Differences in the cost and environmental impact between the current diet in Brazil and healthy and sustainable diets: a modeling study.

BACKGROUND: While healthy and sustainable diets benefit human and planetary health, their monetary cost has a direct impact on consumer food choices. This study aimed to identify the cost and environmental impact of the current Brazilian diet (CBD) and compare it with healthy and sustainable diets. METHODS: Data from the Brazilian Household Budget Survey 2017/18 and the Footprints of Foods and Culinary Preparations Consumed in Brazil database were used for a modeling study comparing the cost of healthy and sustainable diets (based on the Brazilian Dietary Guidelines (BDG) diet and the EAT-Lancet diet) versus the CBD. The DIETCOST program generated multiple food baskets for each scenario (Montecarlo simulations). Nutritional quality, cost, and environmental impact measures (carbon footprint (CF) and water footprint (WF)) were estimated for all diets and compared by ANOVA. Simple linear regressions used standardized environmental impacts measures to estimate differentials in costs and environmental impacts among diets scenarios. RESULTS: We observed significant differences in costs/1000 kcal. The BDG diet was cheaper (BRL$4.9 (95%IC:4.8;4.9) ≈ USD$1.5) than the CBD (BRL$5.6 (95%IC:5.6;5.7) ≈ USD$1.8) and the EAT-Lancet diet (BRL$6.1 (95%IC:6.0;6.1) ≈ USD$1.9). Ultra-processed foods (UPF) and red meat contributed the most to the CBD cost/1000 kcal, while fruits and vegetables made the lowest contribution to CBD. Red meat, sugary drinks, and UPF were the main contributors to the environmental impacts of the CBD. The environmental impact/1000 kcal of the CBD was nearly double (CF:3.1 kg(95%IC: 3.0;3.1); WF:2,705 L 95%IC:2,671;2,739)) the cost of the BDG diet (CF:1.4 kg (95%IC:1.4;1.4); WF:1,542 L (95%IC:1,524;1,561)) and EAT-Lancet diet (CF:1.1 kg (95%IC:1.0;1.1); WF:1,448 L (95%IC:1,428;1,469)). A one standard deviation increase in standardized CF corresponded to an increase of BRL$0.48 in the cost of the CBD, similar to standardized WF (BRL$0.56). A similar relationship between the environmental impact and the cost of the BDG (CF: BRL$0.20; WF: BRL$0.33) and EAT-Lancet (CF: BRL$0.04; WF: BRL$0.18) was found, but with a less pronounced effect. CONCLUSIONS: The BDG diet was cost-effective, while the EAT-Lancet diet was slightly pricier than the CBD. The CBD presented almost double the CF and WF compared to the BDG and EAT-Lancet diets. The lower cost in each diet was associated with lower environmental impact, particularly for the BDG and EAT-Lancet diets. Multisectoral public policies must be applied to guide individuals and societies towards healthier and more sustainable eating patterns.

Temporal Trend in the Coexistence of Risk Behaviors for Noncommunicable Diseases in Brazil: 2009-2019.

INTRODUCTION: Individuals can accumulate multiple risk factors for noncommunicable diseases, increasing the chance of adverse health outcomes. We aimed to analyze the temporal trend in the coexistence of risk behaviors for noncommunicable diseases and their association with sociodemographic characteristics among adults in Brazil from 2009 through 2019. METHODS: This cross-sectional study and time-series analysis was based on data collected by the Surveillance System for Risk Factors and Protection for Chronic Diseases by Telephone Survey (Vigitel) from 2009 through 2019 (N = 567,336). We used item response theory to identify the coexistence of risk behaviors (infrequent consumption of fruits and vegetables, regular consumption of sugar-sweetened beverages, smoking, abusive alcohol consumption, insufficient leisure-time physical activity). We used Poisson regression models to assess the temporal trend in the prevalence of the coexistence of noncommunicable disease-related risk behaviors and associated sociodemographic characteristics. RESULTS: Risk behaviors that most contributed to the occurrence of coexistence were smoking, consumption of sugar-sweetened beverages, and alcohol abuse. Coexistence was more frequent among men and was inversely associated with age and education level. During the study period, we found a significant decrease in coexistence (adjusted prevalence ratio decreased from 0.99 in 2012 to 0.94 in 2019; P = .001), especially before 2015 (adjusted prevalence ratio = 0.94; P = .001). CONCLUSION: We found a reduction in the frequency of the coexistence of noncommunicable disease-related risk behaviors and their association with sociodemographic characteristics. It is necessary to implement effective actions to reduce risk behaviors, especially behaviors that lead to a greater coexistence of those behaviors.

Updating trends in sweetened beverages consumption in Brazil from 2007 to 2021.

OBJECTIVE: To analyze the time trend of sweetened beverages consumption among Brazilian adults in 26 capitals and the Federal District, from 2007 to 2021, with focus on the most recent period (2015 to 2021). METHODS: Data from the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel - Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Survey)were used to conduct a time-series analysis (n = 731,683). The prevalence of regular consumption (five or more days/week), average daily consumption (milliliters) and nonconsumption of sweetened beverages were analyzed. Prais-Winsten regression models were used to calculate temporal trends of the indicators for the complete set of the evaluated population and by sociodemographic characteristics (sex, age group, schooling and development level of the geographic region of residence). RESULTS: Between 2007 and 2021, a reduction in the prevalence of regular consumption (-1.23 pp/year) and daily average consumption (-8.62 milliliters/year) of sweetened beverages was observed. However, between 2015 and 2021, this downward trend did not continue. The prevalence of adults who reported not consuming sweetened beverages increased (1.14 pp/year, for 2007-21), although this trend was not significant in the most recent period. CONCLUSIONS: The consumption of sweetened beverages among Brazilian adults decreased in the 15 years studied. However, this reduction was not observed more recently, suggesting that further actions must be adopted in the country so that the trend observed in the total period is maintained.

Food price trends during the COVID-19 pandemic in Brazil.

The present study aims to analyze the trends in food price in Brazil with emphasis on the period of the Covid-19 pandemic (from March 2020 to March 2022). Data from the Brazilian Household Budget Survey and the National System of Consumer Price Indexes were used as input to create a novel data set containing monthly prices (R$/Kg) for the foods and beverages most consumed in the country between January 2018 and March 2022. All food items were divided according to the Nova food classification system. We estimated the mean price of each food group for each year of study and the entire period. The monthly price of each group was plotted to analyze changes from January 2018 to March 2022. Fractional polynomial models were used to synthesize price changes up to 2025. Results of the present study showed that in Brazil unprocessed or minimally processed foods and processed culinary ingredients were more affordable than processed and ultra-processed foods. However, trend analyses suggested the reversal of the pricing pattern. The anticipated changes in the prices of minimally processed food relative to ultra-processed food, initially forecasted for Brazil, seem to reflect the impact of the Covid-19 pandemic on the global economy. These results are concerning as the increase in the price of healthy foods aggravates food and nutrition insecurity in Brazil. Additionally, this trend encourages the replacement of traditional meals for the consumption of unhealthy foods, increasing a health risk to the population.

Health characteristics and behaviors associated with self-reported depression among Brazilian reproductive-aged women: Data from a population-based survey (2020-2021).

This cross-sectional study aimed to evaluate the health characteristics and behaviors associated with depression in a large probabilistic sample of Brazilian reproductive-aged women. A total of 11,698 non-pregnant women aged 18-49 years old from the 26 Brazilian capitals and Federal District were interviewed by landline between 2020 and 2021. Logistic regression models were used to estimate the Odds Ratio (OR) of health characteristics and behaviors (smoking, alcohol abuse, physical activity, regular intake of fruits and vegetables, overweight, obesity and poor self-rated health) according to the presence of depression and drug treatment for depression. Medical diagnosis of depression, and other health characteristics and behaviors were self-reported. Analyses were adjusted by age, race/skin color, education, and marital status. Prevalence of self-reported depression was 13.3% and drug treatment for depression was reported by 5.3% of the total studied population. The presence of self-reported depression was associated with smoking (adjusted OR - aOR 2.15; CI95%:1.44-3.20), regular intake of fruits and vegetables (aOR 0.75; CI95%:0.59-0.95), overweight (aOR 1.38; CI95%:1.10-1.71), obesity (aOR 1.34; CI95%:1.04-1.71) and poor self-rated health (aOR 4.34; CI95%:3.04-6.21). Drug treatment for depression was associated with smoking (aOR 2.29; CI95%:1.33-3.95), overweight (aOR 1.65; CI95%:1.18-2.30) and poor self-rated health (aOR 4.20; CI95%:2.59-6.83). Self-reported depression and drug treatment for depression were associated with unfavorable health characteristics and behaviors among reproductive-aged women in Brazil.

Changes in Screen Time in Brazil: A Time-Series Analysis 2016-2021.

PURPOSE: To analyze the temporal trend of leisure screen time among adults in Brazil between 2016 and 2021. DESIGN: Time-series analysis of six cross-sectional surveys. SETTING: Data from the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel) (2016/21). SUBJECTS: A probabilistic sample of 265 252 adults (≥18 years). MEASURES: Time watching television (TV), or using cell phone, computer, or tablet (CCT) during leisure time, and indicators of prolonged exposure for the total population and sociodemographic groups. ANALYSIS: Prais-Winsten regression models were used to identify trends in the studied period. RESULTS: Mean time watching TV remained stable (2.3 h to 2.2 h/day) as the frequency of adults watching TV ≥ 3 hours/day (25.7% to 25.1%) for 2016/21. There was an increase in mean time spent on CCT (1.7 h to 2.0 h/day; .08 h/day/year; P < .001) and in the frequency of adults spending ≥ 3 hours/day on CCT (19.9% to 25.5%; 1.33 pp/year; P < .001) for 2016/21. The increase in screen time was relevant in all sociodemographic groups. CONCLUSION: Leisure screen time has increased in Brazil, with greater intensity over time.

Leisure time physical activity among older adults in Brazil: a time series analysis of a population-based survey (2009-2020).

The practice of leisure time physical activity brings several health benefits, such as the prevention of noncommunicable diseases. Investigating the temporal trend of physical activity practice in older adults by sociodemographic characteristics and geographical regions could be important to plan public health policies and effective interventions. This is a time series study that analyzes the temporal trend of leisure time physical activity among Brazilian older adults with data from 2009 to 2020. For this, we used a sample of 186,097 older adults (≥ 60 years old) obtained from the Risk and Protective Factors Surveillance System for Chronic Noncomunicable Diseases Through Telephone Interview (Vigitel) (2009-2020). Information on leisure time physical activity and sociodemographic and health characteristics were collected. Prais-Winsten regression was used to identify significant trends in the annual variation of the leisure time physical activity indicators. Practice of ≥ 150 minutes/week of moderate intensity leisure time physical activity varied from 23.3% to 27.5% (0.41p.p./year) (2009-2020), with a higher increase during 2015-2020 (0.59p.p./year). The increase in the most recent period occurred among men, aged from 60 to 69 years, with lower educational level, residing in the Northeast Region, and without self-reported chronic diseases. These results may contribute to the evaluation of Brazilian health policies targeting the leisure time physical activity practice in older adults.

Chronic disease risk and protective behaviors in Brazilian state capitals and the Federal District, according to the National Health Survey and the Chronic Disease Risk and Protective Factors Telephone Survey Surveillance System, 2019. / Comportamentos de risco e proteção para doenças crônicas nas capitais brasileiras e no Distrito Federal, segundo a Pesquisa Nacional de Saúde e o Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico, 2019.

OBJECTIVE: To describe and compare the results of the main risk and protective factors for chronic non-communicable diseases, in the 26 Brazilian capitals and the Federal District, obtained through the National Health Survey (PNS) and the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL) in 2019. METHODS: Cross-sectional study, in which the difference in prevalence between health behavior indicators investigated by PNS and VIGITEL was calculated. RESULTS: The largest discrepancy between the surveys, PNS (n = 32,111) and VIGITEL (n = 52,443), were observed in relation to leisure-time physical activity (6.8 in percentage points - p.p.), recommended physical activity in the transport domain (7.4 p.p.), and high screen time (21.8 p.p.). Both surveys presented similar prevalence regarding nutritional status, food consumption, smoking, alcohol abuse and negative self-rated health. CONCLUSION: Prevalence in both surveys presented small differences, but point to results in the same direction.

Leisure time physical activity among older adults in Brazil: a time series analysis of a population-based survey (2009-2020) / Atividade física no lazer entre idosos no Brasil: análise de séries temporais de um inquérito de base populacional (2009-2020) / Actividad física por ocio entre adultos mayores en Brasil: análisis de series temporales de una encuesta basada en la población (2009-2020)

The practice of leisure time physical activity brings several health benefits, such as the prevention of noncommunicable diseases. Investigating the temporal trend of physical activity practice in older adults by sociodemographic characteristics and geographical regions could be important to plan public health policies and effective interventions. This is a time series study that analyzes the temporal trend of leisure time physical activity among Brazilian older adults with data from 2009 to 2020. For this, we used a sample of 186,097 older adults (≥ 60 years old) obtained from the Risk and Protective Factors Surveillance System for Chronic Noncomunicable Diseases Through Telephone Interview (Vigitel) (2009-2020). Information on leisure time physical activity and sociodemographic and health characteristics were collected. Prais-Winsten regression was used to identify significant trends in the annual variation of the leisure time physical activity indicators. Practice of ≥ 150 minutes/week of moderate intensity leisure time physical activity varied from 23.3% to 27.5% (0.41p.p./year) (2009-2020), with a higher increase during 2015-2020 (0.59p.p./year). The increase in the most recent period occurred among men, aged from 60 to 69 years, with lower educational level, residing in the Northeast Region, and without self-reported chronic diseases. These results may contribute to the evaluation of Brazilian health policies targeting the leisure time physical activity practice in older adults.

A prática de atividade física no lazer traz diversos benefícios à saúde, como a prevenção de doenças não transmissíveis. Investigar a tendência temporal da prática de atividade física em idosos de acordo com características sociodemográficas e regiões geográficas pode ser importante para formular políticas públicas de saúde e intervenções efetivas. Este é um estudo de série temporal para analisar a tendência temporal de idosos brasileiros à prática de atividade física no lazer entre 2009 e 2020. Uma amostra de 186.097 idosos (≥ 60 anos) foi obtida do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel) (2009-2020). Foram coletadas informações sobre prática de atividade física no lazer e características sociodemográficas e de saúde. A regressão de Prais-Winsten foi utilizada para identificar tendências significativas na variação anual dos indicadores de prática de atividade física no lazer. A prática de atividades físicas moderadas por ≥ 150 minutos/semana variou de 23,3% a 27,5% (0,41p.p./ano) (2009-2020) com maior aumento em 2015-2020 (0,59p.p./ano). O aumento mais recente ocorreu entre homens, indivíduos entre 60 e 69 anos de idade, aqueles com menor escolaridade, residentes na Região Nordeste e sem doença crônica autorreferida. Esses resultados podem contribuir para a avaliação das políticas de saúde brasileiras voltadas à prática de atividade física no lazer em idosos.

La práctica de actividad física por ocio trae diversos beneficios a la salud, como la prevención de enfermedades no transmisibles. Investigar la tendencia temporal de la práctica de actividad física en adultos mayores según las características sociodemográficas y las regiones geográficas puede ser importante para formular políticas de salud pública e intervenciones efectivas. Este es un estudio de serie temporal para analizar la tendencia temporal de adultos mayores brasileños a la práctica de actividad física por ocio entre 2009 y 2020. Se obtuvo una muestra de 186,097 adultos mayores (≥ 60 años) del Vigilancia de Factores de Riesgo y Protección para Enfermedades Crónicas No Transmisibles por Entrevista Telefónica (Vigitel) (2009-2020). Se recopiló información sobre práctica de actividad física por ocio y las características sociodemográficas y de salud. Se utilizó la regresión de Prais-Winsten para identificar tendencias significativas en la variación anual de los indicadores de práctica de actividad física por ocio. La práctica de actividades físicas moderada por ≥ 150 minutos/semana varió de 23,3% a 27,5% (0,41p.p./año) (2009-2020) con el mayor aumento en 2015-2020 (0,59p.p./año). El aumento más reciente ocurrió entre hombres, las personas entre 60 y 69 años de edad, aquellos con menor educación, residentes en la Región Nordeste y sin enfermedad crónica autoinformada. Estos resultados pueden contribuir a la evaluación de las políticas de salud brasileñas dirigidas a la práctica de actividad física por ocio en adultos mayores.

Comportamentos de risco e proteção para doenças crônicas nas capitais brasileiras e no Distrito Federal, segundo a Pesquisa Nacional de Saúde e o Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico, 2019 / Conductas de riesgo y protección en las capitales brasileñas y el Distrito Federal, según la Encuesta Nacional de Salud y el Sistema de Vigilancia para Factores de riesgo y Protección de Enfermedades Crónicas por Encuesta Telefónica, 2019 / Chronic disease risk and protective behaviors in Brazilian state capitals and the Federal District, according to the National Health Survey and the Chronic Disease Risk and Protective Factors Telephone Survey Surveillance System, 2019

Objetivo: Descrever e comparar os resultados dos principais fatores de risco e proteção para doenças crônicas não transmissíveis, nas 26 capitais brasileiras e no Distrito Federal, obtidos pela Pesquisa Nacional de Saúde (PNS) e pelo Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel) em 2019. Métodos: Estudo transversal, no qual se calculou a diferença na prevalência entre os indicadores de comportamentos de saúde investigados pela PNS e Vigitel. Resultados: As maiores discrepâncias entre os inquéritos, PNS (n = 32.111) e Vigitel (n = 52.443), foram observadas para prática de atividade física no lazer (6,8 pontos percentuais - p.p.), prática recomendada no deslocamento (7,4 p.p.) e tempo elevado de tela (21,8 p.p.). Foram semelhantes nos dois inquéritos as prevalências do estado nutricional, consumo alimentar, tabagismo, consumo abusivo de álcool e de autoavaliação negativa do estado de saúde. Conclusão: Os inquéritos apresentaram prevalências com pequenas diferenças, mas que apontam resultados na mesma direção.

Objetivo: Describir y comparar los resultados de los principales factores de riesgo y protección de enfermedades crónicas no transmisibles, en las 26 capitales brasileñas y el Distrito Federal, obtenido por la Encuesta Nacional de Salud (PNS) y el Sistema de Vigilancia para Factores de Riesgo y Protección de Enfermedades Crónicas por Encuesta Telefónica (Vigitel) en 2019. Métodos: Estudio transversal, que calculó la diferencia de prevalencia entre los indicadores investigados por PNS y Vigitel. Resultados: Las mayores discrepancias entre las encuestas, PNS (n = 32.111) y Vigitel (n = 52.443), fueron práctica de actividad física en el tiempo libre (6,8 puntos porcentuales - p.p.), práctica recomendada de desplazamientos (7,4 p.p.) y tiempo de pantalla elevado (21,8 p.p.). La prevalencia del estado nutricional, consumo de alimentos, tabaquismo, abuso de alcohol y la autoevaluación negativa de la salud fueron similares en ambas encuestas. Conclusión: Las encuestas presentaron prevalencias con pequeñas diferencias, pero que apuntan resultados en la misma dirección.

Objective: To describe and compare the results of the main risk and protective factors for chronic non-communicable diseases, in the 26 Brazilian capitals and the Federal District, obtained through the National Health Survey (PNS) and the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL) in 2019. Methods: Cross-sectional study, in which the difference in prevalence between health behavior indicators investigated by PNS and VIGITEL was calculated. Results: The largest discrepancy between the surveys, PNS (n = 32,111) and VIGITEL (n = 52,443), were observed in relation to leisure-time physical activity (6.8 in percentage points - p.p.), recommended physical activity in the transport domain (7.4 p.p.), and high screen time (21.8 p.p.). Both surveys presented similar prevalence regarding nutritional status, food consumption, smoking, alcohol abuse and negative self-rated health. Conclusion: Prevalence in both surveys presented small differences, but point to results in the same direction.

Variação temporal da coexistência de comportamento de risco para doenças crônicas não transmissíveis: 2009 a 2019 / Temporal variation of coexistence of risk behavior for noncommunicable chronic diseases: 2009 to 2019

Introdução: As doenças crônicas não transmissíveis (DCNT) se destacam entre os principais problemas mundiais de saúde pública. A maioria dos óbitos por DCNT estão relacionados a um conjunto comum de fatores de risco comportamentais e modificáveis, como a alimentação inadequada, o tabagismo, o consumo abusivo de bebidas alcoólicas, a inatividade física e a obesidade. Esses comportamentos muitas vezes coexistem nos indivíduos, aumentando assim a chance do desenvolvimento e agravamento de doenças. Objetivo: Analisar a variação temporal da coexistência de comportamentos de risco para doenças crônicas não transmissíveis na população adulta das capitais de estado e Distrito Federal no período entre 2009 e 2019. Métodos: Foi feito um estudo de série temporal com dados do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel) entre 2009 e 2019 com adultos das capitais brasileiras e DF (n=567.336). Para a criação do indicador de coexistência de comportamentos de risco (realização simultânea dos comportamentos) na população estudada, utilizou-se o método da Teoria de Resposta ao Item (TRI). Em adição, com o objetivo de identificar os principais fatores sociodemográficos (sexo, idade e escolaridade) associados a coexistência de comportamentos de risco para DCNT e a variação temporal desse indicador, modelos de regressão de Poisson foram usados para o cálculo de razões de prevalência brutas e ajustadas (segundo sexo, idade e escolaridade). Resultados: No conjunto completo do período estudado, observou-se uma redução da coexistência de comportamentos de risco para DCNT, com uma estabilização da redução a partir de 2015 (entre 4% e 6% ao ano). O maior número de comportamentos coexistindo foi maior no sexo masculino (11% menor entre mulheres) e se associou inversamente à faixa de idade (14% menor entre indivíduos com 60 anos e mais) e escolaridade (10% menor entre indivíduos com 12 anos ou mais de estudo). Conclusão: A realização de comportamentos de risco para DCNT de forma conjunta reduziu entre a população no período. Observou-se também uma associação da coexistência comportamentos de risco ao sexo masculino, indivíduos mais jovens, e com menor escolaridade.

Introduction: Noncommunicable diseases (NCDs) stand out among the main world public health problems. Most NCD deaths are related to a common set of behavioral and modifiable risk factors, such as unhealthy diet, tobacco use, harmful use of alcohol, physical inactivity, and obesity. These behaviors often coexist in individuals, thus increasing the chance of developing and worsening diseases. Objective: To analyze the temporal variation in the coexistence of risk behaviors for noncommunicable diseases in the adult population of state capitals and the Federal District, between 2009 and 2019. Methods: A time-series study was conducted with data from the Surveillance System for Risk and Protective Factors for Chronic Diseases (Vigitel) between 2009 and 2019 with adults from Brazilian capitals and DF (n=567,336). For the creation of the coexistence indicator between risk behaviors (simultaneous realized of behaviors) in the population studied, the method of Item Response Theory (IRT) was used. In addition, with the objective of identifying the main socio-demographic factors (sex, age groups, and years of schooling) associated with the coexistence of risk factors and the temporal variation of this coexistence, Poisson regression models, were used for the calculation of crude and adjusted prevalence ratios (according to sex, age, and schooling). Results: In the complete period of the study, there was a reduction in the coexistence of risk behaviors for NCDs, with a stabilization of the reduction as of 2015 (between 4% and 6% per year). The highest number of coexisting behaviors was higher among males (11% lower among women) and was inversely associated with the age group (14% lower among individuals aged 60 years and older) and schooling (10% lower among individuals aged 12 years or more). Conclusion: The realization of risk behaviors for NCDs together decreased among the population in the period. There was also a greater association of coexistence of risk behaviors for males, younger individuals, and with lower schooling.