Aline Cristine Souza Lopes

Objective: To assess whether participants from a transtheoretical model-based intervention maintained increases in fruit and vegetables (FV) intake 48 months after baseline. Design: Randomised controlled community trial. Setting: A Brazilian primary health care service. Participants: Primary health care service users. The control group (CG) received usual care, and the intervention group (IG) received usual care and a 7-month collective intervention to promote FV intake. We analysed individuals with positive changes 12 months after baseline (baseline intake n 2·232). Outcomes were FV intakes at 36 and 48 months after baseline compared to previous intakes to identify maintenance. We used generalised estimating equations models to assess time and intervention effects in follow-up intake. Results: Participants were mostly adult women. We identified decreases of 54.4 g/d in fruit intake and 38.5 g/d in vegetable intake at 36 months and increases of 6.9 g/d in fruit intake and 23.4 g/d in vegetable intake at 48 months. According to adjusted models, at 36 months, CG and IG participants presented similar decreases in FV intakes, which means initial changes in the IG were not maintained. At 48 months, small increases in intakes were also similar between IG and CG. Conclusions: Intervention participants did not maintain initial changes on FV intake in the long term, and boosters might be necessary to maintain initial increases.

Background/Objectives: The uneven distribution of food stores is a key determinant of health inequities. This ecological study aimed to map socioeconomic inequalities in the food environment of Joao Pessoa, Brazil. Methods: Stores were classified into three categories, according to the main type of food sold: unprocessed, processed, or ultra-processed. The Socioeconomic Index of Geographic Context for Health Studies (GeoSES) and its dimensions (Education, Income, Poverty, Material Deprivation, and Mobility) were used to analyze the territory. The association between the number of food stores and socioeconomic indicators was analyzed through thematic maps, correlation coefficients, and negative binomial regression models. Results: A total of 5087 food stores were mapped. A strong positive correlation was observed between the number of stores selling unprocessed foods and the GeoSES index (r = 0.85; p < 0.001), Education (r = 0.83; p < 0.001), Income (r = 0.85; p < 0.001), and Material Deprivation (r = 0.85; p < 0.001), while Mobility showed a moderate positive correlation (r = 0.59; p = 0.04). In the negative binomial regression model, each one-unit increase in the GeoSES index was associated with a 2.05-fold increase in the expected number of stores selling unprocessed foods (RR = 2.05; 95% CI: 1.48–2.84; p < 0.001). Conclusions: The food environment in Joao Pessoa, Brazil was associated with socioeconomic characteristics, with greater availability of unprocessed food stores in higher socioeconomic areas, while ultra-processed food stores were more evenly distributed across the municipality.

Objective: To identify the individual and contextual factors associated with completion of distance professional qualification for the collective management of obesity in the Brazilian Unified Health System (Sistema Único de Saúde, SUS).

Background: Individual characteristics can be associated with maintaining adequate FV intake over time. Thus, we aimed to identify factors associated with maintaining changes in fruit/vegetable (FV) intake at 48 months. Methods: Longitudinal analysis of data from a randomized trial carried out in a health promotion service, including individuals with positive changes in FV intake after intervention. FV intake was assessed at 48 months, compared to 12 months to identify whether maintenance was associated with demographics, health data, stages of change, self-efficacy, and decisional balance, using multivariate regression. Results: We included 2,232 participants, 88.4% were women, 46.6% were maintainers at 48 months. Maintainers were older, had lower schooling and baseline FV intake, had been in the service for longer, and increased FV intake between 12 and 48 months while non-maintainers decreased it. Being older or in the service for 36 + months were associated with 1% and 30% higher odds of maintenance; higher baseline FV intake and self-efficacy were associated with 1% and 2% lower odds of maintenance. Conclusions: Maintenance of changes in FV intake was associated with higher age, a longer time in the service, and lower baseline FV intake and self-efficacy. Health promotion services should aim for participant retention, and interventionists should pay attention to participants who might face more barriers for maintenance. Trial registration: RBR-9h7ckx. Date of registration: August 12, 2015.

Resumo Objetivo: Identificar os fatores individuais e contextuais associados à conclusão de qualificação profissional a distância para o manejo coletivo da obesidade no Sistema Único de Saúde. Métodos: Estudo transversal com profissionais e estudantes da área da saúde. O curso, com carga horária de 40 horas, contou com tutoria e foi baseado em material do Ministério da Saúde. Os fatores individuais analisados incluíram dados sociodemográficos e profissionais obtidos no início do curso; e os contextuais abarcaram dados econômicos e demográficos das Unidades da Federação de atuação, obtidos em sites institucionais. Participantes que realizaram todas as atividades foram considerados concluintes. Devido à falha de convergência das variáveis contextuais na regressão logística multinível, realizou-se regressão logística multivariada, incluindo razão de chances (odds ratio, OR) ajustada e intervalo de confiança de 95% (IC95%) por sexo, idade e macrorregião do país. Resultados: Foram 3.975 inscritos no curso; 1.620 (40,8%) acessaram a plataforma virtual. A maioria era de mulheres (91,0%) e nutricionistas (56,7%) e atuava na macrorregião Sudeste do país (54,8%) e regiões metropolitanas (51,0%). Após ajustes do modelo, verificou-se que ser nutricionista (OR 1,55; IC95% 1,09; 2,19) e ter acesso prévio a materiais impressos/digitais sobre o tema (OR 1,27; IC95% 1,04; 1,56) aumentavam as chances de conclusão da qualificação profissional. Conclusão: A conclusão da qualificação profissional foi associada a ser nutricionista e ao acesso prévio a materiais impressos/digitais sobre o tema, o que evidenciou a importância da categoria profissional e de sucessivas aproximações com o tema para favorecer o engajamento e a conclusão do curso.

Resumo Objetivo: Analisar a associação entre estado nutricional e percepção de saúde entre participantes do Programa Academia da Saúde de Belo Horizonte, Minas Gerais. Métodos: Estudo transversal com dados da linha de base de ensaio comunitário controlado randomizado conduzido em amostra representativa do Programa. Indivíduos com 20 anos ou mais responderam questionário contendo variáveis sociodemográficas, morbidades referidas e percepção de saúde, e tiveram o estado nutricional aferido. Para apresentação dos dados, utilizaram-se frequências absoluta e relativa e intervalos de confiança de 95% (IC95%). Utilizaram-se ajustes na regressão para verificar a associação entre o estado nutricional (com baixo peso ou eutrofia, sobrepeso e obesidade) e a percepção de saúde (boa ou muito boa e muito ruim, ruim ou regular) e razão de chances (odds ratio) e IC95% como medida de força de associação. Resultados: Dos 3.264 participantes, 2.827 (88,0%) eram mulheres e 1.931 (56,6%) adultos; 1.352 (41,4%) apresentavam sobrepeso e 944 (28,9%) obesidade; 1.730 (53,0%) relataram hipertensão, 1.433 (44,3%) dislipidemia e 548 (16,8%) diabetes. Quanto à percepção de saúde, 2.358 (72,3%) entrevistados consideraram sua saúde como boa ou muito boa. Verificou-se que indivíduos com obesidade tiveram 47,0% mais chances de relatar percepção de saúde muito ruim, ruim ou regular, comparados às contrapartes. Conclusão: A obesidade foi associada à pior percepção da saúde entre participantes do Programa Academia da Saúde.

Objective: To analyze the association between nutritional status and health perception among participants of the Health Academy Program (Programa Academia da Saúde) in Belo Horizonte, Minas Gerais, Brazil. Methods: A cross-sectional study using baseline data from a randomized controlled community trial conducted with a representative sample of the Program. Individuals aged 20 years or older answered a questionnaire including sociodemographic variables, self-reported morbidities, and health perception, and had their nutritional status assessed. For data presentation, absolute and relative frequencies and 95% confidence intervals (95%CI) were used. Regression adjustments were performed to assess the association between nutritional status (underweight or normal weight, overweight, and obesity) and health perception (good or very good, and very poor, poor, or fair), and odds ratios (OR) with 95%CI were used as measures of association. Results: Of the 3,264 participants, 2,827 (88.0%) were women and 1,931 (56.6%) were adults; 1,352 (41.4%) were overweight, and 944 (28.9%) had obesity; 1,730 (53.0%) reported hypertension, 1,433 (44.3%) dyslipidemia, and 548 (16.8%) diabetes. Regarding health perception, 2,358 (72.3%) respondents rated their health as good or very good. Individuals with obesity were found to have 47.0% higher odds of reporting very poor, poor, or fair health perception compared to their counterparts. Conclusion: Obesity was associated with poorer health perception among participants in the Health Academy Program.

Inadequate sanitary–hygienic and physical–structural conditions in food stores can compromise public health and influence consumer choices. Studies addressing these conditions remain scarce in Brazil. The objective was to examine the sanitary–hygienic and the physical and structural conditions of food stores over a 5‐year period, evaluating their compliance with established standards. A five‐year follow‐up of food stores was conducted using a representative sample of 18 specialized establishments selected from the Programa Academia da Saúde (PAS) in Brazil. These establishments included supermarkets, specialized fruit and vegetable (FV) markets, and local stores. Data collection involved variables such as store registration, address, type of establishment, the HVI (Health Vulnerability Index) of the food storage area, and the application of an 11‐item checklist in 140 establishments in 2013 and 2018. The level of compliance was analyzed based on Brazilian Resolutions 275/2002 and 216/2004. The sample was categorized by year, type of store, and HVI of the area. The percentage of stores classified as having good or regular hygienic–sanitary and physical–structural conditions was 7.1% in 2013 and 49.3% in 2018, with differences by store type. After 5 years, 49.3% of the stores became or remained compliant, with supermarkets and local stores standing out, while only 32.5% of specialized FV markets achieved this status. Almost half of the specialized FV markets achieved or maintained adequate conditions after 5 years, with higher compliance levels observed in larger stores. These findings highlight the need for public policies aimed at improving sanitary–hygienic and structural conditions, particularly in smaller establishments.

Resumo Objetivo: Verificar a validade de dados de consumo de frutas e hortaliças entre usuários de serviço de promoção da saúde do Sistema Único de Saúde. Métodos: Estudo de validação conduzido entre 2016 e 2017 no Programa Academia da Saúde de Belo Horizonte, Minas Gerais. O consumo de frutas e hortaliças foi estimado por questionário breve aplicado em entrevista telefônica e validado face a face. Para análises estatísticas da amostra total e estratificada por sexo, foram utilizados teste t de uma amostra, Coeficiente de Correlação de Concordância (CCC), gráficos de Bland-Altman e limites de concordância. Resultados: Foram incluídos 441 respondentes, sendo 378 (85,7%) mulheres, e 255 (57,8%) adultos. Após estratificação por sexo, as diferenças entre métodos foram iguais a zero. A concordância entre os métodos foi substancial para frutas (CCC entre 0,632 e 0,696), e entre baixa e moderada para hortaliças (CCC entre 0,397 e 0,500). Ao estratificar por escolaridade, as diferenças não foram iguais a zero, mas houve concordância de moderada a substancial entre os métodos para frutas (CCC entre 0,572 e 0,766), e moderada para hortaliças (CCC entre 0,405 e 0,513). Os gráficos de Bland-Altman mostraram que as diferenças entre métodos se distribuíram em torno de zero, sendo estáveis nos maiores níveis de consumo. Conclusão: Os dados de entrevistas telefônicas foram válidos para estimar o consumo de frutas e hortaliças entre usuários do Sistema Único de Saúde.