Food Insecurity in Urban and Rural Areas in Central Brazil: Transition from Locally Produced Foods to Processed Items

Changes in dietary carbohydrate and lipid quality indices between 2008 and 2018: Analysis of the Brazilian dietary surveys

The aim of the study was to evaluate characteristics and changes over a decade in dietary carbohydrate and lipid quality according to socio-demographic variables. Data was obtained from two Brazilian National Dietary Surveys 2008-2009 (n = 34 003) and 2017-2018 (n = 46 164) examining a nationwide representative sample of individuals ≥10 years old. Food intake was assessed by means of two non-consecutive diet records (2008-2009) and 24 h diet recalls (2017-2018). Carbohydrate Quality Index is a score ranging from 4 to 20 calculated from fibre intake, global dietary glycaemic index, solid/total carbohydrate (CHO) and whole grains/total grains CHO. Lipid Quality Index was estimated by dividing the sum of the dietary content of monounsaturated and polyunsaturated fatty acids by the sum of saturated and trans fatty acids. Indices were categorised into five categories (1 for lowest and 5 for highest quality). Socio-demographic variables were sex, age, income, urban/rural area and place of food consumption. The estimates (95% CI) were generated separately for each survey and then compared to identify changes in time. Our main findings refer to changes in diet quality according to income. At the lowest income level, the proportions of individuals in the best carbohydrate and lipid quality categories reduced from 26.9% to 20.6% and from 30.0% to 24.9%, respectively. Alternatively, at the highest income level, these proportions increased from 22.9% to 26.6% and from 11.9% to 15.7%, respectively. Furthermore, the quality of lipids improved in women and among individuals reporting some away-from-home food consumption, while the quality of carbohydrates was reduced among adolescents and in rural areas.

What Drives Abdominal Obesity in Peru? A Multilevel Analysis Approach Using a Nationally Representative Survey

Abdominal obesity (AO) is a serious public health threat due to its increasing prevalence and effect on the development of various non-communicable diseases. A multilevel analysis of the 2019 Demographic and Family Health Survey (ENDES in Spanish) using the Latin American Diabetes Association (ALAD in Spanish) cut-off points was carried out to evaluate the individual and contextual factors associated with AO in Peru. A total of 30,585 individuals 18 years and older were included in the analysis. The prevalence of AO among Peruvians in 2019 was 56.5%. Individuals of older age (aOR 4.64; 95% CI: 3.95-5.45), women (aOR 2.74; 95% CI: 2.33-3.23), individuals with a higher wealth index (aOR 2.81; 95% CI: 2.40-3.30) and having only secondary education (aOR 1.45; 95% CI: 1.21-1.75) showed increased odds of presenting AO compared to their peers. At a contextual level, only the Human Development Index (aOR 1.59; 95% CI: 1.17-2.16) was associated with the development of AO. A high Human Development Index is the contextual factor most associated with AO. It is necessary to formulate and implement new public health policies focused on these associated factors in order to reduce the prevalence of OA and prevent the excessive burden of associated noncommunicable diseases.

Prevalence and determinants of obesity and abdominal obesity among rural workers in Southeastern Brazil

The objectives of this study were to assess the nutritional status of rural workers from a municipality in Southeastern Brazil and estimate the association of sociodemographic, labor, lifestyle, and dietary pattern factors with obesity and abdominal obesity of men and women of this rural area. This is a cross-sectional, epidemiological study of 740 farmers (51.5%, n = 381 males; 48.5%, n = 359 females). The sociodemographic, labor, lifestyle and dietary patterns determinants were assessed. Food intake data were obtained by applying three 24-hour recalls and dietary patterns were determined by Principal Component Analysis with Varimax orthogonal rotation. Poisson regression with robust variance stratified by sex was applied. The general prevalence of overweight status was 31.5% (95% CI 28.2-34.8%), 19.7% of obesity (95% CI 16.8-22.6%) and 31.5% of abdominal obesity (95% CI 28.2-34.8%), with higher rates in women (P < 0.001). Men of higher socioeconomic class had a 2.3 times higher prevalence of obesity (95% CI 1.08-4.90). In addition, the shorter travel time to purchase food increased the prevalence of abdominal obesity in males. For women, the older the age group, the greater the general and central obesity. A lower adherence to traditional dietary patterns (approximately PR [prevalence ratio] 1.6 for general obesity and PR 1.3 for abdominal obesity) and a greater number of places to buy food were associated with higher rates of obesity in women. Finally, women farmers with a higher workload had a 20% lower prevalence of central obesity (PR 0.80; 95% CI 0.65-0.97). Such findings demonstrate that obesity must be an issue in the health care of remote and rural populations. There is a need to promote healthier environments that respect traditional food culture through multiple approaches that consider the heterogeneity of rural areas and the differences between sexes.

Rural characteristics associated with excess weight among adolescents

ABSTRACT Objective This study aimed to verify the association between rural characteristics and the nutritional status of adolescents from the rural area of Macaé, a municipality in Rio de Janeiro, Southeast Brazil. Methods This is a cross-sectional study based on secondary anthropometric data, collected at the Macaé Municipal Department of Education between 2013 and 2014. The database refers to the total number of adolescents in the only high school in the rural area of the city. Poisson logistic regression was performed, having excess weight (overweight or obesity- Body Mass Index-for-age equal to or greater than one Z-score) as the dependent variable, used dichotomously. The independent variables were sex, socioeconomic status and three “yes or no” variables that express rural characteristics. Results The adolescents (total=109) were between 14 and 18 years old (mean=16.6 years), 64.2% were girls, 52.3% had vegetable gardens or orchards in their household, 19.4% had animal breeding for consumption purposes and 17.6% had parents/guardians working in the agricultural sector. The prevalence of excess weight was 18.0% in boys and 20.0% in girls. Having a garden/orchard implied a significantly higher chance of having excess weight, both in the bivariate analysis and in the sex-adjusted model (Prevalence Ratio=2.95; Confidence Interval=1.17-7.44). Conclusions Based on a significant association at the municipal level, the results highlight nutritional differences between local and large-scale studies, as well as variations within the same rural area. These findings point out the need to evaluate rural aspects in more detail in studies on underlying determinants of nutritional status.

Urbanization in Peru is inversely associated with double burden of malnutrition: Pooled analysis of 92,841 mother-child pairs

OBJECTIVE

This study assessed the relationship between urbanization and the double burden of malnutrition (DBM) in Peru.

METHODS

A cross-sectional analysis of the Demographic and Health Survey (2009 to 2016) was conducted. A DBM "case" comprised a child with undernutrition and a mother with overweight/obesity. For urbanization, three indicators were used: an eight-category variable based on district-level population density (inhabitants/km² ), a dichotomous urban/rural variable, and place of residence (countryside, towns, small cities, or capital/large cities).

RESULTS

The prevalence of DBM was lower in urban than in rural areas (prevalence ratio [PR] 0.70; 95% CI: 0.65-0.75), and compared with the countryside, DBM was less prevalent in towns (PR 0.75; 95% CI: 0.69-0.82), small cities (PR 0.73; 95% CI: 0.67-0.79), and capital/large cities (PR 0.53; 95% CI: 0.46-0.61). Using population density, the adjusted prevalence of DBM was 9.7% (95% CI: 9.4%-10.1%) in low-density settings (1 to 500 inhabitants/km² ), 5.9% (95% CI: 4.9%-6.8%) in mid-urbanized settings (1,001 to 2,500 inhabitants/km² ), 5.8% (95% CI: 4.5%-7.1%) in more densely populated settings (7,501 to 10,000 inhabitants/km² ), and 5.5% (95% CI: 4.1%-7.0%) in high-density settings (>15,000 inhabitants/km² ).

CONCLUSIONS

The prevalence of DBM is higher in the least-urbanized settings such as rural and peri-urban areas, particularly those under 2,500 inhabitants/km² .

Impacts of market economy access and livelihood conditions on agro-food transition in rural communities in three macro-regions of Brazil

Urbanization has threatened rural communities' livelihoods worldwide, changing their agro-food systems from locally produced traditional items to industrialized foodstuffs. The main objective was to investigate the relationship between livelihood conditions and the agro-food transition process in rural communities of the Center-West, Northeast, and Amazon regions of Brazil. We hypothesized that traditional agroecosystems and local food habits changed with greater access to market economies. The study was conducted with semi-structured questionnaire interviews to verify agro-food patterns, subsistence farming, natural resource use, and socioeconomic conditions. Moreover, we used stable isotope ratios from the inhabitants' fingernails to determine the food source and trophic chain diversity. Data from questionnaires were analyzed using a Bayesian clustering model to characterize the socioeconomic conditions and agro-food patterns among rural and urban communities. The isotopic data were appraised through a nonparametric model to assess food differences among Brazilian regions and different community types. The Bayesian model allowed us to determine the optimal number of groups according to descriptive socioeconomic and agro-food variables sorted by each specific location. We also verified a food change from C₃ (more natural) to C₄ (more processed) with an increase in δ ¹³C and a decrease in δ ¹⁵N in the city and town localities. This indicates a livelihood shift from locally produced foods to processed items toward urban areas. Although remote villages showed more maintenance of their agro-food systems, increased access to market economies and the supermarket diet is changing the livelihood conditions of rural communities, which can compromise their traditional farming and food sovereignty.

Lack of calcium rich foods in the diet, low knowledge on calcium level recommendations and severe food insecurity predicts low calcium intake among Vietnamese women

OBJECTIVE

To assess nutrition knowledge related to osteoporosis and calcium, osteoporosis health beliefs, dietary calcium intake and household food insecurity among adult women in Vietnam.

METHODS

Two hundred fifty-one women aged 30-65 years living in a rural district in Hanoi -Vietnam were recruited. A questionnaire was used to collect information on nutrition knowledge related to osteoporosis and calcium intake, health beliefs, household food security, and dietary calcium intake. Data analysis included descriptive statistics and regressions.

RESULTS

Majority of the participants did not know calcium recommendations (95%) and recommended daily servings of calcium-rich foods (60%). In addition, majority of the participants (83.7%) were not aware of osteoporosis risk factors. Slightly less than half of the participants (46.2%) reported that they would have difficulties changing their current diets to consume more calcium rich foods. Half of the participants (50.4%) reported being food insecure, with 22% of them reporting having severe food insecurity. Mean dietary calcium intake was 534.5 mg/day, of which milk and dairy products contributed only 4%. Nutrition knowledge, perceived benefits, and self-efficacy were positively associated with calcium intake (p < 0.05); whereas perceived barriers and severe food insecurity were significantly associated with low dietary calcium intake (p < 0.05).

CONCLUSIONS

The results of this study showed calcium intake among the participating Vietnamese women was lower than the national recommendation, indicating the need for nutrition programs and promotions to increase calcium intake. These programs should aim at increasing awareness on national calcium recommendations and skills to obtain and consume calcium-rich foods while considering development of safety nets for food insecure households, as pertaining to adequate dietary calcium intake.

Energy contribution of NOVA food groups and the nutritional profile of the Brazilian rural workers' diets

We estimated the caloric contribution of minimally processed foods, processed culinary ingredients, processed foods and ultra-processed foods in Brazilian farmers' diets and their association with the nutritional profile of the diet. It is an epidemiological study of cross-sectional, analytical and quantitative design with 740 farmers adults of Southeastern Brazil. Food intake data were obtained by applying three 24-hour recalls and were classified according to the degree and purpose of processing. The largest caloric contribution came from the group of minimally processed foods (64.7%), followed by ultra-processed foods (17.7%), processed culinary ingredients (12.4%), and processed foods (5.2%). Individuals in the fourth quartile of caloric contribution from minimally processed foods showed lower energy consumption (β -0.16, P<0.001) and greater consumption of all 15 micronutrients analyzed. In contrast to what was identified for this food group, the higher caloric contribution from ultra-processed foods was associated with a greater caloric content of the diet (β 0.17, P<0.001) and lower consumption of all 23 analyzed nutrients. Therefore, the caloric contribution from the consumption of ultra-processed foods in the rural area is still lower than the national average. However, measures aimed at delaying isocaloric exchanges for the group of ultra-processed foods must be carried out, maintaining the local food culture, since this group had worse nutritional levels. In addition, incentives to the greater consumption of minimally processed foods should be carried out, due to their nutritional quality.

[Evaluation indicators of Food and Nutritional Insecurity and associated factors: systematic review]

The scope of this paper was to systematically investigate the indicators used in the evaluation of food and nutritional insecurity and associated factors in Brazilian studies. After selection in the databases using search terms and reverse search, 89 articles were included. The majority of the articles evaluated food and nutritional insecurity according to the indicator of perception, using the Brazilian Scale of Food Insecurity (83.1%), the American Scale (5.62%) and isolated questions (2.25%). The other articles evaluated the presence of malnutrition among children (1.12%), expenditure on food (1.12%), adult-equivalent dietary intake (1.12%), protocols (2.25%), and prediction models (2.25%). Food and nutritional insecurity (measured by the different indicators) was associated with socioeconomic and demographic factors, health and lifestyle conditions, food consumption and nutritional status, based on families, specific age groups, beneficiaries of government programs, among others, as sample units. The majority of the studies merely evaluated the food dimension of the insecurity, thereby increasing the difficulty in evaluating this complex situation.

Mapping carbon and nitrogen isotopic composition of fingernails to demonstrate a rural-urban nutrition transition in the Center-West, Northeast, and Amazon regions of Brazil

OBJECTIVE

The main objective of this study is to investigate diet patterns among rural and urban populations of the Center-West, Northeast, and Amazon regions of Brazil through the carbon and nitrogen isotopic composition of fingernails, recognizing that the extent of market integration is a key driver of food consumption.

MATERIALS AND METHODS

In the Center-West, Northeast, and Amazon regions of Brazil, fingernails were sampled in clusters encompassing a major city, town, and rural village. A total of 2,133 fingernails were analyzed. Fingernails were clipped by donors using fingernail clippers. In the laboratory, samples were cleaned then weighed in small tin capsules before being isotopically analyzed for carbon and nitrogen.

RESULTS

The overall mean δ¹³ C and δ¹⁵ N were -19.7 ± 2.8‰ and 10.6 ± 1.1‰, respectively. In the more remote villages, where access to food markets is more challenging, lower δ¹³ C prevails, suggesting that Brazilian staple foods (rice, beans, and farinha) still dominate. In areas with easier access to food markets, δ¹³ C values were higher, suggesting a change to a diet based on C₄ plants, typical of a Brazilian supermarket diet. The variability among inhabitants in the same location expressed by a significant inverse correlation between δ¹³ C and δ¹⁵ N fingernail values suggested that "market integration" does not affect everyone equally in each community.

DISCUSSION AND CONCLUSION

The nutrition transition has not yet reached some remote villages in these regions of Brazil or that the nutrition transition has not yet reached all residents of these remote villages. On the other hand, in several villages there is a considerable adherence to the supermarket diet or that some residents of these villages are already favoring processed food.

Mineral Intake Status of Community-Dwelling Elderly from Urban and Rural Areas of South Korea: A Cross-Sectional Study Based on Korean National Health and Nutrition Examination Survey, 2013~2016

We aimed to evaluate the intake of minerals (calcium, phosphorous, sodium, and potassium) in the urban and rural elderly and explore the adequacy of intake and food sources for each mineral using nationwide big data. The study used data from the Korea National Health and Nutrition Examination Survey (KNHANES) between 2013 and 2016. We analyzed 5292 elderly individuals that were aged 65 years and older (2271 men, 3021 women). Daily calcium, phosphorous, sodium, and potassium intake, and they were analyzed using the 24-h dietary recall method. Additionally, the adequacy of intake and food sources for each mineral was analyzed. Blood triglyceride level was significantly higher in rural elderly than in urban elderly. The intake of calcium and potassium per 1000 kcal of energy intake was significantly lower in the rural elderly, and the proportion of participants with calcium intake below the Estimated Average Requirement was significantly higher in the rural elderly than in the urban elderly. The intake of calcium, phosphorous, and potassium in the rural elderly was lower than that in the urban elderly. These results can be used as basic data when making social and environmental policies for the health of the elderly and when providing targeted dietary education for the management of chronic diseases for the elderly.

Dietary patterns of Brazilian farmers and their relation with sociodemographic, labor, and lifestyle conditions

Background

The eating habits have changed in the last few decades, but few studies prioritize the food consumption of farmers and the rural population. Therefore, the objective of this study was explore the sociodemographic, occupational and lifestyle factors to the high adherence these dietary patterns.

Methods

This is a cross-sectional epidemiological study of 740 farmers (51.5%, n = 381 males; 48.5%, n = 359 females) from a municipality in Southeastern Brazil. Food intake data were obtained by applying multipass 24-h recall and dietary intake was presented in dietary patterns determined by Principal Component Analysis with varimax orthogonal rotation.

Results

Three dietary patterns were identified. The first pattern, “local traditional”, was associated with sociodemographic and labor variables, being considered typical of the region’s farmer as white race/color (p = 0.003), not extra-physical activity (p = 0.014) and cultivating 5 or more crops (p = 0.005). The permanence of a “traditional Brazilian” pattern and the occurrence of an “industrialized” pattern were also observed. Farmers working in non-conventional agriculture were 54% less adhere to “traditional Brazilian” pattern (OR 0.46, 95% CI 0.25–0.86, p = 0.014). Individuals aged 50 and over years were 82% less likely (OR 0.18, 95% CI 0.10–0.30) to adhere to “industrialized” pattern. Still, individuals of lower socioeconomic class were 52% less likely to adhere to this pattern (OR 0.48, 95% CI 0.24–0.96). Farmers who spent R$ 200 or more per capita to buy food were more than twice as likely to adhere to this food pattern (OR 2.22, 95% CI 1.32–3.73), and who had the habit of frequently eating out were 1.62 as likely adhere to “industrialized” pattern (95% CI 1.11–2.36).

Conclusions

The findings indicate changes in dietary patterns in rural areas of the country, maintaining a traditional Brazilian pattern, as well as a local and an industrialized pattern. This last pattern demonstrates that the contemporary rural population also opts for a diet with ultra-processed products, being associated with the characteristic habits of a more urbanized rural region.

The Eating Motivation Survey in Brazil: Results From a Sample of the General Adult Population

Brazil is undergoing a rapid nutrition transition with unfavorable effects on dietary healthiness. To counteract this trend, knowledge about individual drivers of consumption is needed that go beyond environmental factors. The Eating Motivation Survey represents a comprehensive measure of such individual drivers, assessing 15 eating motives, such as choosing food for health reasons or eating because of a good taste. The aim of this study was to examine the psychometric properties and validity of a Brazilian Portuguese version of The Eating Motivation Survey. In total, 442 participants from the general adult population living in the state of São Paulo, Brazil filled in an online survey. Results showed that the model, including 15 motive factors and 45 items, had a reasonable model fit. Moreover, factor loadings and corrected item-scale correlations were generally good. Fourteen out of the 15 motive scales had a reliability above 0.60. Results also confirmed convergent validity. These results demonstrate that the Brazilian Portuguese version of The Eating Motivation Survey is generally reliable and valid to assess individual drivers of eating behavior in Brazil.

In urban, but not rural, areas of Madre de Dios, Peru, adoption of a Western diet is inversely associated with selenium intake

Road development has been a major driver of the transition from traditional to calorie-dense processed 'Western' diets in lower and middle-income countries. The paving of the Interoceanic Highway (IOH) facilitated rapid development to the Madre de Dios (MDD) region in the Peruvian Amazon. As traditional foods such as Brazil nuts and fish are known to be rich in the essential micronutrient selenium, people further along the nutrition transition to a Western diet may have lower selenium (Se) intake. To test this hypothesis, in 2014 the Investigacion de Migracion, Ambiente, y Salud (IMAS Study) (Migration, Environment, and Health Study) collected household surveys from 310 households in 46 communities along the IOH and nails for Se analysis from 418 adults. Principal component analysis of 25 commonly consumed food items identified a factor resembling Western diet, which was used to calculate household Western diet weighted sum factor scores (WSFS). WSFS means were interpolated into a 10 km buffer around the IOH using inverse distance weighting. Western diet adoption was higher in urban compared to rural areas (p < 0.0001), and geographic variation was observed between mining and agricultural areas. Mean nail Se was 730 ng/g, SD 198 ng/g (range: 200-1390 ng/g). Generalized estimating equation (GEE) models assessed the association between food consumption and nail Se. Household chicken consumption was positively associated with Se in rural areas only. Urban/rural status modified the effect of western diet adoption on nail Se, and Se was inversely associated with WSFS in urban areas only. Conclusion: In urban, but not rural, areas of Madre de Dios, Peru, adoption of a Western diet is inversely associated with selenium intake. As the essential micronutrient selenium is a vital part of antioxidant proteins, lower intake could compound the chronic health effects that may result from transition to a calorie-dense diet.

Is the 'canine surrogacy approach' (CSA) still valid for dogs and humans in market-oriented and subsistence-oriented communities in Brazil?

Based on the assumptions that human food is available for dogs and isotope diet-tissue differences are similar in dogs and humans, the 'canine surrogacy approach' (CSA) has been used to infer patterns of ancient populations. The goal of this study was to test the CSA in urban (Brasília and Piracicaba) and in rural (Ubatuba and Maraã) areas. The hair C and N isotope ratios of modern dogs were compared with those of human fingernails from different regions of Brazil. Our CSA results showed a correlation between dog and human isotopes values: in rural areas δ¹⁵N of humans and dogs was not statistically different; contrarily, in urban centres, δ¹⁵N of humans was approximately 1 ‰ higher (p < 0.01) than δ¹⁵N of dogs; humans had lower δ¹³C values (p < 0.01) than dogs in Brasília, Piracicaba and Ubatuba. In Maraã, there was not any significant difference between dogs and humans. We concluded that CSA is still valid as a first approach in modern societies. However, isotopic differences found suggest that in modern societies processed dog food is increasingly disconnecting human and dog, jeopardising the use of CSA in the future if the trend of increasing processed dog food consumption continues to occur.

The dietary inflammatory index and insulin resistance or metabolic syndrome in young adults

OBJECTIVE

The aim of this study was to assess the association between the inflammatory potential of diet, as measured by the dietary inflammatory index (DII) and insulin resistance (IR) or metabolic syndrome (MetS).

METHODS

A cross-sectional study (nested within a cohort) was conducted on 2017 adults 23 to 25 y of age in Ribeirão Preto, Brazil. Food consumption was assessed using a validated food frequency questionnaire. DII scores were calculated from 35 available food parameters. IR was determined from the classification of homeostatic model assessment (HOMA) values (≥2.7 uU mL-1). MetS was diagnosed based on the Joint Interim Statement (JIS) criterion. The association of DII score with IR or MetS was determined by Poisson regression analysis. The variables included in the multivariable model were selected from directed acyclic graphs.

RESULTS

The diet of the young adults studied showed a high inflammatory potential, with a mean DII score of +1.10 (range: -4.69 to +5.28). The prevalence of MetS was 12.2% and IR 12.3%; both were higher in men than in women. The correlation between DII and HOMA-IR values was -0.038 (P = 0.09). The DII was not associated with IR or MetS in either sex.

CONCLUSION

Although the association between DII and the outcomes was not detected in this sample, the study demonstrated that the diets of these young adult Brazilians had a high inflammatory potential when compared with other studies. Future studies, preferably using longitudinal designs, are recommended.