Time trends in hypertension and diabetes prevalence by body mass index categories in Brazilian adults from 2006 to 2023.

AIM: The prevalence of diabetes and hypertension according to body mass index (BMI) status in Brazilian adults has not been described yet. Herein, we aimed to identify the time trends in hypertension and diabetes, individually and combined (multimorbidity), by BMI in Brazilian adults. METHODS: In this time series cross-sectional study, we retrieved self-reported data from 806 169 adults between 2006 and 2023, using the Surveillance System of Risk and Protective Factors from Chronic Diseases by Telephone Survey (Vigitel). Weight and height were used to classify participants into normal/underweight (<25 kg/m2), pre-obesity (25 to 29.9 kg/m2), and obesity (≥ 30 kg/m2). We calculated the prevalence of medical diagnoses of hypertension and diabetes, individually and combined, by BMI categories, and by sociodemographic characteristics (sex, age group, educational attainment) for participants with obesity. We performed Prais-Winsten linear regression models to identify temporal trends. RESULTS: The prevalence of hypertension and diabetes increased between 2006 and 2023. Among adults with obesity, we observed a slight decrease in the prevalence of hypertension (from 44.5% in 2006 to 41.7% in 2023) and the prevalence of either hypertension or diabetes (47.1% to 45.5%); an increase in the prevalence of diabetes (12.8% to 15.13) and both conditions combined (10.2% to 11.2%). Participants with obesity had more than twice the prevalence of hypertension and diabetes compared with those who were normal/underweight. We observed a differential time trend by sex, age group, and educational attainment. CONCLUSION: Our findings indicate the need for differentiated approaches for interventions for hypertension and diabetes, considering variations over time by sociodemographic characteristics.

Are Neighborhood Greenspaces Associated with Leisure-time Physical Activity? Results from ELSA-Brasil Eight-year Follow-up.

We investigated whether neighborhood greenspaces were associated with physical activity in adulthood over 3 cohort visits after considering perceived safety and neighborhood contextual factors. We also evaluated whether the association with greenspace varied by neighborhood socioeconomic status. Participants (N = 4,800) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) residing in two Brazilian state capitals were evaluated in Visits 1 (2008-2010), 2 (2012-2014) and 3 (2017-2019). Greenspaces were categorized by quintiles of positive Normalized Difference Vegetation Index (NDVI) scores. Physical activity frequency was given by the number of visits at which participants reported moderate/vigorous physical activity (none, 1 or 2, and 3 visits). We used multinomial logistic regression. After adjustment for age, sex, education, research center, residence in slums, individuals in the 4th and 5th NDVI quintiles showed 73% higher odds of physical activity over 3 visits than those in the 1st quintile (4th quintile: 95%CI = 1.24-2.43; 5th quintile: 95%CI = 1.24-2.41). The strength of the association was attenuated after adjustment for perceived safety. After adjustment for contextual factors quantity of sidewalks and streetlights, the OR for the 4th and 5th NDVI quintiles decreased to 1.66 (95%CI = 1.18-2.33) and 1.62 (95%CI = 1.16-2.28), respectively. Finally, after including average household income per capita, the OR for physical activity in 3 visits for the 4th and 5th NDVI quintiles decreased to 1.48 (95%CI = 1.04-2.12) and 1.43 (95%CI = 1.00-2.04; p = 0.053), respectively. Greater greenspace contributed to sustained physical activity during the eight years of follow-up, indicating the potential contribution of public greenspaces to reducing health-related inequalities.

Relationship between body mass index and residential segregation in large cities of Latin America.

BACKGROUND: Obesity is a global health problem, and its connection with social and environmental factors is well-established. Social factors, such as urban segregation, may impact obesity through various mechanisms, including food and physical activity environments, as well as social norms and networks. This multilevel study aims to examine the effect of socio-economic residential segregation of Latin American cities on the obesity of individuals within those cities. METHODS: We analyzed data from national surveys for a total of 59,340 individuals of 18-70 years of age, conducted in 156 cities across Brazil, Chile, Colombia, and Mexico between 2007 and 2013. We adjusted two-level linear mixed models for body mass index (BMI) stratified by sex and country, controlling for age, educational level and poverty. Separate models were built for dissimilarity and isolation segregation indices. RESULTS: The relationships between segregation indices and BMI were mostly not statistically significant, and in some cases, they were opposite to what was expected. The only significant relationships were observed in Colombian men, using the dissimilarity index (-7.5 [95% CI: -14.4, -0.5]) and in Colombian women, using the isolation index (-7.9 [95% CI: -14.1, -1.7]). CONCLUSIONS: While individual-level factors cannot fully explain differences among people in the same city, segregation indices may help. However, we found that in some cases, the relationship between BMI and segregation indices is opposite to what is expected based on prior literature. This should be considered in examining the phenomenon. Further research on obesogenic environments in segregated neighborhoods could provide valuable evidence.

Anthropometric trajectory in the course of life and occurrence of sarcopenia in men and women: results from the ELSA-Brasil cohort.

This study aimed to identify patterns of anthropometric trajectories throughout life and to analyse their association with the occurrence of sarcopenia in people from the Longitudinal Study of Adult Health (ELSA-Brasil). It is a cross-sectional study involving 9670 public servants, aged 38-79 years, who answered the call for new data collection and exams, conducted approximately 4 years after the study baseline (2012-2014). Data sequence analysis was used to identify patterns of anthropometric trajectory. A theoretical model was elaborated based on the directed acyclic graph (DAG) to select the variables of minimum adjustment in the analysis of the causal effect between trajectory and sarcopenia. Poisson regression with robust variance was adopted for data analysis. The patterns of change in the anthropometric trajectory were classified in stable weight (T1); change to normal weight (T2); change to excess weight (T3); weight fluctuation (T4) and change to low weight (T5). The prevalence of sarcopenia in men and women who changed the anthropometric path for the low weight was twice as large when compared to participants with a stable weight trajectory. A protective effect of the excess weight trajectory was observed for the occurrence of sarcopenia in them. The results pointed to the need for health policies that encourage the proper management of body components in order to prevent and control obesity, as well as to preserve the quantity and quality of skeletal muscle mass throughout life, especially in older adults.

Adherence to the EAT-Lancet sustainable reference diet and cardiometabolic risk profile: cross-sectional results from the ELSA-Brasil cohort study.

PURPOSE: The EAT-Lancet Commission released a reference sustainable diet to improve human health and respect the planetary boundaries. The Planetary Health Diet Index (PHDI) was developed with the purpose of evaluate the adherence to this reference diet. The aim of the present study was to evaluate the association between adherence to the EAT-Lancet diet with cardiometabolic risk profile. METHODS: We used the cross-sectional baseline data from 14,155 participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter ongoing cohort study. Dietary data were collected using a 114-item validated food frequency questionnaire. The PHDI was used to assess the adherence to the EAT-Lancet diet. It consists of 16 components and the total score can range from 0 to 150 points. Linear, logistic and quasi-Poisson regression models were built to evaluate the associations between PHDI and the outcomes. RESULTS: Individuals with higher adherence to EAT-Lancet diet (PHDI, 5th quintile) had lower values for systolic blood pressure (ß - 0.84; 95% CI - 1.66: - 0.01), diastolic blood pressure (ß - 0.70; 95% CI - 1.24: - 0.15), total cholesterol (ß - 3.15; 95% CI - 5.30: - 1.01), LDL-c (ß - 4.10; 95% CI - 5.97: -  2.23), and non-HDL-cholesterol (ß - 2.57; 95% CI - 4.62: - 0.52). No association was observed for HDL-c, triglycerides and HOMA-IR. CONCLUSIONS: Our results indicate that higher adherence to the EAT-Lancet diet is associated with lower levels of blood pressure, total cholesterol, LDL-c, and non-HDL-c.

Digital marketing of online food delivery services in a social media platform before and during COVID-19 pandemic in Brazil.

OBJECTIVE: To describe the promotion of food and beverage and marketing strategies used by online food delivery services (OFDS) in a social media platform before and during the pandemic in Brazil. DESIGN: Publicly available data were extracted from OFDS Instagram accounts. Posts published 6 months immediately before and after the first case of COVID-19 in Brazil were randomly sampled. Two independent authors coded the posts' content. Food and beverage items featured in posts were classified according to the NOVA food system classification. Marketing strategies were coded according to protocols from previous studies. SETTING: Top three OFDS Instagram accounts in Brazil. PARTICIPANTS: Posts published in the period studied (n 304). RESULTS: During the pandemic, the proportion of posts featuring at least one food item decreased from 71·6 % to 40·2 %, and the proportion of ultra-processed foods decreased from 57·6 % to 27·9 %. Before the pandemic, the most widely used marketing strategies were branding elements (80·7 %), product imagery (unbranded) (48·9 %) and partnerships/sponsorship (35·2 %). While during the pandemic, branding elements (62·2 %) continued to be the most applied, but were followed by the use of videos/graphics interchange format/boomerangs (34·1 %) and corporate social responsibility (31·7 %). The most frequent COVID-19 marketing strategies were 'social responsibility in the pandemic' (30·5 %), 'combatting the pandemic' (28·0 %) and 'accelerating digitalisation' (20·7 %). CONCLUSIONS: OFDS advertisements on a social media platform placed less emphasis on food items, but improved the nutritional quality of foods and beverages featured in posts. A COVID-washing approach was highlighted, especially through the use of social responsibility marketing during the pandemic.

Scientific research on food environments in Brazil: a scoping review.

OBJECTIVE: To map the scientific research on food environments in Brazil, based on the following questions: How many studies have addressed food environments?; What study designs and methodological approaches were applied?; What is the geographic scope of the studies?; What scenarios and dimensions of food environments were studied?; Which population groups were studied?; How were food environments conceptualised?; What are the main limitations of the studies? DESIGN: Scoping review conducted in four databases, from January 2005 to December 2022, using different food environment-related terms to cover the main types and dimensions proposed in the literature. The studies were independently selected by two authors. A narrative synthesis was used to summarise the findings. SETTING: Brazil. PARTICIPANTS: 130 articles. RESULTS: Scientific research on Brazilian food environments has been increasing. The analytical quantitative approach and the cross-sectional design were the most frequently used. Most articles were published in English. The majority of studies evaluated the community food environment, addressed aspects of the physical dimension, sampled the adult population, had food consumption as an outcome, used primary data, and were carried out in capital cities in the Southeast region. Furthermore, in most articles, no conceptual model was explicitly adopted. CONCLUSIONS: Gaps in literature are related to the need for conducting studies in the Brazilian countryside, the support for the formulation of research questions based on conceptual models, the use of valid and reliable instruments to collect primary data, in addition to the need for a greater number of longitudinal, intervention and qualitative studies.

Ecological study of the association between socioeconomic inequality and food deserts and swamps around schools in Rio de Janeiro, Brazil.

BACKGROUND: Previous research suggests that unhealthy community food environments around schools contribute to unhealthy eating habits and negative health outcomes among the youth. However, little is known about how socioeconomic inequalities in those community food environments are associated with food deserts and food swamps across schools' neighborhoods. METHODS: An ecological study was carried out in all 3,159 public and private schools in Rio de Janeiro, Brazil. Three measures of socioeconomic inequality were evaluated: per capita income, segregation index and deprivation index. The community school food environment was analyzed by metrics of food swamps and food deserts. RESULTS: Food deserts and food swamps were simultaneously more prevalent in neighborhoods of the lowest income, high deprivation, and high segregation. Spatial socioeconomic disparities at the neighborhoods of schools were associated with food deserts and food swamps in Rio de Janeiro. CONCLUSIONS: Our results point to a spatial socioeconomic inequality of establishments that sell food around schools in a Brazilian metropolis, indicating that the areas of greatest deprivation of food services are also the areas with the worst socioeconomic characteristics.

Racial Inequities in Self-Rated Health Across Brazilian Cities: Does Residential Segregation Play a Role?

Racial health inequities may be partially explained by area-level factors such as residential segregation. In this cross-sectional study, using a large, multiracial, representative sample of Brazilian adults (n = 37,009 individuals in the 27 state capitals; National Health Survey (Pesquisa Nacional de Saúde), 2013), we investigated 1) whether individual-level self-rated health (SRH) (fair or poor vs. good or better) varies by race (self-declared White, Brown, or Black) and 2) whether city-level economic or racial residential segregation (using dissimilarity index values in tertiles: low, medium, and high) interacts with race, increasing racial inequities in SRH. Prevalence of fair or poor SRH was 31.5% (Black, Brown, and White people: 36.4%, 34.0%, and 27.3%, respectively). Marginal standardization based on multilevel logistic regression models, adjusted for age, gender, and education, showed that Black and Brown people had, respectively, 20% and 10% higher prevalence of fair or poor SRH than did White people. Furthermore, residential segregation interacted with race such that the more segregated a city, the greater the racial gap among Black, Brown, and White people in fair or poor SRH for both income and race segregation. Policies to reduce racial inequities may need to address residential segregation and its consequences for health.

Consumption of ultra-processed foods and incidence of dyslipidemias: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Ultra-processed foods (UPF) have been associated with cardiometabolic outcomes, but the literature has still not reported their association with incidence of dyslipidemias, one of the most important risk factors for the occurrence of cardiovascular diseases. The objective of this study was to verify the association between consumption of UPF and incidence of dyslipidemia in Brazilian civil servants at a 4-year follow-up. The study used data from 5,275 participants at baseline and on the first follow-up visit in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We applied a food frequency questionnaire (FFQ) at baseline and identified UPF from NOVA, classification of foods as to the extent and purpose of processing. The proportion (in weight) of UPF in the total diet was calculated for each participant and categorized in tertiles, corresponding to low (first tertile), medium (second tertile), and high (third tertile) consumption. A mixed-effects logistic model was used to obtain the incidence of dyslipidemia associated with consumption of UPF. Individuals with medium and high consumption of UPF showed increases in the risks of development of isolated hypercholesterolemia by 12% (OR=1.12, CI:1.00-1.27) and 28% (OR=1.28, CI:1.12-1.47), of isolated hypertriglyceridemia by 14% (OR=1.14, CI:1.03-1.26) and 30% (OR=1.30, CI:1.17-1.45), of mixed hyperlipidemia by 21% (OR=1.21, CI:1.05-1.39) and 38% (OR=1.38, CI:1.18-1.62), and of low-HDL by 12% (OR=1.12, CI:1.00-1.24) and 18% (OR=1.18, CI:1.05-1.32), respectively, compared to participants that consumed less UPF. Our findings showed important cardiovascular risk associated with consumption of UPF and a gradient in the consumption´s effect, so these products should be discouraged.

The inflammatory food index and its association with weight gain and incidence of diabetes: Longitudinal Study of Adult Health (ELSA-Brasil).

BACKGROUND AND AIMS: Diet plays a central role in regulating inflammation and is closely related to the development of chronic diseases. We aimed to develop an inflammatory food index (IFI) based on the relationship of food items with biomarkers of inflammation and to evaluate its association with weight gain and type 2 diabetes. METHODS AND RESULTS: A sample of 9909 participants of the ELSA-Brasil study was analyzed. Standardized measurements including interviews, anthropometry, and laboratory exams were performed at baseline and follow-up. A baseline food frequency questionnaire was used to derive IFI scores using reduced rank regression (RRR). The inflammatory pattern derived included 11 pro-inflammatory food groups: processed meat, red meat, pork, sugary soda, and hot dogs. The anti-inflammatory pattern included seven food groups: fruits, nuts, and wine. The IFI score, adjusted through logistic regression for multiple sociodemographic, behavioral, and clinical covariates, including body mass index, predicted the development of a large weight gain (tertile 3 vs. 1: OR = 1.30; 95%CI 1.08-1.55). The score, adjusted for sociodemographic factors through proportional hazard models, predicted incident diabetes (tertile 3 vs. 1: HR = 1.26; 95%CI 1.04-1.52). CONCLUSION: These findings support the hypothesis that subclinical inflammation caused by a pro-inflammatory food pattern, characterized mainly by greater ultra-processed food consumption, underlies weight gain and the development of type 2 diabetes. This study was registered at clinicaltrials.com as NCT02320461.

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

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

Potential impacts of policies to reduce purchasing of ultra-processed foods in Mexico at different stages of the social transition: an agent-based modelling approach.

OBJECTIVES: To develop a simulation framework for assessing how combinations of taxes, nutrition warning labels and advertising levels could affect purchasing of ultra-processed foods (UPF) in Latin American countries and to understand whether policies reinforce or reduce pre-existing social disparities in UPF consumption. DESIGN: We developed an agent-based simulation model using international evidence regarding the effect of price, nutrition warning labels and advertising on UPF purchasing. SETTING: We estimated policy effects in scenarios representing two stages of the 'social transition' in UPF purchasing: (1) a pre-transition scenario, where UPF purchasing is higher among high-income households, similar to patterns in Mexico; and (2) a post-transition scenario where UPF purchasing is highest among low-income households, similar to patterns in Chile. PARTICIPANTS: A population of 1000 individual agents with levels of age, income, educational attainment and UPF purchasing similar to adult women in Mexico. RESULTS: A 20 % tax would decrease purchasing by 24 % relative to baseline in both the pre- and post-transition scenarios, an effect that is similar in magnitude to that of a nutrition warning label policy. A 50 % advertising increase or decrease had a comparatively small effect. Nutrition warning labels were most effective among those with higher levels of educational attainment. Labelling reduced inequities in the pre-transition scenario (i.e. highest UPF purchasing among the highest socio-economic group) but widened inequities in the post-transition scenario. CONCLUSIONS: Effective policy levers are available to reduce UPF purchasing, but policymakers should anticipate that equity impacts will differ depending on existing social patterns in UPF purchasing.

Is city-level travel time by car associated with individual obesity or diabetes in Latin American cities? Evidence from 178 cities in the SALURBAL project.

There is growing evidence that longer travel time by private car poses physical and mental risks. Individual-level obesity and diabetes, two of the main public health challenges in low- and middle-income contexts, could be associated to city-level travel times by car. We used individual obesity and diabetes data from national health surveys from individuals in 178 Latin American cities, compiled and harmonized by the SALURBAL project. We calculated city-level travel times by car using the Google Maps Distance Matrix API. We estimated associations between peak hour city-level travel time by car and obesity and diabetes using multilevel logistic regression models, while adjusting for individual characteristics and other city-level covariates. In our study we did not observe a relationship between city-level peak-hour travel time by car and individual obesity and diabetes, as reported in previous research for individual time spent in vehicles in high-income settings. Our results suggest that this relationship may be more complex in Latin America compared to other settings, especially considering that cities in the region are characterized by high degrees of population density and compactness and by a higher prevalence of walking and public transportation use.

A rheological approach to identify efficient biopolymer producing bacteria.

This study investigates the relationship between collective motion and propulsion of bacterial consortia and their biopolymer production efficiency. Rheological tests were conducted for suspensions of two different methanotrophic bacterial consortia obtained after enrichment of sediment samples from mangrove sites in Brazil. We considered the linear viscoelasticity region and analyzed the values of storage and loss moduli as functions of days of cultivation, for different values of the volume fraction. The suspensions' rheological behaviors reflected the bacterial growth stage. We found that the formation of structures over time in some types of consortia can hinder the movement of bacteria in the search for nutrients. The change in complex viscosity of the two consortia followed a different and rich behavior that appears to be closely related to their capacity to capture methane. Our analysis showed a possible correlation between collective motion, viscosity reduction, and biopolymer production. The pieces of evidence from this study suggest that the efficiency of bacterial motion is directly related to biopolymer production, and this could facilitate the process of identifying the best consortium of biopolymer producing bacteria.

Beverages Rich in Resveratrol and Physical Activity Attenuate Metabolic Changes Induced by High-Fat Diet.

Consumption of saturated fat causes deleterious effects on health, which could be minimized through physical activity and foods with functional characteristics consumption. The aim of the study was to evaluate the beverage rich in resveratrol consumption and physical exercise in gut microbiota, body composition, lipid peroxidation, interleukin-6 (IL6) concentration and systolic blood pressure (SBP) of rats to the high-fat diet. Wistar rats were fed with control diet, high-fat diet (HFD), HFD and 15 mL solution of resveratrol, HFD and 15 mL of grape juice, HFD and 10 mL of red wine. All animals performed the physical training protocol five days a week. Grape juice and red wine composition were analyzed, SBP, body mass, consumption, adiposity and body composition, gut microbiota, lipid peroxidation and inflammation were evaluated. The grape juice (114.8 ± 22.5 mmHG) and red wine (129 ± 15.8 mmHg) groups showed lower SBP when compared to HFD (216.8 ± 20.6 mmHg) (p < 0.0001). The grape juice group (GJG) (39.1 ± 7) had a higher number of microbiota bands DNA when compared to the other groups (p = 0.002). The GJG (33.7 ± 6.7 pg/mL) presented lower concentration IL6 when compared to high-fat group (47.3 ± 16 pg/mL) (p = 0.003). GJG (4.7 ± 1.2 nmol/L) presented a lower concentration of TBARS when compared to control group (6.1 ± 1.4 nmol/L) and resveratrol group (6.6 ± 0.9 nmol/L), and the red wine group (7.4 ± 1.2 nmol/L) had a higher concentration of TBARS when compared to control group and GJG (p = 0.0001). The consumption of these beverages, especially grape juice, together with physical exercise, was able to promote beneficial changes even in the presence of a HFD.

Web Data Mining: Validity of Data from Google Earth for Food Retail Evaluation.

To overcome the challenge of obtaining accurate data on community food retail, we developed an innovative tool to automatically capture food retail data from Google Earth (GE). The proposed method is relevant to non-commercial use or scholarly purposes. We aimed to test the validity of web sources data for the assessment of community food retail environment by comparison to ground-truth observations (gold standard). A secondary aim was to test whether validity differs by type of food outlet and socioeconomic status (SES). The study area included a sample of 300 census tracts stratified by SES in two of the largest cities in Brazil, Rio de Janeiro and Belo Horizonte. The GE web service was used to develop a tool for automatic acquisition of food retail data through the generation of a regular grid of points. To test its validity, this data was compared with the ground-truth data. Compared to the 856 outlets identified in 285 census tracts by the ground-truth method, the GE interface identified 731 outlets. In both cities, the GE interface scored moderate to excellent compared to the ground-truth data across all of the validity measures: sensitivity, specificity, positive predictive value, negative predictive value and accuracy (ranging from 66.3 to 100%). The validity did not differ by SES strata. Supermarkets, convenience stores and restaurants yielded better results than other store types. To our knowledge, this research is the first to investigate using GE as a tool to capture community food retail data. Our results suggest that the GE interface could be used to measure the community food environment. Validity was satisfactory for different SES areas and types of outlets.

Micronutrients and bioactive compounds in the immunological pathways related to SARS-CoV-2 (adults and elderly).

The new coronavirus pandemic is affecting the entire world with more than 25 million confirmed cases in August 2020 according to the World Health Organization. It is known that the virus can affect several tissues and can progress to a respiratory failure in severe cases. To prevent the progression to this stage of the disease and minimize all the damage caused by coronavirus (SARS-CoV-2) the immune system must be in its integrity. A healthy nutritional status are fundamental to efficient immunological protection and consequently a good response to SARS-CoV-2. Micronutrients and bioactive compounds perform functions in immune cells that are extremely essential to stop SARS-CoV-2. Their adequate consumption is part of a non-pharmacological intervention to keep the immune system functioning. This review has as main objective to inform how micronutrients and bioactive compounds could act in the essential immunological pathways could stop SARS-CoV-2, focusing on the functions that have already established in the literature and transposing to this scenario.

Ultra-processed foods, changes in blood pressure and incidence of hypertension: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

OBJECTIVE: To estimate changes in blood pressure and the incidence of hypertension associated with consumption of ultra-processed foods (UPF) by Brazilian civil servants at a 4-year follow-up. DESIGN: Longitudinal analysis of the ELSA-Brasil with non-hypertensive individuals at baseline. We applied the FFQ at the baseline and categorised energy intake by degree of processing, using the NOVA classification. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at baseline (2008-2010) and again at first follow-up (2012-2014). Incidence of arterial hypertension was defined as SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or antihypertensive medication during the previous 2 weeks. A mixed-effect linear regression model and mixed-effect logistic regression model were used to estimate associations between UPF consumption and, respectively, changes in blood pressure and incidence of hypertension. SETTING: Brazil. PARTICIPANTS: Civil servants of Brazilian public academic institutions in six cities (n 8754), aged 35-74 years at baseline (2008-2010). RESULTS: UPF consumption contributed 25·2 % (sd = 9·6) of total energies consumed. After adjustment, participants with high UPF consumption presented a 23 % greater risk of developing hypertension (OR = 1·23, 95 % CI 1·06, 1·44) than those with low UPF consumption. We did not find association between UPF consumption and changes in blood pressure over time. CONCLUSIONS: The higher the UPF consumption, the higher the risk of hypertension in adults. Reducing UPF consumption is thus important to promote health and prevent hypertension.

Promoting knowledge to policy translation for urban health using community-based system dynamics in Brazil.

BACKGROUND: Effectively bridging the knowledge-policy gap to support the development of evidence-based policies that promote health and well-being remains a challenge for both the research and policy communities. Community-based system dynamics (CBSD) is a participatory modelling approach that aims to build stakeholders' capacity to learn and address complex problems collaboratively. However, limited evidence is available about the contributions of CBSD to knowledge-generating and policy processes across sectors and policy spheres. In the context of a multi-country research project focused on creating an evidence base to inform urban health policies across Latin America, a series of CBSD workshops convened stakeholders from research, policy-making, and other backgrounds working in food and transportation systems. Diverse participants were selected aiming to incorporate multiple perspectives relevant to understanding complex urban systems linked to food and transportation. This study focuses on one of these workshops, whose avenue was São Paulo, Brazil, assembling country-based participants representing local, regional, national, and international institutions with multidisciplinary backgrounds linked to food and transportation systems. OBJECTIVE: The aim of this case study is to explore the perceived influence of one of these workshops on attendees' understandings of food and transportation systems and their relationship to healthy urban environments, with attention to the role of the workshop in supporting knowledge to policy translation for urban health. METHODS: We conducted 18 semi-structured qualitative interviews with attendees one year after their participation in a CBSD workshop held in São Paulo, Brazil. A framework method approach was used to code participants' responses and identify emerging themes. RESULTS: Participants reported that the workshop's group model-building activities influenced their understanding of the knowledge-policy process as it relates to food and transport systems. Workshop contributed to participants' (1) abilities to engage with multisectoral stakeholders, (2) construct a shared language and understanding of urban challenges, (3) improve understanding of the interconnectedness across food and transportation systems, (4) facilitate dialogue across sectors, and (5) apply a systems thinking approach within their sector and professional context. Participants continued to draw on the tools developed during the workshop, and to apply systems thinking to their research and policy-making activities. CONCLUSIONS: CBSD may offer valuable opportunities to connect the research sector to the policy-making process. This possibility may contribute to knowledge to policy translation in the interconnection between the urban context, food and transportation systems, and health.