lower age at menarche, consistent with other studies.

O programa saúde na escola e ações de alimentação e nutrição: uma análise exploratória / The school health program and actions of food and nutrition: an exploratory analysis

A mudança no perfil de adoecimento da população refleteum novo desafio para a saúde pública, em especial para aárea da nutrição. Ações de alimentação e nutrição voltadaspara a ?promoção da saúde? são estratégias que buscamfortalecer a autonomia dos indivíduos e contribuir paraescolhas saudáveis. Este estudo teve por objetivo verificaro desenvolvimento de atividades de promoção da alimentaçãoadequada e saudável no ambiente escolar, na perspectivado Programa Saúde na Escola. Trata-se de pesquisaqualitativa, com aplicação de questionários e realizaçãode entrevista semiestruturada com os nutricionistas desete municípios de Pernambuco. Poucos citaram a educa-ção nutricional como atribuição e apenas um entrevistadoestendia essas ações à unidade familiar ou comunidade.Em metade dos municípios existiam dados relativos aoestado nutricional dos discentes e em apenas três haviaoferta de frutas na merenda, mas em todos havia vendade guloseimas próximo à escola. O profissional queixa-sedo excesso de atribuições, precárias condições de trabalhoe ausência de interdisciplinaridade no planejamento eexecução das ações. Assim, é necessária a conscientizaçãodos profissionais e gestores em prol do incentivo e direcionamentode investimentos para a atenção primária,estendidos ao ambiente escolar.

The change in the disease profile of the populationreflects a new challenge to public health, particularly inthe nutrition area. Actions of food and nutrition aimed in"health promotion" are strategies that seek to strengthenautonomy of individuals and contribute to healthierchoices. This study aimed to verify the development ofactivities to promote adequate and healthy food in theschool environment, in the perspective of the SchoolHealth Program (SHP). The study is qualitative andbased on questionnaires and conducting semi-structuredinterviews with nutritionist of seven cities of Pernambuco.Few mentioned nutrition education as attribution andonly one nutritionist extended these activities to familyor community. In half of the cities there is data onnutritional status of students and only three offeredfruits and vegetables in school lunch program, however,in all of them there was selling goodies near the school.Professional complains of excessive assignments, poorworking conditions and lack of interdisciplinarity inplanning and implementation of actions. Thus, awarenessof professionals and managers in favor of encouragingand directing investment into primary care extended theschool environment, is necessary.