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

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

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

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

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

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

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

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

Food consumption of Brumadinho Health Project participants.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Food consumption differences in Brazilian urban and rural areas: the National Health Survey. / Diferenças no consumo alimentar nas áreas urbanas e rurais do Brasil: Pesquisa Nacional de Saúde.

This paper aimed to identify food consumption differences as per healthy and unhealthy diet markers among adults living in Brazilian urban and rural areas. A cross-sectional study was performed with data from the National Health Survey (2013). Diet was assessed by using healthy and unhealthy diet markers. Prevalence (%) was estimated, and sequential logistic regression models were adjusted to estimate odds ratios (OR) and confidence intervals (95%CI). Urban areas evidenced a higher consumption of fruits and vegetables, fish, soft drinks, and meal replacement by snacks, while rural areas showed higher consumption of meat with excess fat and beans. Adjusted analyses showed higher regular consumption of beans and meat with excess fat; and lower consumption of soft drinks, fruits and vegetables and meal replacement by snacks in rural areas compared to urban areas. Similar trends were observed in the macro-regions of the country. Food consumption differences among Brazilians living in rural and urban areas denote the importance of fostering food policies that respect and value food traditions and culture.

Objetivou-se identificar diferenças no consumo alimentar, segundo marcadores de alimentação saudável e não saudável, entre adultos residentes nas áreas urbanas e rurais do Brasil. Realizou-se estudo transversal com dados da Pesquisa Nacional de Saúde (2013). A alimentação foi avaliada por marcadores de alimentação saudável e não saudável. Estimou-se as prevalências (%) e modelos de regressão logística sequencial foram ajustados para estimar odds ratio (OR) e intervalos de confiança (IC95%). Verificou-se maior consumo de frutas e hortaliças, peixes, refrigerantes e substituições de refeições nas áreas urbanas, enquanto que, o consumo de carne com gorduras e feijão foi maior nas áreas rurais. Análises ajustadas mostraram maior consumo regular de feijão e de carne com excesso de gordura; e menor consumo de refrigerantes, de frutas e hortaliças e de substituição de refeições por lanches nas áreas rurais em comparação com as urbanas. Tendências semelhantes foram observadas nas macrorregiões do país. As diferenças no consumo alimentar de brasileiros residentes em áreas rurais e urbanas denotam a importância de fomentar políticas de alimentação que respeitem e valorizem as tradições e a cultura alimentar.

Health and work in Brazil: physical and psychosocial demands.

This study aims to describe the prevalence and factors associated of physical and psychosocial demands among Brazilian workers. Data were obtained from the 2013 Brazilian National Health Survey. Physical demand was defined as jobs that require intense physical effort or excessive walking, whereas psychosocial demand was defined as involvement in stressful activities. Multivariate logistic regression was used to estimate the association between demands and health conditions, occupational characteristics, and work conditions. Out of 39,590 participants, 54.4% reported physical demands and 35.5% psychosocial demands at work. After adjustment for sociodemographic characteristics, health conditions, occupational characteristics, and work conditions remained significantly associated with physical or psychosocial workload. The results suggest that in Brazil the work has a high level of physical and psychosocial demands, which are associated with occupational features and health conditions. It is necessary to incorporate work activities as significant factors to investigate the causes of diseases. And the interventions and policies aimed at preventing the negative occupational exposures are urgent, and can contribute to improve physical and psychosocial health at the workplace.

Spatial inequalities of retail food stores may determine availability of healthful food choices in a Brazilian metropolis.

OBJECTIVE: To examine the association between economic residential segregation and food environment. DESIGN: Ecological: Food stores categorised according to the NOVA classification were geocoded, and absolute availability was calculated for each neighbourhood. Segregation was measured using local Gi* statistic, a measure of the sd between the economic composition of a neighbourhood (the proportion of heads of households in neighbourhoods earn monthly income of 0 to 3 minimum wages) and larger metropolitan area, weighted by the economic composition of surrounding neighbourhoods. Segregation was categorised as high (most segregated), medium (integrated) and low (less segregated or integrated). A proportional odds models were used to model the association between segregation and food environment. SETTING: Belo Horizonte, Brazil. PARTICIPANTS: Food stores. RESULTS: After adjustment for covariates, neighbourhoods characterised by high economic segregation had fewer food stores overall compared with neighbourhoods characterised by low segregation (OR = 0·56; 95 % CI (0·45, 0·69)). In addition, high segregated neighbourhoods were 49 % (OR = 0·51; 95 % CI (0·42, 0·61)) and 45 % (OR = 0·55; 95 % CI (0·45, 0·67)) less likely to have a high number of food stores that predominantly marketed ultra-processed foods and mixed food stores, respectively, as compared with their counterparts. CONCLUSIONS: Economic segregation is associated with differences in the distribution of food stores. Both low and high segregation territories should be prioritised by public policies to ensure healthy and adequate nutrition as a right for all communities. The former must continue to be protected from access to unhealthy commercial food outlets, while the latter must be the locus of actions that limit the availability of unhealthy commercial food store.

Participação em programas públicos para prática de atividade física e comportamentos de saúde / Participation in public physical activity programs and health behaviors

O objetivo deste estudo foi avaliar as prevalências de comportamentos de saúdede brasileiros se-gundo a participação em programas públicos de estímulo à prática de atividade física.Para isso, foram utilizados dadosda Pesquisa Nacional da Saúde 2013, que entrevistou 60.202 adultos e idosos e investigou comportamentos de saúde protetores (consumo de feijão, peixe, carne sem excesso de gordura, frutas e hortaliças; e prática de atividade física) e de risco (consumo de refrigerante, doces e álcool; substituição de refeições; tabagismo e assistir televisão). Foram calculadas as prevalências e intervalos de confiança (95%). Cerca de 10% dos entrevistados participavam destesprogramas e pos-suíam comportamentos mais saudáveis (maiores prevalências de prática de atividade física e consumo de peixe; e menor ingestão de doces e tabagismo), quando comparados aos demais, com diferenças entre as macrorregiões do país. Desta forma, a expansão destes programas e a diversificação de suas atividades podem constituir importante estratégia de promoção da saúde no país

This study aimsto evaluate the prevalence of health behaviors of Brazilians according to their participation in public programs to encourage the practice of physical activity. For this, data ofNational Health Survey 2013 was used, who interviewed 60,202 adults and elderly and investigated protective health behaviors (consumption of beans, fish, meat without excess fat, fruits and vegetables; and physical activity) and risk (consumption of soda, sweets and alcohol; meal replacement; smoking and watching television). About 10% of Brazilians participated in these Programs and had healthier behaviors (higher prevalence of physical activity and fish consumption; and lower intake of sweets and smoking), when compared to the others, with differences between the country's macro-regions. This way, the expansion of these Programs and diversifica-tion of their activities can be an important health promotion strategy in the country

Health and work in Brazil: physical and psychosocial demands / Saúde e trabalho no Brasil: demandas físicas e psicossociais / Salud y trabajo en Brasil: exigencias físicas y psicosociales

This study aims to describe the prevalence and factors associated of physical and psychosocial demands among Brazilian workers. Data were obtained from the 2013 Brazilian National Health Survey. Physical demand was defined as jobs that require intense physical effort or excessive walking, whereas psychosocial demand was defined as involvement in stressful activities. Multivariate logistic regression was used to estimate the association between demands and health conditions, occupational characteristics, and work conditions. Out of 39,590 participants, 54.4% reported physical demands and 35.5% psychosocial demands at work. After adjustment for sociodemographic characteristics, health conditions, occupational characteristics, and work conditions remained significantly associated with physical or psychosocial workload. The results suggest that in Brazil the work has a high level of physical and psychosocial demands, which are associated with occupational features and health conditions. It is necessary to incorporate work activities as significant factors to investigate the causes of diseases. And the interventions and policies aimed at preventing the negative occupational exposures are urgent, and can contribute to improve physical and psychosocial health at the workplace.

O objetivo do estudo foi descrever a prevalência de demandas físicas e psicossociais e fatores associados entre trabalhadores brasileiros. Os dados foram obtidos da Pesquisa Nacional de Saúde de 2013. A demanda física foi definida como trabalhos que exigem esforço físico intenso ou caminhadas excessivas. A demanda psicossocial foi definida como envolvimento em atividades que levam ao nervosismo. A regressão logística multivariada foi utilizada para estimar a associação entre demandas e condições de saúde, características ocupacionais e condições de trabalho. Dos 39.590 participantes, 54,4% relataram demandas físicas e 35,5% demandas psicossociais no trabalho. Depois de ajustar para características sociodemográficas, as condições de saúde, características ocupacionais e condições de trabalho permaneceram associadas significativamente com a carga de trabalho física ou psicossocial. Os resultados sugerem que o trabalho no Brasil apresenta níveis elevados de demandas físicas e psicossociais. Essa demanda está associada a características ocupacionais e condições de saúde. É necessário incorporar as atividades laborais enquanto fatores importantes na investigação das causas de doenças. Além disso, são urgentes as intervenções e políticas de prevenção das exposições ocupacionais negativas, podendo contribuir para melhorar a saúde física e psicossocial no local de trabalho.

El objetivo de este estudio fue describir la prevalencia y factores asociados a las exigencias físicas y psicosociales entre trabajadores brasileños. Los datos se obtuvieron de la Encuesta Nacional de Salud de 2013 en Brasil. La exigencia física fue definida como trabajos que requieren un esfuerzo físico intenso o caminar excesivamente. La exigencia psicosocial fue definida como la implicación en actividades que conducen al nerviosismo. Se utilizó una regresión logística multivariada para estimar la asociación entre exigencias y condiciones de salud, características ocupacionales y condiciones laborales. De los 39.590 participantes, un 54,4% informó de exigencias físicas y un 35,5% de psicosociales en el trabajo. Tras el ajuste por características sociodemográficas, las condiciones de salud, características y condiciones laborales continuaron significativamente asociadas a la carga de trabajo física o psicosocial. Los resultados sugieren que en Brasil el trabajo posse una alta exigencia física y psicosocial. Asimismo, esta exigencia está asociada con características laborales y condiciones de salud. Es necesario incorporar las actividades laborales como factores importantes para investigar las causas de enfermedades. Asimismo, son urgentes las intervenciones y políticas con el objetivo de prevenir exposiciones laborales negativas, y pueden contribuir a mejorar la salud física y psicosocial en el lugar de trabajo.

Adherence to healthy lifestyles in the Programa Academia da Saúde / Adesão a estilos de vida saudáveis no Programa Academia da Saúde

This study aims to measure healthy lifestyles according to the time of participation in the Programa Academia da Saúde (PAS). We used baseline data from a randomized controlled community trial with a representative sample of PAS users from Belo Horizonte, Brazil (n = 3,414). The data on healthy lifestyles collected were: daily fruit and vegetables intake (≥5 servings); physical activity engagement (≥180min/week); body mass index (18.5kg/m² ≥ BMI ≤ 24.9kg/m²), smoking and drinking habits.The time of participation in the PAS was calculated by the difference between the date of registration in the program and the date of the data collection. Logistic regression models were used to evaluate associations between healthy lifestyles and time of participation in the PAS. Almost half of the participants (43.3%) had three healthy lifestyle factors. The prevalence of having all five factors varied according to the time of participation in the service; the lowest rates were in the first quartile (4.9%) and the highest rates in the fourth quartile (8.1%). Those who have attended the service for the longest time (fourth quartile) were more likely to have a healthy BMI (OR = 1.43; 95%CI: 1.14-1.80; p = 0.002) and to avoid smoking (OR = 1.62; 95%CI: 1.06-4.49; p = 0.01), compared to those who have attended the program for less time (first quartile). The prevalence of healthy lifestyles in PAS users was low. However, a longer permanence in the program seems to favor positive changes on BMI and on smoking habits

Este estudo avaliou estilos de vida saudáveis segundo o tempo de participação no Programa Academia da Saúde (PAS). Para tanto, foram utilizados dados da linha de base de um ensaio comunitário controlado e aleatorizado com amostra representativa (n = 3.414) do PAS de Belo Horizonte, Brasil. Os dados sobre estilos de vida coletados foram: consumo diário de frutas e hortaliças (≥ 5 porções); prática de atividade física (≥180min/semana); índice de massa corporal (18,5kg/m² ≥ IMC ≤ 24,9kg/m²), não fumar e não ingerir bebidas alcoólicas. O tempo de participação no PAS foi calculado pela diferença entre data de ingresso no serviço e da coleta de dados. Modelos de regressão logística foram ajustados para avaliar as associações entre estilo de vida e tempo de participação no PAS. Quase a metade dos participantes (43,3%) apresentou adesão a três fatores de estilo de vida saudável. As prevalências de todos os cinco fatores variaram segundo o tempo de participação no Programa; as menores prevalências foram no primeiro quartil (4,9%) e maiores do quarto quartil (8,1%) de tempo. Aqueles que participavam do PAS a mais tempo apresentaram maiores probabilidades de ter um IMC saudável (OR = 1,43; IC95%: 1,14-1,80; p = 0,002) e de não fumar (OR = 1,62; IC95%: 1,06-4,49; p = 0,01), comparados aos que participavam do Programa a menos tempo (primeiro quartil). A adesão aos estilos de vida saudáveis entre os usuários do PAS foi baixa. No entanto, maior tempo de participação no serviço pode favorecer mudanças positivas no IMC e no hábito de fumar