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.

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.

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.

Consumption of carbonated soft drinks, fruits and vegetables and association with macroeconomic indicators: the analysis of students from seventy-four countries (2003-2015).

This study aimed to compare fruits and vegetables (FV), and carbonated soft drink (CSD) consumption among adolescents from seventy-four countries, according to macroeconomic indicators. This is an ecological study, developed with countries evaluated through the Global School-based Student Health Survey (2003-2014) and the National School Health Survey (PeNSE-Brazil, 2015). The percentages of students in each country who consumed CSD and FV daily and their association with the Human Development Index (HDI) and the Gross National Income per capita (GNIpc) were assessed. Scatter plots were constructed for each marker, and a multilevel model was tested to consider the effects of region in the associations. The overall prevalence of daily CSD consumption was 54·1 %. CSD consumption was positively associated with HDI and GNIpc through multilevel models, and Central and South America showed a considerable higher consumption compared with other regions. Overall, FV daily consumption was 67·9 % and 74·6 %, respectively, and no associations with macroeconomic indicators were found. The study shows concerning rates of CSD consumption among adolescents, and a trend of increased consumption with the improvement of the country's development and GNIpc. This points for the importance of public policies that regulate food and beverage industries to reduce CSD consumption and related co-morbidities among adolescents.

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).

Drought-driven wildfire impacts on structure and dynamics in a wet Central Amazonian forest.

While the climate and human-induced forest degradation is increasing in the Amazon, fire impacts on forest dynamics remain understudied in the wetter regions of the basin, which are susceptible to large wildfires only during extreme droughts. To address this gap, we installed burned and unburned plots immediately after a wildfire in the northern Purus-Madeira (Central Amazon) during the 2015 El-Niño. We measured all individuals with diameter of 10 cm or more at breast height and conducted recensuses to track the demographic drivers of biomass change over 3 years. We also assessed how stem-level growth and mortality were influenced by fire intensity (proxied by char height) and tree morphological traits (size and wood density). Overall, the burned forest lost 27.3% of stem density and 12.8% of biomass, concentrated in small and medium trees. Mortality drove these losses in the first 2 years and recruitment decreased in the third year. The fire increased growth in lower wood density and larger sized trees, while char height had transitory strong effects increasing tree mortality. Our findings suggest that fire impacts are weaker in the wetter Amazon. Here, trees of greater sizes and higher wood densities may confer a margin of fire resistance; however, this may not extend to higher intensity fires arising from climate change.

Coronavirus disease-19 deaths among children and adolescents in an area of Northeast, Brazil: why so many?

OBJECTIVE: To describe COVID-19 deaths among children and adolescents in Sergipe, Brazil. METHODS: Ecological study of all COVID-19 reported cases and deaths occurring in children and adolescents < 19 years of age in Sergipe reported by the health surveillance and mortality information systems of Sergipe's Health Secretary and hospital records. RESULTS: Of 37 deaths of children < 19 years old were reported up to 30 September 2020, corresponding to 4.87 deaths for 100 000 population < 19 years old. Most deaths occurred among infants (44.1/100 000), and this age group had the highest case fatality rate (15.3 %). Most children had comorbidities such as chronic neurological diseases (n = 7; 19%) and prematurity (n = 4; 11%). Most children who died (n = 18; 49%) were not admitted to intensive care units (ICUs). CONCLUSION: COVID-19 mortality in children and adolescents in Sergipe was higher than in other Brazilian states and in high-income countries. A large proportion of the deaths occurred among children with comorbidities and a minority of children were admitted to ICU, reflecting the limited provision of such beds in the State. Newborns and infants are a high-risk group that must have priority in health public policy.

OBJECTIF: Décrire les décès par COVID-19 chez les enfants et adolescents à Sergipe, au Brésil. MÉTHODES: Etude écologique de tous les cas et décès par COVID-19 signalés chez des enfants et des adolescents <19 ans à Sergipe rapportés par les systèmes de surveillance de la santé et d'information sur la mortalité du Secrétariat de la Santé et les dossiers hospitaliers de Sergipe. RÉSULTATS: 37 décès d'enfants <19 ans ont été signalés au 30 septembre 2020, correspondant à 4,87 décès pour 100.000 habitants de <19 ans. La plupart des décès sont survenus chez des nourrissons (44,1/100.000) et ce groupe d'âge avait le taux de létalité le plus élevé (15,3%). La plupart des enfants présentaient des comorbidités telles que des maladies neurologiques chroniques (n = 7; 19%) et une prématurité (n = 4; 11%). La plupart des enfants décédés (n = 18; 49%) n'avaient pas été admis dans des unités de soins intensifs. CONCLUSION: La mortalité par COVID-19 chez les enfants et les adolescents de Sergipe était plus élevée que dans les autres Etats brésiliens et dans les pays à revenu élevé. Une grande partie des décès est survenue chez des enfants souffrant de comorbidités et une minorité d'enfants avaient été admis aux soins intensifs, ce qui reflète la disponibilité limitée de ce type de lits dans l'Etat. Les nouveau-nés et les nourrissons constituent un groupe à haut risque qui doit avoir la priorité dans les politiques de santé publiques.

Dairy versus other saturated fats source and cardiometabolic risk markers: Systematic review of randomized controlled trials.

To analyze the effects of dairy intake on cardiometabolic risk markers compared to other dietary fat sources in adults. Literature database and gray literature were searched for studies published up to October 2018. Two independent authors selected and extracted data from articles. Summary tables were constructed to present data for all outcomes. The intake of dairy appears to have a protective effect on some cardiovascular risk factors, or it is not worse than other SFA sources. The higher intake of dairy can decrease total cholesterol and reduce waist circumference and increase HDL cholesterol. However, it can also increase LDL and triglycerides, although those were small changes. It was observed that the effect of dairy on several serum lipids varied according to the type dairy product used on intervention. Dairy products seem to present a different effect on cardiometabolic risk factors than other fat sources, with evidence of improvement on metabolic parameters compared to another animal source of SFA.

Challenges for obesity management in a unified health system: the view of health professionals.

BACKGROUND: Obesity is an increasingly prevalent chronic condition. Its multiple causes and the complexity of its treatment pose challenges for health professionals. OBJECTIVE: To explore and describe the challenges for obesity management in the Brazilian Unified Health System according to health professionals. METHODS: An exploratory quantitative web-based study, carried out in 2018 with health professionals, developed from the first stage of a national project that aims to examine the management of obesity in Brazil. The questionnaire was self-applied. Invitations to participate in the research were sent by the Ministry of Health, Health Department of Minas Gerais and members of the research group. We collected data on sex, age, professional category, region and level of care. The challenges were investigated using a Likert scale and categorized into structure and work process. RESULTS: We evaluated 1323 professionals, of which about 45% were dietitians, 90.2% were women, and 83.1% self-reported working in primary health care. The main barriers cited included a high demand for curative and individual assistance, the presence of comorbidities, and the absence or insufficient access to instructional materials, professional qualification and lack of support. CONCLUSION: Obesity management is a critical challenge for all professionals. Barriers were related to the work process and structural aspects and reinforce the need to empower health teams. We propose that permanent education activities should be established, as well as the development of instructional materials that are applicable to routine work. Finally, the results may be used to develop policies and strategies to improve obesity management.

Food processing and risk of hypertension: Cohort of Universities of Minas Gerais, Brazil (CUME Project).

OBJECTIVE: To analyse the association between food consumption according to the degree of processing and incidence of hypertension in CUME project participants. DESIGN: Longitudinal study in which food consumption was evaluated according to the percentage contribution of daily energetic intake (%/d) of each NOVA classification group (unprocessed/minimally processed foods and culinary preparations (U/MPF&CP); processed foods and ultra-processed foods (UPF)). Hypertension was defined according to American College of Cardiology/American Heart Association (ACC/AHA) criteria. Adjusted relative risks (RR) and their 95% confidence intervals (95 % CI) were estimated by Poisson regression models with robust variances. SETTING: Brazil. PARTICIPANTS: 1221 graduates classified as non-hypertensive at baseline and monitored for 2 years. RESULTS: Daily energetic percentage from each group according to degree of processing was 64·3 (sd 12) % for U/MPF&CP; 9·9 (sd 5·8) % for processed foods and 25·8 (sd 11) % for UPF. Incidence of hypertension was high (152/1000 person-years; n 113, 193/1000 person-years in males and n 257, 138/1000 person-years in females). After adjusting for potential confounders, participants in the upper quintile of daily energetic intake of U/MPF&CP presented a reduced risk of hypertension (RR: 0·72; 95 % CI 0·52, 0·98), while those in the upper quintile of daily energetic intake of UPF presented an increased risk of the outcome (RR: 1·35; 95 % CI 1·01, 1·81). CONCLUSIONS: In this prospective cohort of Brazilian middle-aged adult university graduates, the highest consumptions of U/MPF&CP and UPF were associated with, respectively, reduced and increased risk of hypertension. Additional longitudinal studies are needed to confirm our results.

Dietary and nutrient intake among participants of a Brazilian health promotion programme: a cross-sectional study.

OBJECTIVE: Developing health promotion activities, aimed at healthy food intake, is essential for improving quality of life and reducing the prevalence of chronic diseases. Thus, the objective of this study is to describe both dietary and nutrient intake, according to length of participation in a health promotion service (Programa Academia da Saúde - PAS). DESIGN: A cross-sectional study was carried out with a representative sample of PAS units in vulnerable areas of the city. Dietary and nutrient intake were assessed, using the average of two 24-h recalls. Food was categorised according to the NOVA (a systematic grouping of all foods according to the nature, extent and purpose of the industrial processes they undergo) classification. The length of participation in PAS is presented in months and is then examined in tertiles for analysis. SETTING: Belo Horizonte - Brazil. PARTICIPANTS: 3372 adults (≥20 years). RESULTS: Users in the third tertile of PAS (24·4-61·6 months) experienced less energy intake, lipids and ultra-processed foods, and more culinary preparations, compared to others. Users in the second (10·1-24·3 months) and third tertiles of PAS had higher carbohydrate intake, Ca and vitamin C v those in the first tertile (0-10 months). CONCLUSIONS: Results suggest that greater participation in PAS can improve dietary and nutrient intake, showing its potential to promote healthy lifestyles, prevent chronic diseases and offer longitudinal health care.

Consumption of ultra-processed foods and nutritional profile in a health promotion service of primary care.

OBJECTIVE: Describing the consumption of ultra-processed foods (UPF) and their association with the nutritional profiles among users of a health promotion service in a Brazilian city. DESIGN: Cross-sectional study. SETTING: Public health promotion service of Primary Health Care in Belo Horizonte, Minas Gerais, Brazil. PARTICIPANTS: Totally, 3372 participants. RESULTS: UPF were found to contribute to 27·7 % of the diet's total energy. The highest consumption was associated with higher values for energy intake (1561·8 v. 1331·8 kcal/d; P < 0·01), energy density (1·7 v. 1·4 kcal/g; P < 0·01), total (32·5 v. 27·3 %; P < 0·01) and trans-fats (2·1 v. 1·2 %; P < 0·01) and Na (1001·6 v. 758·9 mg/1000 kcal; P < 0·01) and with lower values for proteins (14·9 v. 19·6 %; P < 0·01), mono-unsaturated fats (16·1 v. 20·1 %; P = 0·02), n-3 (0·9 v. 1·1 %; P < 0·01) and some vitamins and minerals when comparing individuals in the last quintile of energy contribution from UPF in relation to the first one. The prevalence rate of nutrient inadequacy aimed at preventing non-communicable diseases increased between 30 % and 100 % when compared with the values of the fifth to the first quintile of UPF consumption (P < 0·001). However, the participants had lower energy intake, energy density and Na and higher fibre consumption when compared to Brazilian population. CONCLUSIONS: Participants showed a high consumption of UPF, but also positive diet characteristics when compared with the national data. The results suggest the importance of health promotion services to promote healthy food and the need to include approaches to reduce UPF consumption.

Effect of a Transtheoretical Model-based intervention on fruit and vegetable intake according to perception of intake adequacy: A randomized controlled community trial.

Interventions based on the Transtheoretical Model (TTM) are usually effective at increasing fruit and vegetable (FV) intake, but it is not known whether individuals with misperceived intake [e.g., in pseudomaintenance (PM)] for FV intake also benefit from these interventions. This study aims to describe the effectiveness of a TTM-based intervention for FV intake according to baseline perception of intake adequacy. A randomized controlled community trial was carried out with 3414 users of a health promotion service in Belo Horizonte, Brazil, aged 20 years or over, in 2013-2014. FV intake was estimated using a validated instrument. PM was identified when participants had insufficient FV intake and thought their intake was adequate. The intervention group (IG) received a TTM-based intervention, and the control group (CG) received usual care. Baseline FV intakes were lower among individuals in PM compared to those with a concordant perception (CP). In both the IG and CG, FV intake increased among those in PM. Fruit intake remained stable, and vegetable intake decreased among those with CP. Generalized estimating equations revealed a significant effect of the intervention on fruit intake at follow-up, which was slightly higher among those in PM. We conclude that participants in PM were partially sensitive to the intervention and improved fruit intake at follow-up. We suggest that future studies emphasize vegetable intake and elucidate how TTM pillars (self-efficacy, decisional balance, processes of change) can be best used to increase FV intake.

Structures of N-Glycans of Bothrops Venoms Revealed as Molecular Signatures that Contribute to Venom Phenotype in Viperid Snakes.

The complexity of snake venoms has long been investigated to explore a myriad of biologically active proteins and peptides that are used for immobilizing or killing prey, and are responsible for the pathological effects observed on envenomation. Glycosylation is the main post-translational modification (PTM) of viperid venoms but currently there is little understanding of how protein glycosylation impacts the variation of venom proteomes. We have previously reported that Bothrops venom glycoproteomes contain a core of components that markedly define their composition and parallel their phylogenetic classification. Here we extend those observations to eight Bothrops species evaluating the N-glycomes by LC-MS as assigned cartoon structures and detailing those structures separately as methylated analogs using ion-trap mass spectrometry (MSn). Following ion disassembly through multiple steps provided sequence and linkage isomeric details that characterized 52 unique compositions in Bothrops venoms. These occurred as 60 structures, of which 26 were identified in the venoms of the Jararaca Complex (B. alcatraz, B. insularis, and B. jararaca), 20 in B. erythromelas, B. jararacussu, B. moojeni and B. neuwiedi venoms, and 22 in B. cotiara venom. Further, quantitative analysis of these N-glycans showed variable relative abundances in the venoms. For the first time a comprehensive set of N-glycan structures present in snake venoms are defined. Despite the fact that glycosylation is not template-defined, the N-glycomes of these venoms mirror the phylogeny cladograms of South American bothropoid snakes reported in studies on morphological, molecular data and feeding habits, exhibiting distinct molecular signatures for each venom. Considering the complexity of N-glycan moieties generally found in glycoproteins, characterized by different degrees of branching, isomer structures, and variable abundances, our findings point to these factors as another level of complexity in Bothrops venoms, features that could dramatically contribute to their distinct biological activities.

The transtheoretical model is an effective weight management intervention: a randomized controlled trial.

BACKGROUND: Given the current worldwide epidemic of obesity, there is a demand for interventions with higher impact, such as those carried out in the primary health care (PHC) setting. Here we evaluate the effect of intervention performed according to the stages of change of the transtheoretical model (TTM) for weight management. METHODS: This randomized controlled trial in Brazilian PHC offered free physical exercise and nutrition education. The participants were women, aged 20 years or older who were obese or overweight, users in PHC service. The intervention group (IG, n = 51) received the same orientation as the comparison group (CG, n = 35) plus individual health counseling based on the TTM aimed at weight loss, which lasted 6 months. The outcome measures were anthropometric, food, and nutrient profiles. Inflammatory parameters were evaluated in a random subsample. The inter-group and intra-group differences were evaluated using interntion-to-treat analysis, and analysis of covariance (ANCOVA) used to assess intervention effectiveness. RESULTS: There was a difference between groups of - 1.4 kg (CI95%: - 2.5; - 0.3) in body weight after the intervention. About 97% of women in the IG reported benefits of the intervention and presented positive changes in diet, biochemical markers, and anthropometry. The IG showed better body mass index, resistine, and blood glucose results compared to the CG during follow-up. CONCLUSION: The individualized TTM-based intervention, combined with usual care, was an effective strategy in PHC. These results should encourage the use of interdisciplinary practices; nevertheless, research to identify additional strategies is needed to address barriers to weight maintenance among obese low-income women. TRIAL REGISTRATION: The trial is registered with Brazilian clinical trials under the code: RBR-8t7ssv, Registration date: 12/12/2017 (retrospectively registered).

Does misperception of fruit and vegetable intake adequacy affect progression through the stages of behavior change after nutritional intervention?

Pseudomaintenance (PM) is a Transtheoretical Model (TTM) stage of change that refers to individuals who believe they eat enough fruit and vegetables (FV) despite their low FV intake. It is not known how they change behavior after usual TTM-based interventions. Thus, this randomized controlled community trial describes the effect of PM on progression through the stages of change for FV intake among adult and elderly health promotion service users after TTM-based intervention. The stage of change for FV intake was assessed; FV intake was estimated from brief validated questions at baseline (n = 3414) and follow-up (n = 1782). Individuals whose perception of adequacy matched the estimated intake were labeled as "concordant perception," while those with low intake who believed that their intake was adequate were classified as being in PM. The intervention group received the intervention while the control group received usual care. The prevalence of "no stage progression" at follow-up was close to 50% for those in PM at baseline. After adjustment for demographics, randomization, self-efficacy, decisional balance, and baseline intake, users in PM at baseline had higher odds [OR = 1.53 (1.21-1.94)] of progressing to higher stages for fruit and no difference in progression for vegetables. We propose strategies to approach FV intake in future studies and reinforce the need for additional trials aimed at describing changes in FV intake among individuals in PM, in order to continue answering the scientific questions that we began to investigate.

National general truck drivers' strike and food security in a Brazilian metropolis.

OBJECTIVE: We analysed the impact of the national general truck drivers' strike on the availability, variety and price of foods sold by a food supply centre. DESIGN: Descriptive study using secondary data to examine the percentage change in the mean price of fruits, vegetables and eggs before, during and after the strike. The strike in Brazil lasted 10 d from 21 to 30 May 2018. The drivers were on strike in order to make diesel oil tax-free and to obtain better working conditions. SETTING: The food supply centre, named CEASA-Minas Grande BH, was located in the metropolitan area of a Brazilian city. PARTICIPANTS: We examined twenty types of foods. RESULTS: After 10 d, there was a ~30 % reduction in the availability of all types of foods and prices increased. Foods with the highest price increases included cabbage (233·3 %), potatoes (220·0 %), papaya (160·0 %) and oranges (78·6 %). At the end of the strike, we observed reductions in the price of eggs, fruits, vegetables, roots and tubers; however, some foods remained more expensive than before the strike, including chayote (203·2 % higher), cucumber (66·7 % higher) and potatoes (60·0 % higher). CONCLUSIONS: The general truck drivers' strike was correlated with a reduction in the availability of food and, consequently, increases in price and possibly restrictions on access. The strike demonstrated the dependence of metropolises on road transportation and the conventional market. We speculate that initiatives aiming to shorten the food supply chain and promote food sovereignty and resilience of the supply circuits could be important.

Identification of Phenotypes in People with COPD: Influence of Physical Activity, Sedentary Behaviour, Body Composition and Skeletal Muscle Strength.

INTRODUCTION: People with chronic obstructive pulmonary disease (COPD) present high prevalence of physical inactivity that leads to a negative effect on health-related quality of life (HRQoL). The present study investigated COPD phenotypes according to their levels of physical activity and sedentary behaviour, as well as body composition and skeletal muscle strength. METHODS: This is an observational and cross-sectional study. Anthropometric data and COPD clinical control were collected and all participants underwent assessments of lung function, HRQoL, dyspnoea, levels of physical activity and sedentary behaviour, body composition and skeletal muscle strength. Participants were classified using hierarchical cluster analysis. Age, dyspnoea and obstruction (ADO) index was used to determine prognosis and calculated for each cluster. RESULTS: One hundred and fifty-two participants were included. Three distinct phenotypes were identified. Participants in phenotype 1 were more physically active, less sedentary and had better body composition and lower ADO index (p < 0.0001 for all variables). Overall, participants in phenotypes 2 and 3 were less physically active, more sedentary having a higher ADO index. However, participants in phenotype 2 were older, whereas participants in phenotype 3 had worse HRQoL, clinical control and body composition. Lung function did not differ across the three phenotypes. CONCLUSIONS: Our results show that physical activity, sedentary behaviour and body composition should be considered to determine phenotypes in people with COPD and are involved in the prognosis of the disease. Less sedentary patients have better prognosis while age, body composition and clinical control seems to differentiate physically inactive patients.

Individual and food environmental factors: association with diet.

OBJECTIVE: To examine the associations of individual and food environmental factors with fruit and vegetable (F&V) intake in a city in a low-to-middle-income country (LMIC). DESIGN: Cross-sectional. SETTING: Representative sample of the Brazilian Primary Care service known as the Health Academy Program (HAP) in Belo Horizonte, a Brazilian city. SUBJECTS: Using a conceptual model as a guide, individual and food environment data were obtained through: (i) face-to-face interviews with participants aged 20 years or older; and (ii) F&V food store audits. A broad set of individual, household, and community and consumer nutrition environment variables was investigated. Multilevel linear regression was used to quantify area-level variations in F&V intake and to estimate associations with the factors. RESULTS: Eighteen HAP centres were selected and 2944 participants and 336 food stores were included. F&V intake varied between contexts, being higher in areas with better socio-economic conditions and food store quality, such as specialised F&V markets. Individual-level factors, including age, income, food insecurity, stage of change, self-efficacy and decisional balance, were significantly associated with F&V intake. After controlling for individual-level characteristics, greater F&V intake was also associated with higher quality of food stores. CONCLUSIONS: In one of the first studies to comprehensively assess the food environment in an LMIC, individual-level factors accounted for the largest variation in F&V intake; however, the food environment was also important, because area-level variables explained 10·5 % of the F&V intake variation. The consumer nutrition environment was more predictive of healthy eating than was the community nutrition environment. The findings suggest new possibilities for interventions.

Fruit and vegetable intake: Influence of perceived food environment and self-efficacy.

OBJECTIVE: Identify the effects of food environment and self-efficacy perceptions on fruit and vegetable (FV) consumption. METHODS: A cross-sectional study with a representative sample population from a public health service in a Brazilian city. Participants (3414) aged ≥20 years were recruited from 18 Health Academy Program centres via stratified cluster sampling. Perceptions of the food environment were measured by survey; participants indicated how confident they were about FV availability in their food environment. Statements about self-efficacy assessed three domains regarding perceived affordability, time, and cooking skills. In order to assess the combined effects of both perceptions of food environment and self-efficacy on FV consumption, a combined variable was created. RESULTS: Both perceptions of food environment and self-efficacy in addition to FV consumption were higher in older participants and those with higher incomes and educational levels. Analyses of the combined variables showed that the highest FV intake was found among individuals with better food environment perceptions and greater self-efficacy. After adjustments, the association of food environment perceptions with FV consumption was marginally significant (p = 0.062), while self-efficacy was more strongly associated (p < 0.001); a one standard deviation higher confidence score was associated with a 35.10 g higher FV intake. CONCLUSIONS: Among participants of low socioeconomic position, individuals' self-efficacy for promoting FV intake were more important to greater consumption than perceptions of food environments. In addition to public policies for tackling socioeconomic inequalities in restricted environments, it is possible that building capabilities among vulnerable individuals are fruitful pathways for enabling them to partially overcome the challenges of poor food environments.