Deserts, Swamps and Food Oases: Mapping around the Schools in Bahia, Brazil and Implications for Ensuring Food and Nutritional Security.

Deserts, swamps and food oases terms have been used to characterize the food environment according to the identified food availability. Food swamps are defined as neighborhoods with a predominance of food establishments selling ultra-processed foods compared to establishments selling healthy options. In contrast, food oases are areas with easy access to healthy and nutritious foods, such as fruits, vegetables, and other fresh foods. Food deserts describe densely populated urban areas where residents face difficulty obtaining healthy food. In this context, this work aimed to map deserts, swamps, and food oases around federal schools in Bahia, Brazil, emphasizing the importance of implementing the Brazilian National School Feeding Program (PNAE) in these schools, to guarantee food security and nutrition. An ecological study was carried out in all 35 federal schools in Bahia, Brazil, using an 800 m buffer analysis, with the school as the centroid. The geographic coordinates of schools and food establishments were initially obtained using Google Maps and later confirmed onsite. To evaluate food deserts and swamps, the methodology proposed by the CDC was used and the Modified Retail Food Environment Index (mRFEI) was calculated; when the result was equal to zero, the surrounding area was considered a food desert and values between 0.01 and 20 determined food swamps; for values above 20, the neighborhood was classified as mixed. Food oases were considered regions containing at least one supermarket within the analyzed buffer. Descriptive analyses were carried out with frequency measurements, measures of central tendency (mean and median) and dispersion (standard deviation). The food environment of schools was compared considering the number of students impacted, the area where the school was located (urban or rural) and the size of the municipalities. The average number of food establishments found was 22.39 (±13.03), with the highest averages for snack bars (7.33 ± 4.43), grocery stores (5.83 ± 4.09) and restaurants (2.94 ± 2.19). Food deserts and mixed environments were identified in 40% of the sample, while swamps represented 20% and oases 65%. An association was observed between food deserts and social vulnerability, making it necessary to emphasize the importance of adequate implementation of the PNAE in these schools to reduce food and nutritional insecurity, guaranteeing the human right to adequate and healthy food and providing better nutrition and health perspectives within the school environment and impact on students' lives through food and nutrition education actions, which are also part of the context of PNAE activities.

Challenges for obesity prevention: study of the consumers' food environment around public schools in a small municipality / Desafios para a prevenção da obesidade: estudo do ambiente alimentar do consumidor no entorno de escolas públicas de um município de pequeno porte

ABSTRACT Objective Evaluate the consumer's food environment in food retailers around public schools in the municipality of Governador Celso Ramos, state of Santa Catarina, in southern Brazil. Methods A survey was carried out in the surroundings of three public schools, from March to May 2022. Food retailers located in a pre-established 800m buffer zone were identified. A location system device recorded latitude and longitude. An audit of the establishments was performed using a specific validated instrument for auditing the consumer food environment (AUDITNOVA). These establishments were grouped into: Group 1 - predominantly selling fresh foods, Group 2 - mixed establishments, and Group 3 - predominantly selling ultra-processed foods. These establishments were assessed using a Consumer Food Environment Healthiness Score evaluation system. The data were analyzed using the statistical software Stata version 16.0. Results The study audited 21 establishments, 47.6% of which were small neighborhood food markets, 23.8% bakeries, 14.3% butchers/fishmongers, 9.5% grocery stores and 4.8% supermarkets. It was found that privately-owned vegetable markets had a higher availability of fresh and minimally processed food categories, while the lowest scores for this category were found in bakeries. Regarding ultra-processed foods, the most commonly found items were sugary beverages and candies, chocolates, and filled cookies. Conclusion More audit studies ought to be carried out in the surroundings of schools to broaden the understanding of the relationship between access, availability, prices and food advertisement in order to support the construction of strategies aimed at preventing obesity in the population.

RESUMO Objetivo Avaliar o ambiente alimentar do consumidor em estabelecimentos de comercialização de alimentos no entorno de escolas públicas no município de Governador Celso Ramos, estado de Santa Catarina, no Sul do Brasil. Métodos Foi realizada, entre março e maio de 2022, no entorno de três escolas públicas, auditoria nos comércios varejistas localizados em uma zona pré-estabelecida de 800m. Um equipamento com sistema de localização realizou o registro da latitude e longitude. Esta auditoria foi realizada utilizando um instrumento validado próprio para auditoria do ambiente alimentar do consumidor (AUDITNOVA). Estes foram agrupados em Grupo 1 - com venda predominante de alimentos in natura; Grupo 2 - estabelecimentos mistos; Grupo 3 - com venda predominante de alimentos ultraprocessados. Os estabelecimentos foram avaliados por um sistema de avaliação de saudabilidade do ambiente alimentar do consumidor. Os dados foram analisados no programa estatístico Stata versão 16.0. Resultados O estudo auditou 21 estabelecimentos, sendo 47,6% mercados de bairro, 23,8% padarias, 14,3% açougues/peixarias, 9,5% sacolões/hortifrutis privados e 4,8% supermercados. Foi identificado que sacolões/hortifrutis privados apresentaram maior oferta de alimentos da categoria in natura e minimamente processados, enquanto os menores scores desta categoria de alimentos foram encontrados em padarias. Em relação aos alimentos ultraprocessados, os alimentos mais presentes foram bebidas açucaradas e balas, chocolates e biscoito recheado. Conclusão Sugere-se a realização de mais estudos de auditoria em comércios varejistas no entorno de escolas para ampliar a compreensão da relação entre o acesso, disponibilidade, preços e propagandas dos alimentos de modo a subsidiar a construção de estratégias que visem a prevenção da obesidade na população.

Avaliação da adesão às dietas sustentáveis, desertos alimentares e associações de saúde, aspectos socioeconômicos e espaciais em adultos e idosos do estudo Brazuca-Natal / Assessment of adherence to sustainable diets, food deserts and health associations, socioeconomic and spatial aspects in adults and elderly people from the Brazuca-Natal study

Introdução: Alcançar a segurança alimentar e nutricional e a melhoria da nutrição são metas estabelecidas pelos Objetivos de Desenvolvimento Sustentável (ODS) da ONU e para tanto é fundamental a compreensão das interações entre saúde coletiva, meio ambiente e os determinantes sociais no planejamento de ações eficazes no enfrentamento da Insegurança Alimentar e Nutricional (IAN) e na promoção de territórios saudáveis e sustentáveis. Na perspectiva de identificação da situação da alimentação nos territórios, destacam-se os ambientes alimentares que são influenciados por uma variedade de fatores (disponibilidade, acessibilidade, conveniência, promoção, qualidade dos alimentos e bebidas), incluindo a sustentabilidade dos ecossistemas nos quais estão inseridos. Nesse contexto, este estudo pode fornecer informações valiosas ao identificar e descrever áreas críticas de desigualdades espaciais acerca da adesão às dietas sustentáveis, as quais podem corroborar para o desenvolvimento de políticas públicas focalizadas nas áreas mais vulneráveis do município de Natal. Objetivo: Avaliar a adesão às dietas sustentáveis, desertos alimentares e associações de saúde, aspectos socioeconômicos e espaciais em adultos e idosos do estudo BRAZUCA-Natal. Métodos: Trata-se de um estudo que aborda métodos mistos: 1) Revisão de escopo que buscou compreender as características dos índices de adesão às dietas sustentáveis que foram desenvolvidos com base no relatório da Comissão EAT-Lancet e verificar as principais lacunas de conhecimento destas ferramentas. Essa revisão foi realizada a partir de uma busca sistemática na literatura nas bases de dados PubMed, Embase, Scopus, Web of Science, e Science Direct de 01 de junho a 01 de agosto janeiro de 2022. 2) Estudo transversal que se decompõe, a partir das variáveis independentes, em três artigos científicos que avaliaram 399 adultos e idosos, por meio de entrevistas domiciliares contendo questões sociodemográficas, de estilo de vida, dados clínicos, antropométricos e dietéticos orientado pelo software Globodiet® por meio do Recordatório alimentar de 24h (R24h). A adesão às dietas sustentáveis foi mensurada pelo Planet Health Diet Index (PHDI). No primeiro artigo, avaliamos a adesão às recomendações do EAT-Lancet para dietas saudáveis e sustentáveis em adultos e idosos do estudo Brazuca-Natal. O segundo artigo, buscou avaliar a associação entre a adesão à dieta EAT-Lancet com fatores de risco cardiometabólicos (glicose, triglicerídeos, colesterol total, HDL-c, LDL-c, mensuração da pressão arterial sistólica e diastólica, utilizamos a regressão linear múltipla para avaliar a relação entre o PHDI e variáveis independentes. O terceiro, buscou associar a adesão à dieta sustentável com variáveis individuais e de contexto com foco nos desertos alimentares, IAN e infraestrutura urbana. Essa pesquisa se baseou nos setores censitários da cidade de Natal-RN, a partir da identificação dos estabelecimentos de aquisição de alimentos, agrupados nas categorias de in natura ou minimamente processados, ultraprocessados ou mistos. Os desertos alimentares foram calculados pela densidade de estabelecimentos saudáveis ponderados pela renda dividido por 10 mil habitantes e classificados menor ou igual ao percentil 25. Utilizamos dados socioeconômicos do Censo 2010. Regressão múltipla com seleção Backward foi utilizada para observar a relação entre a adesão às dietas sustentáveis com as variáveis independentes. Resultados: Na revisão de escopo foram recuperados um total de 1.458 artigos, 14 dos quais foram incluídos na revisão. Identificamos sete índices que mensuram dietas sustentáveis, como se segue: EAT-Lancet diet score (ELD-I), New EAT-Lancet diet score (EAT), Planetary Health Diet Index (PHDI), Sustainable Diet Index (SDI), Sustainable-HEalthy-Diet (SHED), novel Nutrient-Based EAT index (NB-EAT) e World Index for Sustainability and Health (WISH). No artigo 2 (transversal), verificamos que o escore total médio de adesão ao PHDI foi de 29,4 pontos (IC 95% 28,04-30,81), em um escore que pode variar de 0 a 150 pontos. As maiores pontuações foram para frutas, leguminosas e vegetais e as menores para gordura animal e carne vermelha. Esse estudo mostrou que a adesão à dieta sustentável está diretamente relacionada a ser do sexo masculino e não consumir álcool e inversamente relacionada a ter 1 a 9 anos de estudos (comparado a quem tem ensino superior) e estar em insegurança alimentar. No artigo 3 (transversal), o PHDI apresentou associação significativa (p <0,05) com a presença de diabetes e dislipidemia, com a pressão arterial sistólica, colesterol total e LDL-c alterados, assim como com um índice que avalia saúde cardiovascular aos seus componentes (de forma positiva com frutas, vegetais e leguminosas e de forma negativa com os alimentos ultraprocessados). No artigo 4 (ecológico transversal) encontramos uma maior adesão à dieta sustentável na região Sul de Natal-RN, em indivíduos com maior renda per capita, em segurança alimentar, moradores de áreas com melhor infraestrutura e que não são desertos alimentares. Identificamos que a ocorrência de desertos alimentares coincide com as áreas em que há uma menor adesão à dieta sustentável, que são as regiões Norte e Oeste da cidade. A adesão à dieta sustentável reduz quando associada à infraestrutura urbana desfavorável e a IAN. Conclusões: Concluímos na revisão de escopo que há a utilização de diferentes métricas que avaliam a adesão às dietas sustentáveis, dificultando a comparação entre os índices e a tendência a negligenciar aspectos sociais. No artigo 2, que a adesão às dietas sustentáveis está distante das recomendações do EAT-Lancet e que essa adesão foi menor em mulheres, com baixa escolaridade, nas classes sociais menos favorecidas, com menor renda per capita e que se encontravam em IAN. No artigo 3, que associação com o padrão alimentar sustentável também sugeriu um menor risco cardiometabólico. E no artigo 4, verificamos no mapeamento de desertos alimentares que a distribuição dos estabelecimentos que comercializam alimentos sustentáveis sofre iniquidades territoriais na cidade de Natal-RN. Apesar de não estarem associados à adesão às dietas sustentáveis nesse estudo, os desertos alimentares ressaltam questões relacionadas às escolhas de alimentos sustentáveis que podem ir além da disponibilidade e acessibilidade. Contudo, são necessários novos estudos que explorem questões relacionadas aos hábitos e poder de compra dessas famílias (AU).

Introduction: Achieving food security and improving nutrition are goals set by the UN's Sustainable Development Goals (SDGs). To this end, it is essential to understand the interactions between public health, the environment and social determinants in order to plan effective actions to tackle Food and Nutrition Insecurity (FNI) and promote healthy and sustainable territories. From the perspective of identifying the food situation in the territories, food environments stand out, which are influenced by a variety of factors (availability, accessibility, convenience, promotion, quality of food and drink), including the sustainability of the ecosystems in which they are inserted. In this context, this study can provide valuable information by identifying and describing critical areas of spatial inequalities regarding adherence to sustainable diets, favoring the development of public policies focused on the most vulnerable areas. Objective: To evaluate adherence to sustainable diets, food deserts and health associations, socioeconomic and spatial aspects in adults and elderly people from the BRAZUCA-Natal study. Methods: This is a multi-method study. 1) A scoping review that sought to understand the characteristics of the sustainable diet adherence indices that were developed on the basis of the EATLancet Commission report and to verify the main knowledge gaps in these tools. This review was carried out through a systematic literature search in the PubMed, Embase, Scopus, Web of Science, and Science Direct databases from June 1 to August 1, 2022. 2) A cross-sectional study that was broken down, based on the independent variables, into two scientific articles that assessed 399 adults and elderly people, through home interviews containing sociodemographic, lifestyle, clinical, anthropometric and dietary questions, guided by the Globodiet® software using the 24-hour dietary recall (R24h). Adherence to sustainable diets was measured using the Planet Health Diet Index (PHDI). In the first article, we assessed adherence to the EAT-Lancet recommendations for healthy and sustainable diets in adults and the elderly in the Brazuca-Natal study. The second article sought to assess the association between adherence to the EAT-Lancet diet and cardiometabolic risk factors (glucose, triglycerides, total cholesterol, HDL-c, LDL-c, measurement of systolic and diastolic blood pressure, we used multiple linear regression to assess the relationship between the PHDI and independent variables. 3) A transversal ecological study that sought to associate adherence to a sustainable diet with individual and contextual variables, focusing on food deserts, FNI and urban infrastructure. This research was based on the census sectors of the city of Natal-RN, based on the identification of food purchasing establishments, grouped into the categories of in-natura or minimally processed, ultra-processed or mixed. Food deserts were calculated by the density of healthy establishments weighted by income divided by 10,000 inhabitants and classified as less than or equal to the 25th percentile. We used socioeconomic data from the 2010 Census. Multiple regression with Backward selection was used to observe the relationship between total of 1,458 articles, 14 of which were included in the review. We identified seven indices that measure sustainable diets, as follows: EAT-Lancet diet score (ELD-I), New EAT-Lancet diet score (EAT), Planetary Health Diet Index (PHDI), Sustainable Diet Index (SDI), Sustainable-HEalthy-Diet (SHED), novel Nutrient-Based EAT index (NB-EAT) and World Index for Sustainability and Health (WISH). In article 2 (cross-sectional), we found that the average total score for adherence to the PHDI was 29.4 points (95% CI 28.04-30.81), out of a score that can vary from 0 to 150 points. The highest scores were for fruit, pulses and vegetables and the lowest for animal fat and red meat. This study showed that adherence to a sustainable diet is directly related to being male and not consuming alcohol, and inversely related to having 1 to 9 years of schooling and being food insecure. In article 3 (cross-sectional), the PHDI showed a significant association (p <0.05) with the presence of diabetes and dyslipidemia, with systolic blood pressure, total cholesterol and LDL-c, as well as with an index that assesses cardiovascular health and its components (positively with fruits, vegetables and legumes and negatively with ultra-processed foods). In article 4 (transversal ecological) we found greater adherence to the sustainable diet in the southern region of Natal-RN, in individuals with higher per capita income, food security, living in areas with better infrastructure and which are not food deserts. We found that the occurrence of food deserts coincides with the areas where there is less adherence to the sustainable diet, which are the North and West regions of the city. Adherence to a sustainable diet decreases when associated with unfavorable urban infrastructure and FNI. Conclusions: The scoping review observed the use of different metrics that assess adherence to sustainable diets, making it difficult to compare the indices and the tendency to neglect social aspects. In article 2, we concluded that adherence to sustainable diets is far from the EAT-Lancet recommendations and that this adherence was lower in women, with low education, in less favored social classes, with lower per capita income and who were in the IAN. In article 3, the association with a sustainable dietary pattern also suggested a lower cardiometabolic risk. And in article 4, we verified in the mapping of food deserts that the distribution of establishments that sell healthy and sustainable food suffers territorial inequities in the city of Natal-RN, concentrated in the South and East regions. Despite not being associated with adherence to sustainable diets in this study, food deserts highlight issues related to sustainable food choices that may go beyond availability and accessibility. However, new studies are needed that explore issues related to the habits and purchasing power of these families (AU).

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.

Presença de desertos alimentares em um distrito sanitário de uma capital brasileira: um estudo descritivo e exploratório sobre a distribuição espacial de estabelecimentos comerciais de alimentos / Food deserts in a health district of a Brazilian capital: a descriptive and exploratory study on the spatial distribution of commercial food establishments

Introdução: O ambiente alimentar que a comunidade está inserida pode influenciar, positiva ou negativamente no acesso à alimentação de qualidade e consequentemente na sua saúde. Objetivo: Identificar a presença de desertos alimentares em um distrito sanitário de uma capital brasileira. Métodos: Estudo descritivo, transversal e exploratório, utilizando dados secundários de diferentes fontes institucionais para mapear a distribuição espacial de estabelecimentos de comercialização de alimentos: restaurantes, padarias, supermercados, minimercados/mercearias, hortifrutigranjeiros, vendedores ambulantes e lanchonetes/fastfood. Os estabelecimentos foram agrupados nas categorias in natura, ultraprocessados e mistos, de acordo com a predominância do tipo de alimentos comercializados. Para a análise, a densidade de estabelecimentos in natura juntamente com os mistos por mil habitantes (usuários cadastrados nos centros de saúde) foram calculadas.  Resultados: Foram investigados 111 estabelecimentos, sendo 20% que comercializavam alimentos in natura (saudáveis), 27% alimentos ultraprocessados (não saudáveis) e 53% considerados mistos. Conclusões: Foram observadas áreas que podem ser consideradas desertos alimentares, locais onde há pouca (ou ausência) de oferta de alimentos in natura, e por consequência dificultando o acesso a alimentos saudáveis.

Introduction: The communities' food environment can positively or negatively influence access to quality food and consequently, people's health. Objective: Identify the presence of food deserts in a health district of a Brazilian capital. Methods: Descriptive, cross-sectional and exploratory study, using secondary data from different institutional sources to map the spatial distribution of food establishments such as restaurants, bakeries, supermarkets, minimarkets/grocery stores, fruit and vegetable stores, street vendors and cafeterias/fast food. The establishments were grouped into fresh, ultra-processed and mixed food categories, according to the predominance of the type of food offered. For the purpose of analysis, the density of fresh food establishments together with mixed food establishments per thousand inhabitants (as registered in the health centers) was calculated.  Results: A total of 111 establishments were investigated, 20% selling fresh foods (healthy), 27% ultra-processed foods (unhealthy) and 53% considered mixed food sellers. Conclusions: Areas that can be considered food deserts were found, i.e. places where there is little (or absence) of fresh food supply, and consequently making access to healthy foods difficult.

Changes in Food Environment Patterns in the Metropolitan Area of the Valley of Mexico, 2010-2020.

The concept of food environment refers to the opportunities; environments; and physical, economic, political, and socio-cultural conditions that frame the interaction of people with the food system and shape decisions about food acquisition and consumption. This study analyzes the relationships between the characteristics of urban environments and the availability of retail food through the evaluation of physical and financial access to food in the Metropolitan Area of the Valley of Mexico (MAVM) between 2010 and 2020. Using Geographic Information Systems (GISs), both physical access through network distance to economic food retail units and financial access through socioeconomic status at the block scale were evaluated. The network distance and socioeconomic status results were used as criteria for the spatially explicit classification of the MAVM into food deserts, oases, and swamps. Food deserts are the most abundant food environments but only increased in the third and fourth metropolitan contours. Swamps have increased throughout the city, related to the proliferation of convenience stores that have replaced grocery stores. This study contributes evidence at a local and regional scale required for the future urban planning of the MAVM and for public health and sustainability programs focusing on treating food-related diseases.

Factors Associated with Home Meal Preparation and Fast-Food Sources Use among Low-Income Urban African American Adults.

This study aimed to assess the factors associated with home meal preparation (HMP) and fast-food sources use (FFS) frequencies of low-income African-American adults and their healthy food beliefs and attitudes, food-related psychosocial factors, food acquisition patterns, food sources use, and BMI. We used cross-sectional data from 295 adults living in Baltimore, USA. HMP was inversely associated with FFS, which had lower odds of HMP ≥1 time/day and higher BMI scores. HMP was positively associated with positive beliefs and self-efficacy toward healthy foods, getting food from healthier food sources, and lower FFS. Higher odds of HMP ≥1 time/day were associated with getting food from farmers' market and supermarkets or grocery stores. FFS had an inverse association with positive beliefs and self-efficacy toward healthy foods, and a positive association with less healthy food acquisition scores. Higher odds of FFS ≥1 time/week were associated with getting food from corner stores, sit-down restaurants, and convenience stores.