This paper describes the design, sampling methods, and data collection procedures, with particular focus on dietary data, used for the 2015 Health Survey of São Paulo (Inquérito de Saúde de São Paulo, 2015 ISA-Capital) with Focus in Nutrition Study (2015 ISA-Nutrition). The ISA is a household cross-sectional, population-based survey that uses complex, stratified, multistage sampling to create a representative sample of residents from urban São Paulo, Brazil. The 2015 ISA-Nutrition comprised a sub-sample of the 2015 ISA-Capital and intended to include 300 adolescents (aged 12 to 19 years), 300 adults (aged 20 to 59 years), and 300 older adults (aged ≥60 years). From February 2015 to February 2016, 1737 individuals answered the first 24-h dietary recall (24HR), and 901 individuals consented to have their blood sample collected, to undergo anthropometric and blood pressure assessment, and to answer the second 24HR. The 2015 ISA-Nutrition aims to evaluate lifestyle-related modifiable factors in São Paulo’s residents, as well as their association with biochemical and genetic markers, and environmental aspects related to cardiometabolic risk factors. This paper concludes that 2015 ISA-Nutrition may provide valuable insights into the cardiometabolic risk factors in a big city in an upper middle-income country and contribute to the formulation of health and nutritional policies.

Recent studies have explored the influence of socioeconomic inequalities on the diet quality. However, there is lack of evidence regarding the level of inequalities in dietary quality and its main contributing factors from population-based follow-up studies. The primary objective of this study was to investigate the level and the determinants of inequalities in diet quality in a representative sample of adolescents, adults and older adults resident in São Paulo, Brazil. Data from the Health Survey of São Paulo (ISA-Capital) were analyzed for 2003 (n = 2398), 2008 (n = 1662) and 2015 (n = 1742) surveys. Information on food consumption was obtained through 24-h dietary recall, and diet quality was assessed based on the Revised Brazilian Healthy Eating Index (BHEI-R). The descriptive variables were compared using 95% confidence interval. The scores of BHEI-R and its components were compared across age groups and year. The association between socioeconomic inequalities and diet quality was based on the estimation of concentration index. We observed that the BHEI-R scores gradually improved over 12-years, with older adults showing the greatest improvement. The increase in overall population score was observed for total fruits, whole fruits, whole grains, oils and sodium. The main contributor to socioeconomic inequality in diet quality in 2003 was ethnic group, and in 2008 and 2015, it was per capita household income; age was a persistent factor of inequality in the population over the years. Concentration indices indicated that lower income individuals had higher BHEI-R scores in 2003; however, there was a shift in favor of higher income individuals in 2008 and 2015. Changes in the patterns of determination of inequalities according to age, ethnic group or income during the period analyzed show the existence of ongoing process of contribution of demographic and socioeconomic factors in the diet quality of individuals in a large urban center.

Although studies show that portion size affects energy intake, few have demonstrated a link between portion size and weight status, especially in free-living populations. The objective of the present study was to assess the relationship between food portion sizes and overweight in a representative population of adults of São Paulo, Brazil. Cross-sectional population-based study with 1005 adults from São Paulo, Brazil. Dietary data were obtained from two 24-hour recalls. Reported foods were classified into groups and energy contribution, prevalence of consumers and portion sizes were calculated. Individuals were classified according to BMI in with and without overweight. Logistic regression models were used to evaluate the association between food portion sizes and being overweight. The most consumed food groups were: beans, breads/rolls, coffee/tea, milk, rice, and sugar. Rice, red meat, breads/rolls, and white meat were the groups with the highest percentage of contribution to total energy intake. Butter/margarine, toasts/biscuits, sugar, and cakes were the groups with the highest energy density. After adjustment for confounding variables, overweight was associated with larger portions of pizza (OR = 1.052; p = 0.048), red meat (OR = 1.025; p = 0.043), rice (OR = 1.033; p<0.001), salted snacks (OR = 1.078; p = 0.022), and soft drinks (OR = 1.016; p = 0.007). Larger portions of few food groups with different energy densities were associated with being overweight, suggesting that overweight may be related to the consumption of larger portion sizes of a series of food groups, not a food group alone. Additionally, we highlight the importance of considering underreporting as a confounding factor in these associations.

Although changes in Brazilian diet have occurred over the last decades, there is no evidence about differences in food portion sizes (FPS) over time. Therefore, we aimed to evaluate the association of FPS with excess body weight (EBW), and to monitor differences in the population from São Paulo, Brazil, from 2003 to 2015. Data came from three cross-sectional population-based studies with 5270 individuals aged ≥12 years in 2003, 2008, and 2015. Dietary data were obtained from 24-h recalls. Logistic regression models were used to evaluate the association between FPS and EBW. Over the years, there was a diverse variation in FPS, with an increase in some groups (white meat, salted snacks, coffee/tea, eggs) and decrease in others (rice, red meat, sweets, pasta, sandwiches, cold cuts). The percentage of people reporting the intake of six food groupings (rice, white meat, sweets, fruits, commercial juices, toasts/biscuits) increased in the period. In this population, EBW was associated with larger FPS of 11 of the 30 food groupings investigated (cold cuts, fried snacks, fruit and commercial juices, pizza, red meat, rice, salted snacks, soft drinks, soups, sugar). These findings could support future interventions and policies for optimal food intake in Brazil.