Regulatory measures on the sale of food at schools can influence consumption by students. The aims of the present cross-sectional study were to determine whether attending schools with norms that regulate the sale of food is associated with the consumption of ultra-processed foods by students in Brazilian state capitals and investigate the association between the availability and consumption of ultra-processed foods in school cafeterias. A systematic survey was performed of Brazilian norms in force up to 2019 that regulate the sale of food and beverages in school cafeterias. In terms of regulatory coverage, schools were categorized as covered/not covered. The availability and consumption of ultra-processed foods were assessed using data from the 2019 Brazilian National Survey of School Health. Multilevel linear regression analyses were adjusted by sociodemographic variables and school characteristics to test the association between regulatory coverage and the consumption of ultra-processed foods by students (n = 81,362). A second analysis restricted to students at schools with cafeterias (n = 53,137) investigated the association between the availability and consumption of these foods. Attending schools with regulatory coverage on the sale of food and beverages was associated with a reduction of -0.10 points (95%CI: -0.16; -0.03) in the consumption score of ultra-processed foods by students in Brazilian capital cities, whereas the availability of ultra-processed foods in school cafeterias was associated with an increase of 0.02 points (95%CI: 0.00; 0.03) in the consumption score in the adjusted analyses. These findings can assist in the establishment of a national Law on the offer of ultra-processed foods at schools.

Medidas regulatórias sobre a venda de alimentos nas escolas podem influenciar o consumo alimentar dos estudantes. Este estudo transversal teve como objetivos: investigar se frequentar escolas cobertas por normas que regulamentam a venda de alimentos está associado ao consumo de ultraprocessados por estudantes de capitais brasileiras; e verificar se há associação entre a disponibilidade de ultraprocessados em cantinas escolares e seu consumo. Foi realizado um levantamento sistemático de normas brasileiras vigentes até 2019 que regulamentam a venda de alimentos e bebidas em cantinas escolares. A cobertura normativa das escolas foi avaliada por uma variável dicotômica (cobertas/não cobertas). A disponibilidade e o consumo de ultraprocessados foram avaliados por meio de escores com dados da Pesquisa Nacional de Saúde do Escolar de 2019. Foram realizadas análises de regressão linear multinível, ajustadas por variáveis sociodemográficas e características das escolas, para avaliar associação entre a cobertura normativa das escolas e o consumo de ultraprocessados pelos estudantes (n = 81.362). Uma segunda análise, restrita a alunos de escolas com cantinas (n = 53.137), avaliou a associação entre a disponibilidade desses alimentos e seu consumo. Frequentar escolas com cobertura normativa sobre a venda de alimentos e bebidas esteve associado a uma redução de -0,10 (IC95%: -0,16; -0,03) pontos no escore de consumo de ultraprocessados por estudantes de capitais brasileiras, enquanto a disponibilidade de ultraprocessados nas cantinas escolares foi associada ao aumento de 0,02 (IC95%: 0,00; 0,03) pontos no escore de consumo, nas análises ajustadas. Os achados podem fundamentar uma lei nacional sobre a oferta de ultraprocessados nas escolas.

BACKGROUND:The consumption of ultra-processed foods (UPF) has been associated with diseases in which inflammation plays a key role. The Dietary Inflammatory Index (DII) was developed as a tool to estimate the inflammatory potential of the diet; however, the association between UPF consumption and higher DII scores remains insufficiently explored. OBJECTIVE:To investigate the association between UPF consumption and the DII. DESIGN:This was a cross-sectional study. PARTICIPANTS:/Setting: Data from 36,669 adults enrolled in the NutriNet-Brasil cohort between 2020 and 2025 were analyzed. MAIN OUTCOME MEASURES:The outcome was the DII, calculated as proposed in previous studies, based on dietary components such as macronutrients, vitamins, minerals, and bioactive compounds STATISTICAL ANALYSES: UPF contribution to energy intake was estimated using the mean of 2-3 24-hour recalls (Nova24h). Associations between UPF consumption (percentage of energy, in quintiles and as a continuous variable) and the DII were analyzed using multiple linear regression models. RESULTS:The mean DII was 1.31 (95% CI: 1.28-1.33) and mean UPF contribution was 22.7%, ranging from an average of 7.50% (Q1) to 41.14% (Q5). In adjusted models, the DII increased linearly across quintiles of UPF intake (p for linear trend < 0.001). The estimated DII score in the highest quintile (Q5: 2.57) was eleven times higher than in the lowest quintile (Q1: 0.22), demonstrating a strong positive association between UPF consumption and the pro-inflammatory potential of the diet. As a continuous variable, each 10% increase in UPF energy was associated with a 0.70-point higher DII (p <0.001). CONCLUSIONS:Higher UPF consumption was associated with a more pro-inflammatory dietary pattern. These findings highlight the potential role of UPF consumption in shaping the inflammatory potential of the diet and support further research on its implications for diet-related health outcomes.

Objective: To propose a new classification system for food acquisition locations based on the Dietary Guidelines for the Brazilian Population, called Locais-Nova. Methods: This system uses data on household food acquisition from the 2017-2018 Household Budget Survey. Foods were categorized, according to the Nova classification, into natural or minimally processed foods, culinary ingredients, processed foods, and ultra-processed foods. The average contribution of each Nova classification group to the total grams acquired in Brazil was estimated. This estimate was compared with the average contribution of each Nova classification group in each of the 16 evaluated acquisition locations. Locations were classified as "acquisition sources" for a specific Nova classification group whenever the contribution of that group in a given location was equal to or greater than the national average. Results: Locais-Nova identified three categories of acquisition locations: sources of natural or minimally processed foods and culinary ingredients, sources of processed foods, and sources of ultra-processed foods. Fruit and vegetable stores and butchers stood out as the main sources of fresh or minimally processed foods; minimarkets and grocery stores, as the main sources of ultra-processed foods; and bakeries and confectioneries, as sources of processed and ultra-processed foods. Supermarkets were classified as sources of fresh or minimally processed and ultra-processed foods. Conclusion: This study presented an innovative classification of food acquisition locations. This reflected the recommendations of the Food Guide for the Brazilian Population and made it possible to understand food acquisition patterns in different types of locations.

Unhealthy concentrations of food outlets near schools are a growing public health concern, as they may negatively influence the dietary habits and overall health of children and adolescents attending these institutions. This study investigates the spatial association between schools and food outlets selling ultra-processed foods (UPFs) in five Brazilian capital cities. Schools and ten types of UPF-selling outlets were georeferenced within neighborhoods across these cities. Density measures of schools and stores per 10,000 inhabitants were calculated for each neighborhood. Associations between school and food outlets densities were analyzed using negative binomial regression models for each city, as well as a multilevel negative binomial regression model for all cities combined. The results revealed that the densities of snack bars, bakeries, mini-markets, restaurants, and the total number of UPF-selling establishments were positively associated with school densities across all cities and collectively. This suggests that children and adolescents may be exposed to unhealthy food environments around their schools, emphasizing the need for targeted public health interventions.

The scope of this study was to verify differences in the characteristics of predominantly ultra-processed foods or culinary dishes on sale from the largest food delivery app in Brazil in neighborhoods with differing socioeconomic categories in the city of S & atilde;o Paulo. Twenty neighborhoods were selected, categorized according to quartiles of the Municipal Human Development Index. Data on food on sale, classified as culinary preparations or ultra-processed foods, were collected from the centroid of the neighborhoods. A sample of 350 promotions was analyzed, and their characteristics were compared according to the degree of processing categories and vulnerability of the neighborhood. A higher prevalence of promotions for ultra-processed foods was observed in three out of four socioeconomic categories. Places that offered culinary preparations were closer than places that offered ultra-processed foods. The average price and discount were higher for ultra-processed foods. Given the wide availability of ultra-processed foods, it seems necessary to promote the consumption of culinary preparations and highlight them in digital food environments in order to discourage the choice of ultra-processed foods.

Resumo O objetivo deste estudo foi verificar diferenças em características das promoções de alimentos predominantemente ultraprocessados ou predominantemente preparações culinárias no maior aplicativo de delivery de comidas do Brasil em bairros com distintas categorias socioeconômicas na cidade de São Paulo. Foram sorteados 20 bairros categorizados segundo quartos do Índice de Desenvolvimento Humano Municipal. Do centroide dos bairros, foram coletados dados de promoções de alimentos, classificadas como preparações culinárias ou alimentos ultraprocessados; 350 promoções compuseram a amostra e suas características foram comparadas segundo as categorias de grau de processamento e de vulnerabilidade do bairro. Observou-se maior prevalência de promoções de ultraprocessados em três de quatro categorias socioeconômicas. Locais que ofereciam preparações culinárias estavam mais próximos que os locais que ofereciam ultraprocessados. O preço e o desconto médios foram maiores para alimentos ultraprocessados. Diante da ampla oferta de alimentos ultraprocessados, parece necessário um maior incentivo ao consumo e destaque a preparações culinárias nos ambientes alimentares digitais, a fim desestimular a escolha por alimentos ultraprocessados.

OBJECTIVE:To propose a new classification system for food purchasing places (Locais-Nova) based on the Dietary Guidelines for the Brazilian Population. METHODS:We used 2017-2018 Brazilian Household Budgets Survey data on household food purchasing. Foods were categorized, according to the Nova classification, into unprocessed or minimally processed food, processed culinary ingredients, processed foods and ultra-processed foods. We estimated the average share of each Nova classification group in the total of grams acquired in Brazil. This estimate was compared with the average share of each Nova classification group in each of the 16 purchasing places assessed. Places were classified as "purchasing sources" for a specific Nova classification group whenever that group's share a given place was equal to or greater than the national average. RESULTS:Locais-Nova identified three categories of purchasing places: sources of unprocessed or minimally processed food and processed culinary ingredients, sources of processed foods and sources of ultra-processed foods. Fruits, vegetables, and farm products and butcher shops stood out as the main sources of unprocessed or minimally processed food; minimarkets and grocery stores were the main sources of ultra-processed foods; and bakeries and confectionaries, stood out as sources of processed and ultra-processed foods. Supermarkets were classified as sources of unprocessed or minimally processed food and ultra-processed foods. CONCLUSION:This study presented an innovative classification of food purchasing places. This reflected the recommendations of the Dietary Guidelines for the Brazilian Population and made it possible to understand food purchasing patterns in different types of purchasing places.

Introdução: Os locais de aquisição de alimentos são vetores centrais dos ambientes alimentares, influenciando a qualidade da dieta da população. No Brasil, estudos prévios focaram na participação calórica ou gramas de alimentos adquiridos, mas não na frequência e na diversidade de locais. Objetivo: Descrever as tendências temporais da prevalência e da diversidade dos locais de aquisição de alimentos frequentados pelos domicílios brasileiros entre 2002 e 2018 e a concomitância entre esses locais em 2002-2003 e 2017-2018. Métodos: Foram utilizados dados das Pesquisas de Orçamentos Familiares (POF) produzidos pelo Instituto Brasileiro de Geografia e Estatística de 2002-2003, 2008-2009 e 2017-2018. Os locais de compra foram agrupados em 10 categorias: supermercados; pequenos mercados/mercearias; feiras livres e quitandas; centros de abastecimento; padarias e confeitarias; pequenos produtores; açougues, granjas e peixarias; vendedores de rua/ambulantes; bares, cafeterias e restaurantes; e outros. Analisou-se a prevalência (percentual médio) e o número médio de locais (diversidade) frequentados em sete dias considerando o Brasil como todo, área, região e quintos de renda entre 2002 e 2018. Para a concomitância, foi considerado apenas o Brasil como todo em 2002-2003 e 2017-2018. Resultados: A prevalência de aquisição em supermercados aumentou de 54,8% (2002-2003) para 64,5% (2017-2018), enquanto feiras livres e quitandas reduziram de 36,6% para 20,9%, e padarias e confeitarias de 50,5% para 37,5%. A diversidade média de locais frequentados semanalmente diminuiu de 2,8 para 1,9. Esse padrão foi consistente entre áreas, regiões e quintos de renda. Na comparação entre 2002-2003 e 2017-2018, a concomitância indicou crescente concentração das compras em supermercados. Conclusão: Entre 2002 e 2018, consolidou-se no Brasil um ambiente de varejo alimentar mais concentrado em supermercados e menos diverso, com o declínio de estabelecimentos tradicionais. Essas mudanças estruturais exigem atenção das políticas públicas de alimentação e nutrição.

Purpose Non-communicable diseases (NCDs), such as diabetes, cardiovascular diseases and cancer, are major global public health concerns. Diet quality—particularly the consumption of ultra-processed foods—has been associated with increased risk of NCDs. Traditional cohort studies are often expensive and logistically complex. The NutriNet-Brasil cohort leverages a web-based approach, offering a cost-effective and practical solution for comprehensive data collection and long-term follow-up.Participants Recruitments began in January 2020 through mass media, social media campaigns and collaborations with health organisations. Eligible participants are adults (aged ≥18 years) living in Brazil with internet access. Participants complete self-administered online questionnaires covering dietary intake, health status and other health determinants. Dietary assessment is based on the Nova classification system, which categorises foods by their level of processing.Findings to date Over 88 000 participants have completed the initial questionnaire. The cohort is predominantly women (79.9%) and highly educated (67.9% had completed higher education). The web-based design enabled the development and application of innovative dietary assessment tools, including the Nova24h and the Nova24hScreener, specifically designed to evaluate food processing levels. These tools have shown good performance in capturing dietary patterns and are central to the cohort’s aim. The online platform facilitates efficient recruitment, data collection and participant retention.Future plans NutriNet-Brasil is pioneering the development of web-based cohort methodologies and instruments tailored to food processing research. Future work includes leveraging collaborations with national and international research centres to conduct multidisciplinary analyses and inform public health policies.

INTRODUCTION:Ultraprocessed dietary patterns have been associated with higher risk of weight gain. Previous studies were conducted in high-income countries using dietary assessment tools not specifically designed to identify ultraprocessed foods. The purpose of this study was to examine the prospective association between ultraprocessed dietary pattern and risk of weight gain in Brazilian adults. METHODS:Data from 24,453 participants from NutriNet-Brasil cohort study who responded to 2 Nova24h dietary recalls at baseline and were followed for a median of 43.6 months were analyzed. Ultraprocessed dietary pattern was assessed on the basis of the contribution of ultraprocessed foods to total energy intake. Weight gain was defined as ≥5% and ≥10% increase from baseline body weight on the basis of self-reported measurements. Cox proportional hazards models, and stratified analyses were performed. RESULTS:A linear dose-response association was observed: for each 10% increase in ultraprocessed foods contribution, the risk of ≥5% weight gain increased by 5% (10,092 cases, hazard ratio=1.05; 95% CI=1.04, 1.07), and the risk of ≥10% weight gain increased by 8% (4,865 cases, hazard ratio=1.08; 95% CI=1.06, 1.10). Compared with participants in the lowest quintile (<11.8% of ultraprocessed foods), those in the highest quintile (≥34.0%) had higher risk of weight gain (≥5%: hazard ratio=1.23; 95% CI=1.15, 1.31; ≥10%: hazard ratio=1.35; 95% CI=1.23, 1.48). These associations persisted but attenuated after adjustment for diet nutritional profile. CONCLUSIONS:Higher exposure to ultraprocessed dietary pattern was associated with an increased risk of weight gain in Brazilian adults.

Resumo Objetivo Propor um novo sistema de classificação de locais de aquisição de alimentos com base no Guia Alimentar para a População Brasileira, denominado Locais-Nova. Métodos Trata-se da utilização dos dados de aquisição domiciliar de alimentos da Pesquisa de Orçamentos Familiares 2017–2018. Os alimentos foram categorizados, segundo a classificação Nova, em alimentos in natura ou minimamente processados, ingredientes culinários, alimentos processados e alimentos ultraprocessados. Estimou-se a contribuição média de cada grupo da classificação Nova para o total de gramas adquiridas no Brasil. Comparou-se essa estimativa com a contribuição média de cada grupo da classificação Nova em cada um dos 16 locais de aquisição avaliados. Os locais foram classificados como “fontes de aquisição” para um grupo específico da classificação Nova sempre que a contribuição desse grupo em determinado local foi igual ou superior à média nacional. Resultados A Locais-Nova identificou três categorias de locais de aquisição: fontes de alimentos in natura ou minimamente processados e ingredientes culinários, fontes de alimentos processados e fontes de alimentos ultraprocessados. Hortifrutigranjeiros e açougues destacaram-se como principais fontes de alimentos in natura ou minimamente processados; minimercados e mercearias, como principais fontes de alimentos ultraprocessados; e padarias e confeitarias, como fontes de alimentos processados e ultraprocessados. Supermercados foram classificados como fontes de alimentos in natura ou minimamente processados e ultraprocessados. Conclusão Este estudo apresentou a classificação inovadora dos locais de aquisição de alimentos. Isso refletiu as recomendações do Guia Alimentar para a População Brasileira e possibilitou entender os padrões de aquisição alimentar nos diferentes tipos de locais.

This study characterizes the community food environment around households in Brazil with children < 5 years of age and analyzes its association with socioeconomic and demographic stratifiers. Data from 12,524 households from the Brazilian National Survey on Child Nutrition (ENANI-2019) were used. The community food environment was assessed through the perception of mothers or caregivers using three indicators: fruit and vegetable score (FV-S), ultra-processed foods score (UPF-S), and community food environment healthiness score (CFEH-S), all ranging from 0–10 points, categorized as low (worse), medium, and high (better). Unadjusted and adjusted multinomial logistic regression analyses were conducted to determine the independent associations between macro-region, household location, race/skin color, level of education of the mother or caregiver, and basic sanitation, and FV-S, UPF-S, and CFEH-S. The frequency of low and high categories was 21.8

ABSTRACT OBJECTIVE Evaluate changes in the Brazilian population’s diet and its determinants during the covid-19 pandemic. METHODS We used diet data collected by the Datafolha Institute in 2019 (n = 1,384), 2020 (n =1,214), and 2021 (n = 1,459) from independent and representative samples of the adult population (aged 18 to 55 years) from all socioeconomic classes and geographic regions of Brazil. Food consumption was measured by checking the consumption of 22 sets of food on the day before the survey. The third cycle also included questions about changes in eating habits during the pandemic. We estimated the prevalence of consumption of the food sets in each cycle of the survey and used statistical tests for comparisons of proportions between the three cycles. RESULTS Between 2019 and 2020, we observed a significant increase in the consumption of cereals, milk, packaged snacks or salty cookies, and industrialized sauces, as opposed to a decrease in the consumption of eggs. Between 2019 and 2021 and between 2020 and 2021, on the other hand, there was a significant decrease in the consumption of cereals, vegetables, fruits, and industrialized fruit juices and an increase in the consumption of soda, sweets, cookies, sausages, industrialized sauces, and ready meals. When asked about the main changes in the purchase and preparation of meals, 46.3% of the respondents reported consuming more food prepared at home during the pandemic. Regarding changes in eating habits, 48.6% of the respondents reported a change in their eating habits during the pandemic. The main reasons for such changes were greater concern with health (39.1%) and self-reported decreased family income (30.2%). CONCLUSIONS The covid-19 pandemic had a negative impact on the diet of the population, and increased consumption of ultra-processed foods was reported for that period.

Abstract: Malnutrition affects billions of individuals worldwide and represents a global health challenge. This study aimed to determine the prevalence of malnutrition (undernutrition or overweight) among mother-child dyads in children under 5 years old in Brazil in 2019 and to estimate changes in this prevalence from 2006 to 2019. Individual-level data from the Brazilian National Survey on Child Nutrition (ENANI-2019) and the Brazilian National Survey of Demography and Health of Women and Children carried out in 2006 (PNDS 2006) were analyzed. Malnutrition outcomes in mother-child dyads included overweight mother and child, undernourished mother and child, and the double burden of malnutrition, i.e., overweight mother and child having any form of undernourishment (stunting, wasting, or underweight). Prevalence and 95% confidence intervals (95%CI) were estimated. Most women (58.2%) and 9.7% of the children were overweight, 6.9% were stunted, and 3.1% of mothers and 2.9% of the children were underweight. The prevalence of overweight in the mother-child dyad was 7.8% and was statistically higher in Southern Brazil (9.7%; 95%CI: 7.5; 11.9) than in the Central-West (5.4%; 95%CI: 4.3; 6.6). The prevalence of overweight mother and stunted child was 3.5%, with statistically significant difference between the extremes of the mother’s education [0-7 vs. ≥ 12 years, 4.8% (95%CI: 3.2; 6.5) and 2.1%, (95%CI: 1.2; 3.0), respectively]. Overweight in the dyad increased from 5.2% to 7.8%, and the double burden of malnutrition increased from 2.7% to 5.2% since 2006. Malnutrition in Brazilian mother-child dyads seems to be a growing problem, and dyads with lower formal education, higher maternal age, and from the South Region of Brazil were more vulnerable.

This study is to identify victimization patterns and analyze the association between the experience of polyvictimization and overweight or obesity among adolescent girls and boys. The sample consisted of 2680 Brazilian ninth-graders enrolled in public and private schools, taken from the São Paulo Project for the social development of children and adolescents (SP-PROSO). Victimization was explored in two ways: (i) as per Finkelhor and (ii) by latent class analysis (LCA). The interest outcomes were overweight and obesity. Multinomial logistic regression models were used to study the relationship between victimization and overweight or obesity, controlling for confounders. LCA grouped boys and girls adolescents into three classes. These classes received the same labels, but the patterns differed between sexes. Class 1 was characterized by fewer types of victimization suffered and lower endorsement values in the analyzed items and was named bullying and indirect victimization (♀: 42.7%, n = 546; ♂: 21.6%, n = 293). Class 2 included more victimization types than Class 1 and less than Class 3. This class was labeled family violence and peer victimization (♀: 29.1%, n = 356; ♂: 47.9%, n = 652). Class 3 was named high polyvictimization (♀: 28.2%, n = 345; ♂: 30.5%, n = 418). According to Finkelhor, polyvictimization was not associated with overweight or obesity in both sexes. Only the class of high polyvictimization was associated with being overweight (ORadj: 1.60, 95%CI: 1.01-2.54) in girls. In this study, polyvictimization was associated with being overweight only among adolescent girls. Longitudinal studies in different contexts and populations are needed to understand this relationship.

EDITORIAL article Front. Nutr., 29 September 2023Sec. Nutritional Epidemiology Volume 10 - 2023 | https://doi.org/10.3389/fnut.2023.1297262

Abstract: We aimed to investigate and compare the distribution of establishments that sell food near municipal, state, and private schools in the municipality of São Paulo, Brazil. This cross-sectional, exploratory, and census study was conducted in 3,121 schools. Circular buffers were traced around schools and concentrations or dispersions of food stores (in absolute numbers and densities) were analyzed. A p-trend was calculated to analyze how food stores density behaved as the buffer radius distance increased. Stratified regression models were built to analyze the characteristics of the food environment. Snack bars and street vendors are the most common types of establishments surrounding schools. Some categories of food stores are concentrated (such as candy stores around municipal and private schools, mini markets around municipal schools, and snack bars around private schools), whereas others (such as super and hypermarkets and fruit and vegetable stores) are dispersed around public schools. The food environment around schools shows differences regarding the instance that administers them and private schools have more food stores around them. Poor-quality food environment around schools exposes students to risk factors regarding excessive unhealthy food consumption.

The analysis of food using a perspective centred on nutrients seems inadequate for understanding the dietary transition and its impact on the growth of obesity and chronic diseases. Industrial food processing is now proposed as the key to explain the relationship between food and health. The NOVA food classification considers the degree and the purpose of food processing, which includes physical, biological and chemical processes used after foods are separated from nature, and before being consumed or prepared as dishes and meals. NOVA has four food groups: (1) unprocessed and minimally processed foods; (2) processed culinary ingredients; (3) processed foods and (4) ultra-processed foods, which are formulations made mostly or entirely from substances derived from group 1 foods and additives, with little if any intact group 1 food. Many investigations linking high ultra-processed food consumption with deterioration of diets and adverse health outcomes are reinforced by prospective studies, systematic reviews and meta-analyses. There are various plausible explanations of why diets high in ultra-processed foods are harmful. Their production and consumption continue to rise worldwide. Efficient and effective public policies and actions that reduce production and consumption of ultra-processed products are needed, to protect human health now and in future.