Undernutrition, and overweight and obesity: the two faces of malnutrition in Brazil, analysis of the Global Burden of Disease, 1990 to 2019

OBJECTIVES

The objective of this study was to analyse the global burden of disease attributable to undernutrition and high body mass index (BMI) in Brazil and its 27 states, as well as its association with the socio-demographic index (SDI) from 1990 to 2019.

STUDY DESIGN

This is an epidemiological time-series study.

METHODS

This study analysed the undernutrition and high BMI estimated by the Global Burden of Disease study conducted from 1990 to 2019 for Brazil and its states, using the following metrics: absolute number of deaths, standardised mortality rate, and disability-adjusted life years (DALYs). This study also analysed the correlation between the percentage variation of mortality rates and SDI.

RESULTS

A decrease in the number of deaths (-75 %), mortality rate (-75.1 %), and DALYS (-72 %) attributable to undernutrition was found in Brazil and in all regions. As regarding the high BMI, an increase in the number of deaths was found (139.6 %); however, the mortality rate (-9.7) and DALYs (-6.4 %) declined in all regions, except in the North and Northeast regions, which showed an increase. A strong correlation was identified between undernutrition and high BMI with SDI.

CONCLUSION

Our study observed a double burden of malnutrition in Brazil, with a reduction in the burden of diseases due to malnutrition in Brazil and variation in the burden due to high BMI according to the socioeconomic status of the region. Public policies are necessary in order to guarantee the human right to a healthy and sustainable diet, together with food and nutrition security and a diminishing of social inequality.

Improving knowledge, self-efficacy and collective efficacy regarding the Brazilian dietary guidelines in primary health care professionals: a community controlled trial

Background

Capacity-building of health professionals regarding to nutrition is a strategy for qualifying public health work to promote healthy diets in primary health care (PHC) services.

Objective

To evaluate the effect of an intervention based on Brazilian Dietary Guidelines (BDG) on the knowledge, self-efficacy (SE) and collective efficacy (CE) of interprofessional teams working in PHC.

Methods

It refers to a pre-post intervention study involving 24 health professionals divided into a control group (CG) and intervention (IG). The IG received a 16-h educational workshop on the BDG, guided by a validated protocol. Knowledge, SE and CE for using the BDG were assessed via a self-administered scale, ranging from 0 to 16 and 0 to 36 points, respectively; the scale was previously validated, completed before and after 2 months of the intervention. The effects of the intervention were estimated by paired t-test for intragroup comparisons over time.

Results

The mean difference in the knowledge and SE scores of the IG pre- and post-intervention was 2.0 (CI 0.49–3.51) and 6.75 (CI 4.05–9.45) points, respectively. These results means the IG participants obtained 59 and 52.8% more points in knowledge and in SE in relation to CG, with significative difference (p = 0.007 and p <  0.00, respectively). There was no significant variation in the CE scores in both groups.

Conclusions

Considering the results presented and due to the originality of the study in question, the educational workshop was effective in increasing the knowledge and SE of professionals working in PHC in using the Dietary Guidelines in their work routines. These findings can assist other research in developing nutrition interventions with interprofessional teams.

Nutritional profile of ultra-processed foods advertised in small food retailers

Background

It is necessary to analyze the nutritional profile and advertising claims of ultra-processed foods available in small food retailers.

Methods

This is an observational cross-sectional study that carried out an audit on small food businesses. Information was collected on advertising, price, ingredient list, nutritional composition and portion size. All investigated foods were grouped according to the NOVA food classification. Food advertising was categorized into 11 different consumer appeals. The relationship between the type of advertising appeal of the ultra-processed food and its nutritional profile was analyzed. A comparison was made between the nutritional composition of the advertised food and the recommendations of sugar, saturated fat and sodium of the Pan American Health Organization (PAHO).

Results

The most prevalent ultra-processed foods in small retailers were sweets and treats (18.5%); sugary sweetened beverages (15.7%), sausages (12.0%) and baked goods (11.1%). Most of the advertising on the packaging of ultra-processed foods was about healthy eating and physical activity and sensory aspects of the product (color, flavor, texture). Foods classified as high in sugars had the highest number of advertisements related to healthy eating and physical activity, foods high in sugar and saturated fats, had the highest number of advertisements related to sensory aspects, healthy eating and physical activity and foods high in sodium and / or saturated fats, had more advertising related to convenience.

Conclusions

Identifying that advertising for ultra-processed foods is associated with health and well-being, physical activity and sensory aspects leads us to a better understanding of the factors that influence consumer perception in small businesses. Advertising for foods rich in sugar, saturated fat and sodium based on health and well-being should be better regulated by public agencies in Brazil, supporting consumers to make healthier choices.

Key messages

Ultra-processed foods induce to consume large quantities, due to the convenience and the advertising present in their packaging that stimulate a healthy life, physical activity and sensory aspects. It is necessary support and defend changes in nutrition labeling, in order to clarify the nutritional information to consumers.

Does access to healthy food vary according to socioeconomic status and to food store type? an ecologic study

BACKGROUND

The food environment can influence opportunities and barriers to food access. This study aimed to investigate whether access to healthy foods varies according to store types and the socioeconomic status of the users of the public health promotion program in Brazil, known as the Health Academy Program.

METHODS

A total of 18 Health Academy Program centers were selected via simple conglomerate sampling. Health Academy Program users living up to 1 km from the food stores were evaluated (n = 2831). Their socioeconomic status was investigated via face-to-face interviews. The food stores were audited through direct observation. Variables included the community nutrition environment (type and location) and consumer nutrition environment (healthy food store index, involving variables such as availability, variety, and advertising of healthy and unhealthy products). Multiple linear regression analysis was performed to examine the association between access to healthy foods, socioeconomic status, and food store type.

RESULTS

A total of 336 stores were investigated. The majority were specialty fruit and vegetable markets/stores or open-air food markets. Access to healthy food was only associated with the food store type. An increase of 1% in the availability of specialized fruits and vegetable markets or open-air food markets and supermarket raised healthy food store index values by 0.12 and 0.07, respectively.

CONCLUSIONS

Public food supply policies aimed at improving the diet quality of the population and reducing inequality in access should prioritize the implementation of stores of better quality, such as specialty fruit and vegetable markets and open-air food markets.

Brazilian obesity prevention and control initiatives

Obesity prevalence in the Brazilian adult population is 12.5% among men and 16.9% among women. Obesity control has been a subject of concern in Brazilian health policies since the publication of the National Food and Nutrition Policy in 1999. The initiatives include a comprehensive national intersectorial plan for obesity prevention and control focused on confronting its social and environmental causes, development of a food and nutrition education framework aimed at intersectorial public policies in the food and nutritional security field, promotion and provision of healthy food in school environments (linked to family farming), structuring nutrition actions in primary healthcare in the national healthcare system, promoting community physical activity, food regulation and control, and encouragement of public participation and food control. We conclude that several initiatives have been developed in Brazil to deal with the challenge of implementing an intergovernmental, intersectorial response to reverse the rising overweight and obesity rates. The success of this response will depend on a governance model that promotes joint and integrated action by different sectors and active participation of society to consolidate the actions, places and laws that protect health and promote healthy lifestyles.

Can self-reported height and weight be used among people living with HIV/AIDS?

To assess the reliability and validity of self-reported height and weight in adults living with HIV/AIDS (ALWHA) we assessed 508 ALWHA of both genders on antiretroviral therapy. Height and weight were directly measured in a subsample. Sensitivity and specificity analysis were performed to determine the validity of self-reported measures. Bland-Altman's method was used to calculate the limits of agreement between values while reliability was assessed using intraclass coefficients. Regression equations were devised to determine actual measures from self-reported values. Mean differences among measured and self-reported weight were -0.96 kg for men and -0.54 kg for women. Mean height differences were less than 2 cm, yielding good reliability for body mass index (BMI). Overweight (BMI ≥ 25 kg/m(2)) diagnosis sensitivity was 90.6% and specificity was 81.2%. Corrected measures determined by regression equations had stronger correlation with self-reported values (r > 0.980). Self-reported height and weight showed good reliability and validity compared with directly measured height and weight. However, measures should be corrected whenever possible to achieve higher accuracy.

Diet quality of persons living with HIV/AIDS on highly active antiretroviral therapy

BACKGROUND

This study sought to assess the diet quality of individuals living with HIV/AIDS who were receiving antiretroviral therapy in São Paulo, Brazil.

METHODS

This cross-sectional study involved 56 HIV-infected adults. Demographic and anthropometric data were collected, and diet quality was measured using the Healthy Eating Index (HEI), modified for Brazilians, which included ten components: adequacy of intake of six different food groups, total fat, cholesterol, dietary fibre and dietary variety.

RESULTS

Among the individuals assessed, 64.3% of the participants had a diet needing improvement, while 8.7% had a poor diet. The overall HEI score was 68.3 points (SD = 14.9). Mean scores were low for fruits, vegetables, dairy products and dietary fibre; and high for meats and eggs, total fat and cholesterol. The overall HEI score was higher among individuals who were not overweight (P = 0.003), who were also more likely to achieve dietary goals for dairy products (P = 0.039) and grains (P = 0.005).

CONCLUSION

Most of these adults living with HIV/AIDS had diets that required improvement, and being overweight was associated with poorer diet quality. Nutritional interventions aimed at maintaining healthy body weight and diet should be taken into account in caring for HIV-infected people.

Risk factors for proximal femur osteoporosis in men aged 50 years or older

The objective of this study was to analyze the risk factors for osteoporosis in 325 volunteer men aged 50 years or older. Participants completed questionnaires including demographic and social information, personal medical history, maternal and paternal history of bone fracture after the age of 50 years, smoking habit, alcoholic beverage consumption, calcium intake and present and past physical activities. The individuals were submitted to bone densitometry of the femoral neck and to anthropometric measurements. The chi2 test and multiple logistic regression were used to evaluate the association between the independent variables and the presence of osteoporosis. We concluded that the independent risk factors for osteoporosis were body mass index, present practice of physical/leisure activity (last 12 months), age, present and past smoking habit, no current thiazide diuretic use, white race and maternal history of fracture after the age of 50 years.

Bone mineral density in Brazilian men 50 years and older

Bone mineral density (BMD) in the lumbar spine (LSBMD), femoral neck (FNBMD) and whole body (WBBMD) and whole body tissue composition were evaluated in 288 Brazilian men 50 years and older, 80% white and 20% Mulattoes. Age was inversely correlated with WBBMD (r = -0.20) and FNBMD (r = -0.21) but not with LSBMD (r = 0.03). Body mass index and weight showed a strong positive correlation with WBBMD (r = 0.48 and 0.54), LSBMD (r = 0.37 and 0.45) and FNBMD (r = 0.42 and 0.48). Correlation with height was positive but weaker. No significant bone loss at the lumbar spine level was observed as the population aged. FNBMD and WBBMD decreased significantly only in the last decade (age 70-79) studied. BMD was higher for Brazilian men as compared to Brazilian women at all sites. No significant differences were observed between Brazilian and the US/European male population for BMD in the femoral neck. BMD measured by dual-energy X-ray absorptiometry in South American men is reported here for the first time. A decrease in FNBMD was detected only later in life, with a pattern similar to that described for the US/European male population.