Background: Food deserts are neighborhoods with little or no access to healthy food, whereas food swamps are neighborhoods where unhealthy food options prevail over healthy ones. The main aims of the current study are to feature and compare the neighborhoods of food deserts and food swamps based on social inequality. Methods: Ecological study carried out in Belo Horizonte City, Minas Gerais State, Brazil. Information about commercial food establishments derived from two different databases. It was measured by secondary governmental databases, which were virtually conferred in the present study. Census tracts were considered as analysis units and classified as food deserts and food swamps, based on the Brazilian methodology. Take into consideration the density of establishments classified as selling fresh or minimally-processed food, mixed establishments, and establishments selling ultra-processed food. The Brazilian methodology evaluates food deserts by the density of healthy establishments (establishments classified as mostly selling fresh or minimally-processed food and mixed establishments) per 10 thousand inhabitants. And the metric to evaluate food swamps considers the density of unhealthy establishments (establishments mostly selling ultra-processed food) per 10 thousand inhabitants. Information about social inequalities comprised aspects such as income, population count, number of households, number of literate individuals, race, water and energy supply, and garbage collection. The Health Vulnerability Index (HVI) was used as a synthetic social vulnerability indicator. Results: Neighborhoods of food deserts presented worse essential service availability, lower income per capita, and smaller mean number of literate individuals. Census tracts classified as food swamps presented better socio-demographic conditions than those areas food deserts. Neighborhoods simultaneously classified as food deserts and food swamps presented lower income per capita and were more often observed in census sectors presenting medium and high HVI. Conclusion: The food environment in Belo Horizonte was featured by the strong presence of food deserts and food swamps. However, the potential influence of these areas on food intake has changed depending on social inequalities.

Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P < .01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P = .15). Secondary end points did not differ between groups after follow-up. The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death.

Half of all mental health problems diagnosed in adulthood have their onset before or during adolescence, especially common mental disorders (CMD). Thus, it is relevant to study the factors associated with these disorders. This study aimed to investigate the association of school characteristics, consumption of ultra-processed foods, and waist-to-height ratio with the presence of CMD in Brazilian adolescents. This is a school-based, cross-sectional study that analyzed data from 71,553 Brazilian adolescents aged 12-17 years. The prevalence of CMD in these adolescents was 17.1% (cut-off point 5 for the General Health Questionnaire-12). Associations were estimated using multilevel logistic models, with the presence of CMD as the dependent variable. The final model, adjusted for non-modifiable individual variables, modifiable individual variables and family characteristics, identified a positive association between private-funded schools (OR = 1.10; 95%CI: 1.07-1.14), advertisements for ultra-processed foods (OR = 1.13; 95%CI: 1.09-1.17), the second to fourth quartiles of ultra-processed food intake and waist-to-height ratio (OR = 2.26; 95%CI: 2.03-2.52). This study demonstrated that the private-funded schools , the presence of ultra-processed food advertisements, the consumption of ultra-processed food, and an increased waist-to-height ratio are risk factors for CMD in Brazilian adolescents.

Background: The prevalence of obesity in adolescents has increased significantly in recent years. The growth of obesity is motivated by the association with modifiable behaviors, however, this behavioral are commonly evaluated individually, not considering the possibility of these factors coexisting in the individual. The purpose of this essay was to identify the coexistence of obesogenic behaviors among Brazilian adolescents and to assess the factors associated with the presence of these behaviors. Methods: This a cross-sectional, national, school-based study with data from the Study of Cardiovascular Risks in Adolescents (ERICA), totaling a sample of 71,552 Brazilian adolescents. To identify the coexistence of obesogenic behaviors in adolescents, the Principal Component Analysis has been performed. To assess the association between factors that influence the coexistence of modifiable behaviors in the pattern of obesogenic behavior, logistic regression was used. The magnitude of the associations was estimated by the Odds Ratio (OR), with the respective 95% confidence intervals (95%CI). Results: The component was characterized by a higher percentage of ultra-processed food intake, longer in front of screens, having a habit of snacking in front of the television, and not having the habit of eating breakfast. In the adjusted logistic model, it shows that female adolescents and who declare themselves black are more likely to belong to the third tertile of the pattern of obesogenic behavior. As for teenagers who sometimes or almost always or always have lunch or dinner with parents or guardians, who have longer hours of sleep and who live in economically disadvantaged regions have reduced chances of belonging to the third tertile of the pattern of obesogenic behavior. Conclusion: The identification of obesogenic behavior patterns allows assertive interventions to eliminate or reduce these changeable behaviors, also aiming at the possibility of reducing obesity among adolescents.